Cape Town - The remains much uncertainty around how the National Health Insurance (NHI) Act will be effected, after being officially signed into law by President Cyril Ramaphosa last week.
The aim of the highly contentious NHI, which has received much pushback due to concerns related to increased pathways for rampant fraud and corruption within the healthcare sector, is to provide universal access to quality healthcare for all South Africans, and with the ultimate goal of achieving Universal Health Coverage (UHC). Ramaphosa officially signed the NHI Bill on May 15, 2024.
The NHI Act will see a public health fund, the NHI Fund established to meet the health needs of the entire population, with this pool of public healthcare providing funding for private and public healthcare providers.
When users visit healthcare facilities, there will be no fees charged as the NHI Fund will cover the required costs.
The NHI Fund will be funded from general taxes; contributions of persons earning above a set amount; and monthly contributions by the employees to the fund.
Employers will be expected to ensure their employees’ contributions are collected and submitted.
The NHI will not be a replacement for medical aid schemes and members can continue with their medical schemes. However, when the NHI is fully implemented, the role of medical schemes will change and will cover services not reimbursable by the NHI Fund. Once the NHI is fully implemented, medical schemes will only offer complementary cover to services not reimbursable by the fund.
The NHI will be rolled out in phases with “key milestones” in each phase. Phase 1 will consist of a period of four years from 2023 to 2026. Phase 2 will last for a period of three years from 2026 to 2028.
Any person seeking access to healthcare services from an accredited service provider or health facility under the fund must be registered as a user. The person would be required to provide their biometrics, including fingerprints, photographs, proof of residence and identity card; original birth certificate; or a refugee identity card.
Treatment won’t be funded if it’s found that no medical need exists; no cost-effective intervention exists; or the healthcare product or treatment is not included in the formulary, except where a complementary list has been approved by the minister.
The auditor-general must audit the accounts and financial records of the fund annually, and the fund’s board must submit to the minister and Parliament a report on the fund’s activities in a financial year as determined by the Public Finance Management Act.
During the signing of the bill.Ramaphosa said the provision of healthcare in the country was fragmented and unsustainable. The challenge was the misallocation of resources favouring the private healthcare sector at the expense of public health needs.
He said the fund would procure services from public and private service providers, and that access to quality healthcare would be determined by need and not the ability to pay.