09 July 2009

National health: just join the dots

A national health insurance scheme is nothing new in larger, wealthier democracies. The question is whether such a system is a good fit for South Africa.

Recent government documents have detailed the plans for a national health insurance scheme or NHI for South Africa.

The advent of NHI was set out in the National Drug Policy published back in 1996, so proposals on NHI are really not novel. In that Policy, NHI is premised on the ideology that all South Africans are entitled to access healthcare services. This ideology became entrenched in the Bill of Rights and is a Constitutional prerogative for government.

  • the Medical Schemes Act was amended to remove risk-rating and allow more equitable entry criteria;
  • community service was introduced for healthcare professionals and pharmacists;
  • larger corporations were allowed to enter the pharmacy industry and, in theory, use their economic muscle to provide cheaper pharmacy services;
  • the base of primary healthcare providers was broadened to include allied professions and traditional healers;
  • regulated medicine pricing was ushered in and the medicines base was widened to include traditional Western medicines, herbal medicines, Chinese and Indian medicines, etc;
  • certain cost or managed care solutions were introduced for medical schemes, enabling them to negotiate cheaper membership rates;
  • the concept of accrediting healthcare providers was introduced;
  • the national health reference price list was published. In the light of proposed amendments to the National Health Act, it becomes a maximum price for healthcare services;
  • the Medical Schemes Act already makes provision for prescribed minimum benefits and other guaranteed services, which shadow the NHI.


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