Updated 11 December 2015

NHI to be compulsory for all, says Motsoaledi

Medical schemes will only provide top-up cover under the NHI, there will be a central fund established to pay for the NHI, and doctors could choose to participate in this scheme if they wanted to.

Under the NHI, medical schemes will only offer top-up cover for those services not covered by the NHI, the NHI will be funded through a central fund (partially funded from a payroll levy), medical brokers will be done away with (they currently receive R1.5 billion rand per year), and doctors will be able to access the central fund if they choose to participate in the NHI.

These were some of the key announcements made by Health Minister Aaron Motsoaledi at the release of the White Paper on National Health Insurance at a press conference in Pretoria.

Read: 10 NHI facts

The NHI will not be a sprint, but will be an ultramarathon, said Motsoaledi.

The Cabinet met on 9 December, and it was presumed that the NHI White Paper was on the agenda, as it was later confirmed that the cabinet had approved the White Paper, and that public comment would be invited.

The purpose of the NHI

National Health Insurance “seeks to transform the South African Healthcare system with emphasis on the promotion of health and the prevention of diseases. It also seeks to provide access to quality and affordable healthcare services for all South Africans based on their health needs irrespective of their socio-economic status”, according to the South African Government website.

The government green paper was released in August 2011, and it proposed that the NHI would be implemented within 14 years. Pilot districts were established in all nine provinces.

Where will the money come from?

The cost of implementing the NHI is projected to R225 billion by 2025. Possibilities of raising these funds, according to reports from 2012, include a pay roll levy for all employed South Africans, and increase in VAT, or an income tax surcharge. These possible sources of revenue were confirmed on Friday by Motsoaledi in the press conference in Pretoria.

SA’s economy is under increasing pressure, and how the government proposes to fund the NHI is a topic of interest for all South Africans. Another issue is how the public and private health sectors will function alongside one another, and what the future would be of medical schemes in South Africa. Motsoaledi announced on Friday that under the NHI, medical schemes will only offer top-up cover for those services not covered by the NHI.

Read about the services the NHI originally proposed to provide.

State hospitals vs. private hospitals

There are state hospitals that would need a serious upgrade and in 2013 President Zuma proposed that this would be undertaken through public-private partnerships. Motsoaledi confirmed in Friday’s address that you can’t have a proper healthcare service without a proper healthcare infrastructure. He has also consistently attacked private hospitals for the high cost of the care they provide, saying that this contributes to high medical inflation.

“Everyone wants to own a private hospital in SA, because they say there is money in it”, he said on Friday. He also mentioned that most European countries are moving to mandatory universal healthcare coverage and compared Obamacare to what the NHI is trying to achieve in South Africa.

The minister has expressed ongoing concern about the fact that 80% of the medical specialists in the country are servicing only 16% of the population – something the NHI is set to address. One of the ways of achieving this would be requiring doctors to show a certificate of need before being allowed to practise in certain areas. There is still no certainty with regards to the implementation of this.

Read about the possibility of the certificate of need being implemented under the NHI and what it would mean to doctors.

Concerns raised by commentators on the NHI include financial constraints of already overburdened taxpayers, the possible exodus of medical staff from the private sector to other countries, the poor condition of many state facilities, the lack of properly trained managers and the lack of trained medical staff willing to work in rural areas.

Read more:

The ANC's NHI plan

NHI: key details

NHI reflects global trend


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