National Health Insurance

Meeting Universal Healthcare Goals

By Jessie Taylor

South Africa is poised to introduce a universal healthcare system that would make affordable healthcare more accessible to those in disadvantaged communities: National Health Insurance (NHI).

The NHI Bill was passed last year and is currently awaiting sign-off from President Cyril Ramaphosa. The Bill looks to lay the groundwork for a fund from which the government will buy healthcare services for South Africans from healthcare providers both in the public and private sectors. While there has been some resistance to the NHI, with some saying it will lead to disinvestment in the healthcare sector, the South African government has stressed that the move will be in line with the United Nation's Sustainability Goals.

Universal Healthcare As A Sustainable Development Goal

The NHI Bill seeks to reform South Africa's healthcare sector to create a more equitable, accessible and affordable healthcare system based on the premise that everyone deserves equal access to quality and affordable healthcare.

South Africa is a member of the United Nations community and has committed to implementing universal health coverage for all under the UN's Sustainable Development Goals. According to the World Health Organisation (WHO), the world is off track to make significant progress towards universal health coverage by 2030, with improvements to health services coverage having stagnated since 2015.

The WHO found that the proportion of the population not covered by essential health services has shown minimal improvement in the last decade, and in 2021, about 4.5 billion people were not fully covered by essential health services. The WHO estimates that globally 344 million people are going deeper into extreme poverty due to health costs.

For the NHI Fund to be effective, the entire health system will undergo reforms, including partnerships between the private and public sectors and implementing robust governance structures. President Cyril Ramaphosa said that the NHI will be implemented incrementally, with the government dealing with issues like health system financing, the health workforce, medical products, vaccines and technologies, and health information systems.

Reforming Healthcare

There are both pros and cons to implementing the NHI system, which has undergone robust debate in the public sector.

Some Of The Advantages Include:

• Lowering healthcare costs through the government determining fair healthcare prices

• The potential for higher standards to be set at hospitals and clinics, especially those in the public sector

• Reduced unexpected or out-ofpocket costs for patients

• The removal of barriers to accessing healthcare services

• Better salaries for healthcare workers in the public sector

• Improved socio-economic rights and reducing inequalities through access to healthcare resources

Protecting people from the financial consequences of paying for health services out of their pockets can reduce the risk of being pushed into poverty. However, ensuring the entire population has access to healthcare also prevents other social issues, such as crime and welfare dependency and stimulates the economy by ensuring a healthier workforce.

There are some downsides to the NHI system, such as removing the autonomy of those who would like to choose their medical aid system. It also places an increased burden on taxpayers and may result in some unemployment should medical aid and private healthcare providers downscale. In addition, medical practitioners, particularly in the private sector, may wish to seek more lucrative opportunities abroad.

In addition, there are concerns that patients may face long wait times for procedures, experience a decrease in the quality of care provided, and have an increased potential for corruption and misappropriation of funds. For South Africans without medical aid or in lower income groups, the NHI will be beneficial in that it will offer more equitable access to healthcare services. The NHI will provide health insurance to those not currently a medical aid member, and will also seek to improve the resourcing of public hospitals and healthcare.

What is the NHI?

The National Health Insurance (NHI) is South Africa’s strategy to achieving universal health coverage. It is a fund that aims to give all South Africans access to quality and affordable healthcare by covering the healthcare costs of South Africans, regardless of their socioeconomic status. This means there will be no fees charged at healthcare facilities, and the cost of healthcare will likely remain reasonable while compensating healthcare providers fairly. This will see public and private healthcare providers compensated on the same basis and expected to provide the same standard of care.

The NHI will be funded through taxes, which will see every South African earning above a certain amount required to contribute towards the fund. This will be administered in the same way as contributions to the Unemployment Insurance Fund.

How Does The NHI Differ from Medical Aid?

The NHI has two key differences from private medical aids currently available in South Africa:

• It will cover every South African, regardless of employment or income level, and does not need the individual to opt in.

• The type of healthcare provided to each patient will be of the same standard and will be determined by their health condition and not their choice of healthcare plan. This means there will be no limits on benefits.

Individuals will be free to continue their medical scheme membership, but they will not be able to opt out of making contributions to the NHI Fund. It is likely that many people will need a form of additional health insurance to cover healthcare procedures considered cosmetic or non-essential.