The National Health Insurance Bill in a Nutshell

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On the 8th of August, Minister of Health Dr Zweli Mkhize announced the National Health Insurance Bill (NHI) in the national assembly. The Bill, which seeks to “achieve universal access to quality healthcare services” for all South Africans, has been met with mixed feelings. There are those who fear that the purpose of the bill will be defeated by systemic corruption while others are concerned about the effect the Bill will have on medical aids and private medical providers. In this article, we break down what the NHI is, how the public will benefit from it and what its establishment means for medical aid schemes. 

What exactly is the NHI?

According to the Government, the NHI is “a health financing system that is designed to pool funds to provide access to quality affordable personal health services for all South Africans based on their health needs, irrespective of their socio-economic status. NHI is intended to ensure that the use of health services does not result in financial hardship for individuals and their families.” 

Healthcare in South Africa has been the subject of many conversations, particularly around service delivery and equitable access to quality and efficient healthcare services. The unfortunate reality is that the majority of South Africans cannot afford private healthcare, which, more often than not, offers better quality services and resources; this means that most South Africans have to rely on the public health system, which is known for being in crisis. The system is overwhelmed and cannot cater to the needs of all South Africans. Many are forced to stand in long lines, rely on low-quality services, and they’re subjected to poor hospital conditions. If South Africa’s public healthcare crisis is not addressed accordingly, it will lead to problems that will be very difficult to undo in the long run. 

How will South Africans benefit?

As noted by prominent South African journalist Ferial Haffajee, national health insurance “is a [great] idea for the nation and for social justice.” Without access to quality healthcare, many South Africans will not be able to become the best versions of themselves and contribute to the socio-economic development of the country. If more people have access to better healthcare services, it will be a win for social transformation, especially in a country that has a painful history of injustice. The aim of the NHI is to transform South Africa’s healthcare system by making quality medical services easily accessible to those who have been left on the margins for far too long. 

According to Dr Mkhize, “The National Health Insurance won’t check whether you have medical aid or whether you’re employed. It will provide services based on the treatment you need.” This means that many South Africans will get the treatment they need at a faster rate. The stress of how you will get the medical attention you require will be alleviated, and many will have more options in terms of where they can get medical care.

There is concern regarding how the NHI will affect those seeking private healthcare as medical aids will be restricted to only providing services that are not covered by the NHI. According to Daily Maverick, “Medical schemes may only offer complimentary cover…[ for]… services not reimbursable by the fund.” Regarding the functionality of medical schemes, Sipho Kabane, Chief Executive and Registrar of the Council for Medical Schemes, says “there’s no major change in terms of mandate—all the schemes will still exist even in the National Health Insurance dispensation.”

Once the NHI is implemented, all healthcare facilities, private and public, will have to be accredited with the NHI to provide services that only the Fund will cover; this means that should you require treatment, you would need to “register at an NHI-accredited primary healthcare facility” in your area. 

National health insurance case study – Brazil

South Africa is not the only country that regards access to quality healthcare as a constitutional right. Brazil is another developing nation that has been providing nationwide healthcare coverage.  Over the decades, Brazil has done well in improving its public healthcare system. According to KPMG, the country’s public healthcare model has, in fact, “provided a beacon for the benefits of universal health coverage around the world”. Through its universal health insurance system, Sistema Único da Saúde (SUS), Brazil managed to increase its life expectancy from around 64.4 years to 75.3 years in 2017, and it has seen a decline in infectious diseases. Brazil’s programme has had its challenges but it has been successful in providing much-needed primary healthcare to its population of over 209 million citizens. Brazil’s SUS took decades to get right since its implementation in 1988, and, to this day, the policy faces challenges related to funding. Brazil’s SUS shows us that it takes time to conceptualise and implement a healthcare provision model that will be sustainable and far-reaching. South Africa has a chance to get it right. An important factor to consider is how the fund will be safe-guarded against an unstable economy; this is the one problem that is starting to affect Brazil’s national health insurance coverage. 

There is still much to be understood about how the NHI will achieve its purpose. Since it will effectively function as a state-owned medical scheme, we don’t know how it will be “protected” from corruption, mismanagement of funds, and economic uncertainty. The concerns around the NHI are warranted, however, it is a great step to addressing the medical and healthcare requirements of the many South Africans who are in desperate need of better healthcare services. 

Want to read more on the NHI? Here are additional resources:

Business Tech (2019). 6 things that every South African should know about the NHI – according to a legal expert. Retrieved from https://businesstech.co.za/news/finance/334705/6-things-that-every-south-african-should-know-about-the-nhi-according-to-a-legal-expert/ 

González, L. (2019). The three biggest fights looming for the National Health Insurance. Retrieved from https://bhekisisa.org/article/2019-08-12-the-national-health-insurance-what-it-means-and-the-fights-we-can-expect/ 

National Health Insurance Bill (2019). Retrieved from https://www.gov.za/sites/default/files/gcis_document/201908/national-health-insurance-bill-b-11-2019.pdf 

South African Government (2019). National Health Insurance. Retrieved from https://www.gov.za/about-government/government-programmes/national-health-insurance-0

References:

Business Tech (2019). The role of private hospitals and doctors under the new NHI. Retrieved from https://businesstech.co.za/news/government/334633/the-role-of-private-hospitals-and-doctors-under-the-new-nhi/ 

Eye Witness News (2019). NHI will benefit all South Africans, says Health Minister. Retrieved from https://ewn.co.za/2019/07/18/nhi-will-benefit-all-south-africans-says-health-minister

Greca, D. & Fitzgerald, E. (N.D). Healthcare in Brazil – Meeting Future Challenges. Retrieved from https://home.kpmg/xx/en/home/insights/2019/04/meeting-healthcare-challenges-in-brazil.html

Haffajee, F. (2019). Ambitious National Health Insurance plan stalked by the shadow of State Capture. Retrieved from https://www.dailymaverick.co.za/article/2019-08-14-ambitious-national-health-insurance-plan-stalked-by-the-shadow-of-state-capture/ 

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