The National Health Insurance (NHI) is a financing system that will make sure that all citizens of South Africa (and legal long-term residents) are provided with essential healthcare, regardless of their employment status and ability to make a direct monetary contribution to the NHI Fund.
Why does South Africa need national health insurance? Healthcare is a human right – this is a widely accepted international principle. This right should not depend on how rich we are or where we happen to live. The right to obtain healthcare is written into our Constitution.
But large numbers of our people continue to die prematurely and to suffer unnecessarily from poor health. Treatable conditions are not being treated on time and preventable diseases are not being prevented.
This is in spite of the fact that government has tried its utmost since 1994 to ensure that everyone in this country has equitable access to necessary healthcare services. There are still serious challenges mainly caused by a skewed healthcare financing system. Without NHI, the burden of disease in the country will not be reduced because the majority of the population – and the section suffering the greatest ill health – will not access good quality healthcare.
What healthcare services will be funded by NHI?
The NHI will offer all South Africans and legal residents access to a defined package of comprehensive health services. The state is committed to offering as wide a range of services as possible. Although the NHI service package will not include anything and everything, it will offer care at all levels, from primary health care, to specialised secondary care, and highly specialised tertiary and quaternary levels of care.
Examples of what the NHI package will exclude are:
Cosmetic surgery that is not necessary or medically indicated but done as a matter of choice – for instance, botox, liposuction and face-lifts. Expensive dental procedures performed for aesthetic purposes. Expensive eye-care devices like trendy spectacle frames. Medicines not included in the National Essential Drug List except in circumstances where the complementary list has been approved by the Minister of Health. Diagnostic procedures outside the approved guidelines and protocols as advised by expert groups.
The benefits provided will cover preventive, promotive, curative and rehabilitative health services. It is important to note that emphasis will be placed on prevention of disease and promotion of health. The present healthcare system places undue focus on curing of disease and performance of procedures when people have developed complications.
Will the NHI destroy the private sector?
No, the NHI is not intended to destroy the private sector. It will actually make the sector more sustainable by making it levy reasonable fees. The intention of NHI is rather to make sure that citizens are able to use both the public and private sectors in such a way that they complement each other rather than one undermining the other. At the present moment, private healthcare is only for the rich. NHI is trying to blend the two in a more sustainable manner that benefits the population.
,br> Will private medical schemes be abolished and will private healthcare providers be forced to contract with NHI?
Government does not intend to abolish private medical schemes if individuals members wish to keep them.
Participation in NHI is solely a matter of choice for the individual healthcare provider. However, those that choose to participate will need to meet certain requirements that will be prescribed under the NHI policy. These will include compliance with quality standards, provision of a package of services that will extend to prevention of diseases and promotion of health, acceptance of capitation as a method of payment instead of fee for service, and appropriate pricing mechanisms.
If people can afford to buy private healthcare, will they have to participate in NHI?<br. We need to make a distinction between a citizen participating in the NHI as a contributor and a citizen participating in NHI as a patient. If you earn above a certain income you will be required by law to make a contribution to the NHI Fund. It will not be possible to opt out of this responsibility.
However, as a patient, if you wish to make use of services of a healthcare provider who is not accredited and/or who chooses not to contract to NHI, you would have to pay the provider directly or else maintain medical scheme cover (in addition to making NHI contributions).
How will the quality of healthcare be ensured under the NHI? Quality will be ensured through three mechanisms:
Firstly there needs to be a radical improvement in the quality of services in the public health facilities. This means massive investment in improvement of health infrastructure, both buildings and equipment.
Then, in every single health institution, certain basic core standards must be complied with. To ensure adherence to standards, an independent “watchdog” body called the Office of Health Standards Compliance will be established by an Act of Parliament.
Thirdly, there needs to be a radical change to healthcare management within the public healthcare system in line with the 10 Point Programme of the Department of Health: “Overhauling the health care system and improve its management”. Regulations will include measures to standardise hospital care across the country and to ensure that managers of different categories of hospitals have specific skills, competencies and appropriate qualifications.
What are the processes going forward after the publication of the Green paper?
The purpose of the Green Paper is to outline the broad policy proposals for the implementation of NHI. The document is published for public comment and engagement on the broad principles. After the consultation process the policy document or White Paper will be finalised. Thereafter draft legislation will be developed and published for public engagement. After public engagement the legislation will be finalised and submitted to Parliament for consideration. After Parliamentary approval, the Bill has to be approved by the President of the Republic.
What will happen in April 2012?
Piloting of NHI will commence in ten selected districts. The Department of Health is busy conducting an audit of all public health facilities in our country. The selection of the 10 districts will be based on the results of the audit. Consideration will be given to a combination of factors such as the district’s health profile, demographics, income levels and other social factors impacting on health, health delivery performance, management of health institutions, and compliance with quality standards. Will people be required to pay NHI contributions in 2012?
No. In 2012 we will start piloting NHI to help us finalise how the service benefits will be designed, how the population will be covered and how the services will be delivered. A special Conditional Grant will be provided in the 2012 budget to fund the pilot projects.
What will happen in the first five years of NHI implementation?
The first five years of NHI will include pilot studies and strengthening the health system in the following areas:
Management of health facilities and health districts Quality improvement Infrastructure development Medical devices including equipment Human Resources planning, development and management Information management and systems support Establishment of an NHI Fund.