How South Africa’s National Health Insurance will work

Government’s White Paper on the National Health Insurance (NHI) proposes a single, compulsory medical scheme for all, with private medical schemes being reduced to offering “complementary services”.

A central NHI Fund will buy health services from accredited healthcare providers.

All citizens and permanent residents will be covered by the NHI, while a special fund will be set up for refugees. Documented asylum seekers will be able to access emergency care. Everyone else will need medical insurance.

Launching the massive NHI White Paper in Pretoria, Health Minister Dr Aaron Motsoaledi described the NHI as “very, very impactful and complex”. But he warned that its introduction was an “ultra-marathon” not a sprint.

Motsoaledi also as at pains to explain that ensuring universal healthcare for all is happening in countries all over the world, and that there is a “moral imperative” to ensure that those who need healthcare the most are prioritised, irrespective of their “socio-economic status”.

The NHI will be introduced in three phases, starting with preparing central hospitals to provide specialised services to all citizens, under the control of central government.

In phase two, all those who qualify for NHI will be registered and given NHI cards. Priority will be given to those most vulnerable, such as mothers, small children and old people.

A transitional fund will be set up to buy PHC services from certified non-specialist public and private providers. All “ideal clinics” will be accredited to provide primary care.

Public hospitals accredited by the Office of Health Standards Compliance (OHSC), emergency medical services and the National Health Laboratory Services (NHLS) will also be contracted.

Private doctors will be contracted to provide services at primary level, and this will be extended to healthcare providers who can assist to address “physical barriers to learning” for school children, such as audiologists, speech therapists, psychologists and optometrists.

The Medical Schemes Act will be amended so that medical aids will only provide complementary services.

In the third phase, working people will start to make mandatory payments and private sector providers such as hospitals and specialists, will be contracted to provide services.

No one will be able to simply walk into a specialists’ office. They will need to “start at the bottom, which is why the bottom will need to be improved”, said Motsoaledi.

Motsoaledi said money had to be found for the NHI and there was already R50-billion in primary healthcare, but that Treasury had proposed a number of options including taxes and increasing VAT.

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