National Health Insurance (NHI) is one of the most costly and controversial reforms proposed by the South African state.
We offer an update on the NHI and how it could affect medical aids and their members – as well as the access of South Africans to quality healthcare in the future.
What is the National Health Insurance (NHI) policy?
The National Health Insurance is a proposed health financing system that will cover 60.7 million South Africans, irrespective of socio-economic status.
The state, through the NHI Fund, is envisaged to be the sole purchaser of healthcare services from the public and private sectors.
All tax-paying South Africans, whether existing medical aid scheme members or not, will contribute to the fund – but only if the economic environment lends itself to the introduction of an additional personal tax.
An update: what’s happening with the NHI in 2022?
The NHI is in the second, legislative phase of implementation. The Bill, which is presently with Parliament’s Portfolio Committee on Health, is expected to be finalised by the end of April 2022.
From there, the Bill goes to the National Council of Provinces (NCOP), where it will be passed, rejected or amended.
At this point in time, the end of 2022 is pencilled in as the end of the NHI’s legislative process.
Some obvious NHI challenges
Corruption, mismanagement and poor communication have clouded the NHI in uncertainty and mistrust.
Healthcare professionals have reservations about the viability of the system, given the parlous state of public hospitals.
Experts warn that an underfunded and incapacitated healthcare sector can’t support the NHI. Government does not have sufficient funds to properly resource the project.
Underperformance has resulted in a delay to the implementation of the NHI, to the point where the NHI Fund has not yet been established.
The technical skills required to develop and maintain centralised purchasing platforms are lacking.
Similarly, there has been little progress in the design and development of capitation models for strategic, cross-sector purchasing.
At this point, the NHI is all but grounded due to the lack of funds, skills and consultation with key role players – not to mention a primary healthcare system deep in crisis.
How the NHI could affect South African medical aids
According to the Department of Health, private medical aid schemes in South Africa will continue to operate under the NHI regime. The role of schemes would, however, change.
Rather than offering a comprehensive benefit structure to cover all healthcare procedures, treatments and events, medical aid schemes will only provide cover for services “not reimbursable” by the NHI Fund.
Quite what those services are has not been clearly communicated.
What the Bill does state is South Africans seeking reimbursement from the fund must follow the NHI’s “referral pathways”.
The implication is if patients choose to use their own non-NHI healthcare providers, they can’t claim from the NHI but they can claim from private medical aid schemes.
With uncertainty swirling around the implementation of the NHI, the role of medical schemes in South Africa remains unchanged for the foreseeable future.
What we offer at IFC
At IFC, we offer informed, objective advice about South African medical aids and health insurance options. We can assist you in joining the scheme that best suits your needs and budget.
We also stay abreast of developments in the medical aid industry, including the NHI and how it could affect medical aids, and adapt our advice accordingly.
Contact us for more information or to discuss your medical aid needs.
