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NHI: Good or bad for struggling South Africans?

Most people struggle to pay their bills, and many don’t have money saved for emergencies, including medical needs. If you have medical aid cover in South Africa, you are lucky. But no doubt, this comes at a high cost. Most state health facilities are not up to par. The waiting times are long, and their service needs a lot to be desired. To try and level the playing field, government wants to introduce National Health Insurance (NHI)

South Africans have heard of it, but don’t know too much about it. I thought it would be a good idea to upack it.

Here are some frequently asked questions and answers:

What is the NHI?

The NHI is a fund paid for by taxes, from which the government purchases health care services for all residents of South Africa.

When you feel unwell, you can visit a GP or clinic that has a contract with the NHI without worrying about the cost of care.

Why do we need NHI?

  • Healthcare for all: South Africa is committed to implementing universal health coverage. Access to healthcare is considered a fundamental right for everyone.
  • Improving quality: Both the public and private sectors need reform to enhance the quality of health services.
  • Reducing disease burden: Extending health coverage will improve access, quality, and continuity of care.
  • Financial risk protection: The NHI Fund will protect individuals from financial hardship when accessing healthcare service

Who will be covered under the NHI Fund?

  • The fund will purchase services on behalf of SA citizens, permanent residents, refugees, inmates and specific categories of foreign nationals.
  • Asylum seekers and illegal foreigners will be covered for notifiable conditions and emergency medical services.
  • All children will be covered for all benefits the fund purchases regardless of nationality.
  • Visiting foreign nationals will be covered by their mandatory travel insurance.

What services will be covered by NHI?

The service benefits include services provided at primary, secondary, tertiary, specialized and quaternary levels.The Benefits Advisory Committee will determine which benefits are medically necessary benefits and this will include:

  • Primary Health Care services: visits to clinics, community health centres and accredited multi-disciplinary group practices and centres at a non-specialist level, community health care outreach workers, integrated school health services,
  • Hospital services: outpatient and in-patient visits at all accredited hospital levels, using a referral system (requiring a letter from a PHC centre/ provider unless in case of emergency)
  • Rehabilitation health services
  • Palliative Care
  • Mental health services
  • Emergency medical services
  • Transportation for patients who are referred to and from another health facility.
  • Medicines and medical devices specified on the Essential Medicine List and Essential Equipment List.
  • Diagnostic procedures specified in the Treatment Guidelines and protocols.

How will medical schemes be affected by NHI?

  • Once implemented, medical aid schemes won’t be able to offer any health services already offered by the NHI.
  • Medical schemes will only offer you extra services not covered by the NHI.
  • The NHI will offer comprehensive health care service coverage – no co-payments will exist.
  • Medical Aid schemes will remain voluntary arrangements for those who choose to contribute to them. Still, they will only cover you for any additional benefits the NHI Fund does not pay for, so they should be significantly cheaper.

Will unemployed people be able to access health care services?

  • Yes. The NHI Fund will purchase services on behalf of all South Africans. All users will be able to access health care services without paying anything at the point of care, regardless of their socioeconomic status.

How much will it cost to receive services at a clinic, GP or hospital?

  • The NHI Fund will pay the clinic, GP or hospital. You will not pay anything when receiving care.

This is to make sure that everyone can receive health care services when they are sick, at a facility close to them (as long as the facility has a contract with the NHI Fund)

How will the NHI be funded?

  • Taxpayer Contributions: South African taxpayers will contribute to the NHI through a combination of direct and indirect taxes. These include:
  • General tax revenue: Funds will be shifted from the provincial equitable share and conditional grants into the NHI Fund.
  • Reallocation of medical scheme tax credits: These funds will be redirected from medical schemes to support the NHI.
  • Payroll tax: Both employers and employees will contribute.
  • Surcharge on personal income tax: This additional tax will be earmarked for the NHI fund.

What are NHI Pros?

  • Universal Access: The NHI aims to provide all South Africans with universal access to quality healthcare services. This aligns with the constitution’s declaration that everyone has the right to healthcare.
  • Equity: By establishing a fund to pay for medical treatments from accredited providers, the NHI seeks to create a more equitable system. Private health insurers would cover services not included in the fund.
  • Noble Goal: The concept of national health insurance is noble, as it strives for a fairer society regarding healthcare access.

What are the NHI Con’s?

  • Implementation Challenges: Critics argue that the practical implementation of the NHI faces significant challenges. Concerns include the migration of hospitals, contracting unit structures, accreditation issues, and payment concerns.
  • Autonomy Impact: All South Africans would be required to use the NHI, regardless of their preferences. This could impact individual autonomy.
  • Taxpayer Burden: The NHI’s funding model involves taxpayers covering costs, which raises concerns about financial sustainability

Not everyone is going to be happy about the NHI, especially private medical schemes. In theory, the NHI aims to ensure equitable access to healthcare, improve service quality, and reduce financial barriers for all South Africans. However, ongoing monitoring of it’s implementation will be required.

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