The National Health Insurance Bill (NHI) was released on 8 August by Health Minister Aaron Motsoaledi. This means that all South Africans, irrespective of their socio-economic status will become a member of the NHI Fund that will be managed by the government. However, the NHI Bill has polarised the private and public sector and is much criticised.

The NHI addresses human rights as enshrined in Section 27 of the South African Constitution. To give effect to this stipulation, the Government has set up a NHI Fund which is a non-profit body to ensure that all South Africans have access to essential healthcare, irrespective of their socio-economic status.

The aim of government to get the nation healthy is to provide quality and affordable healthcare for all no matter what healthcare facility one attends, without having to pay part of the bill thereafter. NHI allows patients to receive treatment at an early stage of illness for preventive and early stage care while family health teams in all neighbourhoods will assist in providing preventive health services, information for better health and home-based care.

Medical fees will be managed and paid to healthcare providers by the government. Healthcare providers will be monitored for making unreasonable profits. The NHI ensures equal uniform healthcare for all South Africans. The unemployed and poor will get free medical care, which includes doctors visits, hospitals and medicines, in the same way as everyone else.

South Africans will now pay extra monthly tax based on earnings. People with low incomes will not make any direct payment to the NHI Fund. The employer will match their employees’ contributions to NHI and make deductions in a similar manner to UIF contributions. The Health Department said that the Bill promised to create a healthier population with benefits to foreign nationals, inmates and refugees.

Nearly seven out of ten South Africans (68 percent) rely entirely on public health services, while 16 percent are members of medical schemes. Another 16 percent pay from their pockets to see private GPs and dentists but use public hospitals for serious illnesses.

Private sector NHI concerns:
• The NHI will become one of government’s “state owned enterprises” that will be unmanageable by the state.
• The implementation and affordability in the current economic climate.
• Citizens who have private medical aid schemes will no longer receive tax credits.
• Private doctors, specialists and hospitals will have to be accredited by the state or they will not get paid for services rendered.
• Medical schemes will only be allowed to provide “complementary or top up cover” for services not reimbursable by the NHI.
• There will be limitations on how often a patient can visit a GP.
• Visits to specialists like paediatricians and gynaecologists cannot be done directly without a referral.
• Treatments that are not regarded as ‘medical necessity’ will not be paid for by the state, however a reasonable time being given to appeal the decision.
• Government will determine the prices for services rendered including purchasing medicines for all patients instead of the private sector buying medicines for its patients.
• The state will rely on non specialists like midwives which means fewer caesarean sections will be done.
• Accessibility to private hospitals accredited with the state will become difficult as more people will be admitted.
• Adult asylum seekers or illegal foreigners will only receive emergency medical services. Children of asylum seekers and illegal foreigners will only receive basic healthcare services. Foreign visitors to South Africa will require travel insurance to receive healthcare services via the NHI fund.
• Insufficient checks and balances by government as the fund will be managed by a chief executive who will be appointed by the Minister of Health and can serve for a maximum of 10 years supported by a board of 11 persons also appointed by the minister.

Meanwhile, the South African Private Practitioners’ Forum (SAPPF) has voiced their objection to the NHI model chosen regarding it as ‘vague and ambiguous’. They believe that it will cause harm to the entire South African healthcare industry if implemented. The forum believes that the NHI will not lead to the progressive realisation of access to healthcare that is demanded in the Constitution.

Dr Chris Archer, the forum’s chief executive said: “By implementing this model in an environment which is not able to afford a very comprehensive NHI service basket, will lead to the majority of South Africans having less access to comprehensive health services than is currently the case in both the public and private sectors.”

Post release of the NHI Bill, share prices slumped as the healthcare groups faced uncertainty about the impact of the Bill. Discovery Health raised some concerns around the role of medical aids as contained in the Bill. However, it welcomes its publication as it provides more clarity on the implementation of the policy objective of Universal Health Coverage (UHC) and the establishment of the NHI Fund.

The South African healthcare landscape will change drastically when the NHI is implemented. The Health Department’s Deputy Director-General Anban Pillay said: “The NHI is intended to be implemented over a seven-year period from now. It is planned to be fully implemented by 2026 through a phased implementation approach and the bill identifies the two phases. We are now in phase two, and then there is a phase three thereafter. Phase two ends in 2022, phase three commences in 2023 to 2026.”

Meanwhile, the ANC Study Group on Health on the NHI Bill said that it was ‘pleased’ with its introduction. The study group said in a statement: “The NHI will guarantee that all South Africans have access to free, comprehensive and quality healthcare in the country’s health facilities. For more than a decade, the ANC-led government has been advocating for the implementation of National Health Insurance (NHI), based on the principle of universal health coverage. The NHI is in line with the Freedom Charter, which states that ‘free medical care and hospitalisation shall be provided for all, with special care for mothers and young children’.”