NHI and the future of SA healthcare: What needs to be done

The success or failure of the NHI will be determined by the strength of its foundation and the collaborative efforts of both the public and private sectors. Picture: Simphiwe Mbokazi / African News Agency (ANA)

The success or failure of the NHI will be determined by the strength of its foundation and the collaborative efforts of both the public and private sectors. Picture: Simphiwe Mbokazi / African News Agency (ANA)

Published Aug 21, 2023


The National Health Insurance (NHI) is poised to play a pivotal role in shaping the trajectory of South African healthcare.

Its success or failure will be determined by the strength of its foundation and the collaborative efforts of both the public and private sectors.

This is according to the the Health Funders Association (HFA), an influential body representing over half of the lives covered by medical schemes.

The association has emphasised the critical need for a united front in moulding a universal health coverage that truly serves the nation's interests.

Phumelele Makatini, the CEO of the HFA, said: “At the heart of our endeavours, we all fundamentally desire a healthcare system of quality, one that is accessible to every South African.”

She pointed out that while South Africa's public health expenditure commendably surpasses the 15% Abuja target set by the African Union, the journey to crafting a sustainable and universally accessible health system is fraught with complexities.

This is a challenge that even developed nations grapple with, indicating the magnitude of the task at hand.

This week, NHI Deputy Director General Dr Nicholas Crisp answered questions about the integrity and the coverage of the Fund posed by health standing committee members Thembile Klaas (EFF) and Rachel Windvogel (ANC).

Crisp said NHI was a health financing system designed to pool funds to provide access to quality, affordable personal health services for all South Africans based on their health needs, irrespective of their socio-economic status.

He said: “In a way, the fund is more like Sassa. Money is appropriated through Parliament. It’s paid to the fund and the fund pays it out.”

Crisp said the NHI would not run hospitals or clinics as these functions would be left to provincial and local governments.

Makatini shed light on the efficiency and effectiveness of private healthcare funding in the country.

In 2021 alone, medical schemes amassed a staggering R225 billion in contributions. Remarkably, over 91% of this amount was directly channelled towards medical treatments, showcasing the sector's commitment to fulfilling its non-profit social solidarity mandate.

This efficiency, Makatini believes, closely mirrors the objectives and aspirations of the NHI.

She further elaborated on the tangible benefits that medical scheme members currently enjoy.

These members, some of whom suffer from chronic conditions like diabetes or asthma, are assured of uninterrupted benefits for their ailments.

Furthermore, in the unfortunate event of an emergency, members are fully covered, irrespective of their claim history.

This robust safety net has led to a scenario where South Africans bear only 5% of all health expenses directly from their pockets.

In stark contrast, upper-middle-income nations face out-of-pocket expenses amounting to 31%, as per World Bank data.

Medical schemes have also been proactive in forging contracts with designated service providers. This strategic move is aimed at shielding members from unforeseen out-of-pocket payments. The treatment pathways charted out are strikingly similar to those proposed under the NHI. Over the years, significant progress has been made in establishing quality healthcare access. The impending finalisation of a low-cost benefit option framework is set to further bolster this access.

Statistics from South Africa’s General Household Survey of 2021 offer insightful revelations.

Approximately half of the surveyed individuals affiliated with a medical scheme hail from households with a monthly income of less than R30,000.

A significant majority of respondents with healthcare cover were identified as belonging to previously disadvantaged groups.

It's noteworthy that members' contributions are drawn from their income, and while they receive tax rebates, medical schemes aren't privy to such incentives.

Makatini highlighted the phased approach envisioned for the NHI's implementation. “Healthcare access is an immediate need, not a luxury that can be indefinitely postponed. Even post the NHI's full-fledged operation, it might take years, if not decades, to achieve the comprehensive quality care we envision for our loved ones,” she said.

She said the HFA's commitment to the cause is unwavering.

They are staunch advocates for universal health coverage and believe that time is of the essence.

The association, buoyed by industry stalwarts like Bankmed, Discovery Health Medical Scheme, and Momentum Medical Scheme, among others, is eager to pool resources, knowledge, and expertise with the government. The collective goal is clear: to devise evidence-based solutions that guarantee quality healthcare access for every South African.

Makatini emphasised the collective responsibility that rests on all stakeholders. Until the NHI is fully operational, there's an imperative to preserve and enhance the pockets of excellence within the public sector.

The standards of care that private healthcare funding has facilitated must be the benchmark.

“Our journey towards implementing the NHI will undoubtedly be Herculean, perhaps even spanning generations. The healthcare landscape will undoubtedly be fortified if the globally competitive healthcare financing systems we've nurtured in South Africa are given a platform to offer strategic insights,” she said.

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