The long-awaited NHI Bill, which aims to contain the cost of comprehensive public health care, was tabled in Parliament on Thursday. Picture: Armand Hough / African News Agency (ANA)

Parliament - South Africa's long-awaited National Health Insurance Bill, which aims to contain the cost of comprehensive public health care by prioritising primary and preventative medical services, was tabled in Parliament on Thursday.

The bill is the first piece of legislation towards realising the government's plan for universal health care and aims to ensure that all those who qualify receive free health care of a professional standard within a reasonable time. 

The proposed new law introduces a "gatekeeping" mechanism on referrals to specialist care and is accompanied by a memorandum setting out a timeline for a phased implementation process.

Under its provision, an NHI fund and its executive authority will in the near future begin to bid for money from the national budget and it also moots new taxation options as a source of revenue, including a surcharge on income tax or a "small payroll tax". Funding that the provinces receive as part of their equitable share will also be shifted to the national health fund.

The memorandum further flags the affordability and sustainability of national health insurance as a legitimate concern.

"This can best be considered with reference to the nature of the proposed system and the checks and balances that will be put in place to limit unnecessary expenditure increases for supply-side as well as demand-side management," it says.

It proposes placing increased emphasis on preventative and primary health care, contending that most health care problems can be diagnosed and treated at this level.

Primary health care must therefore be made the foundation of the national health service.

Under the legislation, the state would introduce a system where patients would access higher level services on the basis of referral networks to keep costs down. A health care user would be denied free treatment should they deviate from the prescribed referral pathway.

The bill provides for a patient to be denied care should there be "no cost-effective intervention for the health care service" as determined through a technological assessment. 

It aims for the NHI Fund to be in place by 2026, when phase two of the implementation of the NHI must be completed, and seeks to extend free health care to all South Africans, permanent residents and refugees. Asylum seekers will only be entitled to emergency health care, and for health conditions of notifiable public concern.

However, all children, including those of asylum seekers and illegal immigrants, will be entitled to basic health care in terms of section 28 of the Constitution.

The bill envisions the fund as the sole purchaser and payer of health care services "in order to ensure the equitable and fair distribution and use of health care services". It says that the minister health must designate central hospitals that will be run as part of national government.

The fund will be an autonomous public entity but will report to the minister of health.

African News Agency (ANA)