Long queues, not enough medical staff and resources, expensive medication… When it comes to healthcare, South Africa has a long way to go. The proposed National Health Insurance (NHI) has given hope to millions of South Africans as it aims to make quality healthcare accessible and affordable for everyone, regardless of their income or background.
In the midst of this enormous government-led plan being pushed ahead, there is some confusion about what it is and how it will impact ordinary South Africans’ lives.
This big change in the country’s healthcare system has left many South African citizens with questions and valid concerns. Thus, Health For Mzansi went to find out from the department of health spokesperson Foster Mohale what the NHI actually is and what its implementation would mean for citizens.
Candice Khumalo: What is the NHI, and how does it work?
Foster Mohale: The National Health Insurance (NHI) is a health financing arrangement that allows the government to better coordinate financial resources that are intended for the purchase and provision of personal health services on behalf of the population. With NHI, the State creates an NHI Fund into which all public funds intended to purchase personal health services for the population are collected, and the fund utilises ’strategic purchasing arrangements’, which include contracting with providers (public and private) to provide clearly defined health benefits to the population.
Under the NHI, no person will be expected to pay for personal healthcare services at the point of accessing and utilising the services. Instead, services will be prepaid and, hence, completely free at the point of use.
What are the key differences between the NHI and the current public healthcare system in South Africa?
The primary differences between the current public healthcare system in South Africa and the envisaged NHI are:
- Firstly, the issue of fragmentation of healthcare funding pools and the service delivery platform, and
- Secondly, the two-tier nature of the overall health system. Currently, South Africa has various funding pools (1 national plus 9 provincial departments of health), and these funds are not adequately utilised to benefit the population in terms of meeting their health needs.
Currently, South Africa has more than 70 medical schemes funding the health needs of about 8.6 million people who are primarily employed and better off; they also have greater access to various health professionals (general practitioners, specialists, and other services such as radiology, etc.) to the detriment of the broader population.
Healthcare professionals are concentrated in the private sector because that is where almost 50% of the national healthcare expenditure sits, despite the fact that only less than 20% of the population accesses services in that environment.
NHI is strategically designed and directed at reversing the two-tier hegemony that dominates the South African health system; this will be done by creating a single fund that collates all the financial resources required to purchase personal health services for the entire population.
Why did the department see a need to implement the NHI?
South Africa has two parallel health sub-systems: the public and the private healthcare systems. The private sector is better funded but serves fewer people (16% of the population) than the poorly funded public sector, which is used by the majority (84%). Unfortunately, the two systems are competitive rather than complementary. The middle class and rich pool their funds into 76 different schemes, each with several sub-pools, separately from the poor, but both systems compete for scarce resources (health professionals).
More affluent people can always pay more, so it is not surprising that they attract more resources to their care relative to the funds available to care for people experiencing poverty. Consequently, those with the greatest healthcare needs (mainly the poor) have the least access to services and are subjected to long waiting times and bad staff attitudes.
What challenges does the NHI face in terms of implementation and funding?
NHI will be implemented in a phased manner. In practice, this means that changes will not all be introduced simultaneously but over several years. NHI will ensure that all who live in South Africa will have their healthcare paid for by a single NHI Fund.
A government agency will administer this fund and purchase health services for legally eligible healthcare users. The system will be financed through taxation, with funds appropriated annually through Parliament. The financial allocation will be progressively linked to a progressive increase in the benefits the fund will cover.
What role will the private sector play in the implementation of the NHI?
For those healthcare services providers and suppliers operating in the private sector, the NHI Fund will implement clear accreditation and contracting systems so that they are drawn upon to provide healthcare services to the population.
As for medical schemes, they will still exist under NHI. However, as NHI is gradually implemented, the role of medical schemes will slowly adapt to the transformed NHI environment. No one eligible to benefit from NHI services can opt out of paying the appropriate taxes or using services purchased for them by the NHI.
In the long run, medical schemes will eventually offer only top-up health insurance for services that are not part of the NHI benefits. This could include payment for medicines not covered by the NHI.
Membership in medical schemes will be voluntary, and the medical cover provided by schemes will adapt to the new environment. Services that are not covered under the comprehensive NHI service benefits will be paid for either by out-of-pocket payment or through a top-up cover offered through the evolved medical scheme of your choice.
The tax credits on medical scheme contributions will be phased out. Respective employers will choose to continue subsidising additional employee health benefits, but only for the statutory up-to-date coverage.
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