Compulsory contributions envisaged for new NHI We take a closer look at the recently released White Paper on the new National Health Insurance, which is expected to start operating a decade from now.
changes in the country’s health sector and medical schemes in the coming decade are envisaged in the White Paper on the new National Health Insurance (NHI).
The White Paper was finally issued in December after a wait of almost three years. The public has until the end of May to make comments on it.
It is proposed that in about a decade from now there will be an NHI fund that will offer a package of benefits for the entire population. Individuals will have NHI cards that they will use for visits to a doctor for which the fund will then pay.
The NHI will be implemented in three phases and involves, in the first five years, the improvement of primary healthcare – which has already started.
Health minister Dr Aaron Motsoaledi said primary healthcare will be the “heartbeat” of the system, and general practitioners and primary health providers will be the “gatekeepers” of the system and refer patients to specialists and hospitals.
General practitioners in the private sector are already being contracted to provide services to the NHI.
One proposal in the White Paper is that in a decade from now medical aid schemes will have only a “complementary role” and may not provide the same cover as the NHI. By then compulsory contributions to the NHI by individuals will be required, probably through taxation. It is not yet clear how the NHI will be financed.
Further details from the National Treasury are being awaited. The White Paper proposes five potential sources to raise revenue to fund the NHI, including combinations of a surcharge on taxable income, a VAT increase and a payroll tax.
The White Paper says the NHI will protect individuals and households from out-of-pocket expenses and financial catastrophe related to healthcare.
Households will benefit from increased disposable income as a result of a significantly lower mandatory prepayment level, savings that will be made due to economies of scale, efficiency gains as a result of reductions in non-healthcare costs, and affordability of healthcare as a result of strategic purchasing arrangements.
It is envisaged that when the NHI is fully implemented, the number of medical schemes will decline from the current 83 to a much smaller number that will provide “complementary” cover. The remaining schemes will not be allowed to cover the benefits covered by the NHI. However, Motsoaledi said recently he expects the role of the medical schemes will still be debated.
It is proposed that in about a decade from now there will be an NHI fund that will offer a package of benefits for the entire population.
Dr Aaron Motsoaledi Minister of health