BHF360° | DECEMBER 2021
T HE ROA D A HEAD
The National Health Insurance Bill What will work, what needs to change Selaelo Mametja MBBCh, MMED Public Health (FCPHM(SA), Chief Research Officer, GEMS
Section 27 of the South
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African Constitution
arious arguments have been made pro- and anti-NHI as a financing mechanism for the country. Among many arguments is that South Africa already has existing Universal Health Coverage (UHC) through the tax-financed public sector- and medical scheme-funded private sector. Despite what many may define as UHC, both medical scheme beneficiaries and patients accessing state healthcare find that on the ground, both systems leave them vulnerable to lack of access (especially in resource-constrained public sector facilities), exorbitant premiums and out-of-pocket expenditures. The inequitable distribution of healthcare resources (e.g. hospitals, human resources) further exacerbates geographical and income disparities.
The introduction of NHI to advance equitable access to healthcare for all South Africans is both a moral imperative and a tool to advance our constitutional right to quality healthcare irrespective of our socio-economic means. Pooling of financing mechanisms and having a mandatory prepaid NHI will provide South Africans with equal opportunity to participate meaningfully in their healthcare financing, irrespective of their socioeconomic means. The bill also outlines mechanisms to improve efficiencies, such as using general practitioners (GPs) as gatekeepers, referral pathways and formularies. A Government Employees Medical Scheme (GEMS) study has shown that this mechanism can improve efficiency and reduce costs by 16-20%.
guarantees everyone the right to healthcare and places upon the state a duty to take reasonable measures within its available resources to achieve the progressive realisation of this right. Therefore implementation of National Health Insurance (NHI) using various legislative frameworks is pro-South African Constitution. The purpose of this article is to highlight what will work.
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