LARISSE PRINSEN | NHI aims to ensure all have access to quality healthcare

Stock photo.
Stock photo.
Image: 123RF/HXDBZXY

Last month, the National Health Insurance (NHI) Bill was passed by the National Assembly. From there, the bill would be sent to the National Council of Provinces, and if also passed there, it will be signed into law by the president. This may, however, still take years.

Universal access to healthcare has long been envisioned by not only the constitution, but also by the National Health Act of 2003.

The bill aims to ensure that all South Africans have access to quality healthcare services and for the establishment of a fund which will be used to pay for almost all medical treatments from accredited providers, with rates to be determined by the state.

Private health insurers will only be able to pay for treatments, health products and services not covered by the fund.

The bill, however, has from the inception been contentious and has been fought against from the start. A mere two weeks before its passing in the National Assembly, the SA Medical Association rejected the bill in its current form.

In spite of this, it will most probably become law in some shape or form. It is thus pertinent to examine that which it espouses, National Health Insurance, as this concept is a noble one at its core – the achievement of a more equitable society in the context of access to healthcare.

The current two-tier system has not sufficiently catered for good quality healthcare for all. It has precluded the poor or those without medical aid from accessing a large number of health professionals, services and facilities. NHI will establish a single pool of funding for private and public healthcare providers and will pay both on exactly the same basis while expecting the same standard of care from them.

For South Africans without medical aid or in lower income groups, the NHI will be beneficial in that it will allow these persons to consult private healthcare practitioners and make use of private healthcare facilities and practices with the NHI footing the bill.

For South Africans who do have medical aid, the NHI may be a shock to the system. Those accustomed to private care may have to settle for lower standards while still paying a similar or higher fee. South Africans within a certain income bracket will still have to make mandatory monthly payments towards healthcare in addition to carrying a higher tax burden.

Once the NHI is implemented, medical aid schemes will not be able to offer any services offered by the NHI and will only be able to provide for “complementary or top-up cover”. South Africans will be able to use their free NHI cover for various healthcare needs and no co-payments will be charged.

The bill does provide for gap cover but the relevant section is greatly understood and interpreted as meaning that medical aid schemes will cease to operate as current members will be obligated to make use of their NHI.

The private sector, for now, will not be nationalised and private practices, pharmacies and hospitals will still be available and South Africans will still be able to register with their preferred healthcare provider.

Many concerns and critiques have been lobbied at the bill.

Thus far, satisfactory solutions have not been offered to all these problems. The NHI cannot be avoided but perhaps, for it to be beneficial to all and truly live up to its potential for betterment, it should not be rushed.

Dr Prinsen is a senior lecturer in the department of public law at the University of the Free State

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