And if Health Minister Aaron Motsoaledi and his team get it right, it will mean that decades from now, all South Africans will access multifaceted public and private health care with a swipe of a card connected to a public pool of funds.
Motsoaledi released the proposed policy for public comment on Thursday.
The healthcare plan is set to make tremendous changes to the way health care in South Africa works with a view to ensuring all citizens and certain long-term residents, asylum seekers and refugees, get access to medical care at accredited public and private medical service providers.
To ensure this, it will be mandatory for South Africans to register as a members of the NHI fund if it’s accepted into legislature.
You will also be required to contribute financially to the fund if you earn an income - whether or not you are already on a medical aid scheme.
But how much it will cost or whether the contribution will be like a tax on income has not been revealed.
Motsoaledi’s mantra that comes with the proposal is “the rich must subsidise the poor, the young must subsidise the old and the healthy must subsidise the sick”.
Currently, the rich have access to both private and public health care while the poor rely on the public healthcare services which require improvement, Motsoaledi said.
“Any health system where the better paid, employed people and the affluent have a separate healthcare system based on medical schemes, while other citizens are left in a separate system, is a recipe for disaster,” he said.
According to the General Household Survey for 2017, conducted by Statistics South Africa, few people are satisfied with treatment from public healthcare facilities.
The survey found that 72% of white South Africans were on medical aid schemes compared to 10% of black South Africans.
These numbers would have been different a few years ago when only 7.3 million South Africans were on medical aid schemes compared to the 9.5 million people on schemes today.
In reaching nationalisation, Motsoaledi is hoping to change how these schemes work.
While he released the NHI policy he also revealed the Medical Aid Scheme Amendment Bill for public comment, stating the two worked together.
The changes to the Medical Aid Scheme via the proposed bill would include that the practice of co-payments and the use of brokers be abolished.
This means that anyone belonging to medical aid schemes, including the NHI fund, would not have out-of-pocket expenses for approved services.
The Board of Healthcare Funders of South Africa (BHF), which represents 45 medical aid schemes in South Africa, are among those cheering on the NHI.
Chairperson Dr Ali Hamdulay said: “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. It’s therefore imperative that the private sector collaborates closely with the minister and the Department of Health and share their views, insights and knowledge to positively shape the healthcare landscape.”
Public Servants Association general manager Ivan Fredericks said if, as the bill promises, more people have access to primary health care the country would be on its way to restoring human dignity.
Citing corruption within health departments, AfriForum described the NHI as a stillborn baby.
Dr Eugene Brink, strategic advisor for community affairs at AfriForum, condemned the state for being unable to manage its current funds, but requesting more money from the public to fund the NHI.
“They need to at least get their house in order before money can in the slightest be collected from the taxpayer again to finance their wishful thinking. Otherwise more money will in addition simply be misallocated while the public health sector still remains dismal,” he said.
The NHI has been a talking point since 2007 when the ANC adopted the idea at its Polokwane conference, followed by the release of the NHI Green Paper in 2011 that promised to have universal health care in place within 14 years.
National Treasury has allocated R1 billion for pilot programmes across 10 districts.
Interested parties have three months to comment on the bill, which was published at the same time as the Medical Schemes Amendment Bill.