4 minute read
National Health Insurance
A Path Towards Equitable Healthcare
By Jessie Taylor
South Africa is on the cusp of implementing the National Health Insurance (NHI) Act, following the signature of President Cyril Rampahosa. This legislation, aimed at achieving Universal Health Coverage (UHC), promises to reshape the nation’s healthcare system, making quality healthcare accessible to all citizens, regardless of their financial status.
While the new legislation will significantly change South Africa’s healthcare landscape, the government has assured citizens that it will be rolled out in a phased and structured approach that will bring gradual reform to the existing system.
A Phased Approach
Health Minister Dr Aaron Motsoaledi has emphasised the importance of implementing NHI in phases to ensure a smooth transition and address any challenges.
The implementation of the NHI will be phased over several years, with a structured approach designed to integrate and reform the existing healthcare system gradually. The NHI Act, signed into law by President Cyril Ramaphosa in May, outlines a twophase plan for its rollout.
Phase 1: The first phase, which will run until 2026, focuses on strengthening the foundation of the healthcare system. This includes improving infrastructure in public health facilities, upgrading healthcare management systems, and enhancing the quality of care in public hospitals and clinics. During this phase, the government will also establish the NHI Fund and begin accrediting healthcare providers who will deliver services under the NHI.
Phase 2: The second phase, between 2026 and 2028, will see the gradual expansion of NHI benefits to the broader population. This phase will focus on contracting private healthcare providers to supplement public healthcare services and address gaps in service delivery.
The full range of healthcare services covered by the NHI will be rolled out progressively, depending on the availability of financial resources. Dr Motsoaledi says: “We will have to start implementing NHI in phases, as we are already in phase 2. The rest of the building blocks of health will easily fall into place.
He has pointed out that five of the six building blocks of health systems – leadership and governance, access to essential medicines, health workforce, health information systems, and service delivery – are generally accepted. However, the sixth, health systems financing, which is the basis for NHI, has generated significant debate.
The Minister said some believe that the country is not ready for the NHI, while others are of the view that it is “very expensive” and the country has no money for it. “NHI is a health financing system … which is meant to be an equaliser between the rich and the poor.”
Creating Healthcare Equality
The National Health Insurance (NHI) is a health financing system designed to pool funds to provide access to quality, affordable personal health services for all South Africans, irrespective of their socio-economic status. The NHI represents a significant shift from the current healthcare financing model, where services are largely divided between a well-resourced private sector and an underfunded public sector.
Under the NHI, healthcare services will be purchased from accredited public and private providers and will be free at the point of care for all eligible South Africans. This means that individuals will no longer pay out-of-pocket for healthcare services at the time of use. Instead, the NHI Fund will cover these costs, reducing financial barriers to accessing care.
The concept of NHI in South Africa is not new. The country has been grappling with healthcare financing reforms for nearly a century. As early as 1928, discussions around health insurance began with various commissions and committees exploring ways to create a more equitable healthcare system.
However, despite numerous proposals and reports, meaningful change remained elusive. Today, South Africa’s healthcare system reflects a stark disparity between the quality of care in the public and private sectors. While a small minority, around 14% of the population, has access to world-class healthcare through private medical schemes, the majority, approximately 86%, rely on an overburdened and under-resourced public health system.
The NHI is seen as a necessary intervention to correct these imbalances. It aims to create a unified health system that ensures everyone has access to the same level of care, irrespective of their income or social status.
