SOUTH Africa being a developing nation with a modest democracy of about 25 years, is still a country with a huge backlog to address in the form of infrastructure, human capital and economic resources. The National Health Insurance (NHI) is by far the biggest health policy/ system change post the apartheid regime.

The World Health Organisation (WHO) actually encourages countries to move towards universal health coverage, which was brought on by a United Nations resolution as a pillar of sustainable development and global security.

The intention of National Health Insurance is to make sure all South African citizens are able to use both the public and private sectors in such a way that they complement each other rather than one undermining the other.

Access to healthcare is highlighted in the South African Constitution under section 27 that makes it a fundamental right and not a privilege.

NHI, simply put, aims to address the accessibility of quality health care while tackling the burden of inequality between the private and public health space.

The impact of implementation is to realise one of the National Development Plan’s goals, which is: to increase the life expectancy of South Africans by reducing the burden of diseases such as TB, HIV/ AIDS, cancer, infant and maternal mortality.

The NHI will function just like any other insurance model would.

The NHI is a pre-payment of money to cover individuals in the event that they become sick.

One of the key objectives of the NHI Bill is to establish a state-run fund that ensures sustainable and affordable universal access to health services.

There are many questions about the future of medical schemes that remain unanswered, and details of the exact role and format of medical schemes under the NHI are yet to be negotiated and decided.

Changes to the National Health Insurance (NHI) are going to happen.

The final details are not yet cast in stone but a dramatic shift is imminent.

By 2022, the NHI should be in full effect. Here is what we know:

• All South Africans will be members of the NHI fund. Participation is not voluntary and you will not be given a choice to join or not join.
• All South Africans earning an income will have to contribute to the NHI fund. Details of how this will be done and the amounts are still being decided but all income earners will be obligated to contribute.
• Contributions will go into an NHI pool. Funds will be used by the government to pay the costs of public and private healthcare provides. They will cover any shortfall.
• The NHI fund will pay the full costs of a number of treatments, procedures and services.

Again, the specifics have not been finalised but there will be no additional costs or co-payments for a range of treatments and procedures.

• GPs will be contracted with the state and individuals will register with them. There might be limits on how many visits you can make to your GP in a given time period.
• Visits to specialists will be possible but with strict rules and possible waiting periods. When deemed necessary, a GP can refer patients to specialists that will be covered by the NHI.

There will be strict rules however, and a waiting period is expected.

• Those who can afford and still wish to, can have private medical cover but they will still contribute to the NHI. People can avoid delays by still having private medical aid. It is also anticipated that a number of new plans will become available for certain procedures.

While the intentions of the NHI plan are good, there is still much to be finalised. Many people might resent paying for private cover while still having to contribute towards the fund.

It also remains to be seen how well the national health department can cope with these changes and how well the fund is administered.

Hopefully, the poor and low-income earners should have access to better healthcare.

Whether you’re for or against the NHI does not necessarily matter as it is already in the process of being implemented.

We think our focus should be on the monitoring and evaluation of the efforts made in the various indicators and targets set by the national and provincial departments of health.

In that way, we shall hold the institutions accountable and may also work as preventative, detective and responsive models to realising the goal of universal coverage of quality health service for all.

Please note that the above is for information purposes only and does not constitute tax advice. As each individual’s personal circumstances vary, we recommend they seek advice on the matter. Please note that while every effort is made to ensure accuracy, Nexia SAB&T does not accept responsibility for any inaccuracies or errors contained herein. If you are in doubt about any information in this article or require any advice on the topical matter, please do not hesitate to contact any Nexia SAB&T office nationally.