Illustration: Colin Daniel

National Health Insurance (NHI) inched closer to becoming a reality this week after the Ministry of Health published the draft National Health Insurance Bill for public comment.

The bill lays the foundation for the establishment of an NHI Fund, and this, together with changes proposed in the Medical Schemes Amendment Bill, also introduced by the minister, will impel a raft of changes in the healthcare industry.

The Minister of Health, Aaron Motsoaledi, says one of the proposed changes is to do away with healthcare brokers.

“Almost two-thirds of principal members of medical schemes pay a monthly fee to a broker as part of their premium, and most members don’t even know they pay brokers.  The total amount paid to brokers by members of medical schemes is now R2.2 billion,” Motsoaledi says. “We want this money to be available to pay for direct health expenses of members rather than to brokers, who are not needed in the healthcare system.”

The draft NHI bill says the fund will be the single public purchaser and financier of health services. The fund will also be a “mandatory prepayment health services system”.

The bill states that the minister must, in consultation with the Minister of Finance, determine the budget and allocation of revenue to the fund annually.

According to the bill, the NHI Fund will:

• Enter into contracts with accredited public and private service providers based on the healthcare needs of users;

• Determine prices annually after consultation with healthcare providers, healthcare establishments and suppliers; and

• Collate utilisation data and implement information management systems to assist in monitoring the quality and standard of healthcare services, medicines, health goods and health-related products procured by the fund.

The fund will purchase health service benefits on behalf of South African citizens, as well as accommodate people who are permanently resident in the Republic. A temporary resident will have the right to emergency medical treatment in terms of the provisions of his or her travel insurance.

The fund will also service all inmates as provided for in section 12 of the Correctional Services Act. Refugees and asylum seekers who have not been granted refugee status will have the right to emergency healthcare services and paediatric and maternity services at primary healthcare level.

The General Household Survey released by Statistics South Africa this week shows that, between 2002 and 2017, the percentage of individuals covered by a medical scheme increased marginally from 15.9% to 16.9%. This means that more than 46 million South Africans do not belong to a medical scheme.

The Ministry of Health says the Act is being implemented over three phases:

  • The first phase, which ran from 2012 to 2017 and included the testing and strengthening of the healthcare system, has ended.
  • Phase two runs from 2017 to 2022. It includes the development of NHI legislation and amendments to other legislation. This phase also includes the interim purchasing of personal healthcare services for vulnerable people, such as children, women, people with mental health disorders, people with disabilities and the elderly.
  • The third phase, envisioned to run from 2022 to 2026, includes the contracting of selected healthcare services from private providers.

Dr Ali Hamdulay, the chairperson of the Board of Healthcare Funders of Southern Africa, says it is imperative that the private sector collaborates with the Minister and the Department of Health to positively shape the healthcare landscape.

“The private healthcare sector cannot stand by and think that it won’t be affected should the public sector suffer. Public and private healthcare sectors are not mutually exclusive,” Hamdulay says.

“Some schemes use state institutions for designated service providers, and our entire healthcare workforce is trained via academic and public institutions.”

Neil Kirby, the head of healthcare and life sciences law at Werksmans Attorneys, says the bill is like building a house with no land on which to put it.

“The qualification process, within and of itself, means that certain providers may be excluded from providing NHI benefits and, in turn, from receiving payment for the provision of certain healthcare services,” he says. “The prudence of excluding healthcare providers, in an already strained system starving from a lack of available expertise, is highly questionable if not irrational.”

Members of the public who want to provide input on the two bills must, within three months, write to: The Director-General of Health, Private Bag X 828, Pretoria, 0001 (for the attention of the Deputy Director-General: NHI, Dr Anban Pillay) or email [email protected]

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