The minister, the medical aids and you
We answer your questions about what the National Health Insurance means for you
WThe NHI will pool private and public funding to provide better and more equal healthcare for all South Africans. The government will become the only largescale purchaser of healthcare services from private and public providers. By doing this, Health Minister Aaron Motsoaledi says the government will be able to set prices for health services and also negotiate better deals as it buys larger quantities of, for instance, medicine. The NHI will be rolled out in stages and the minister says it will be complete by 2025. 20% of doctors must serve the rest. How can you expect not to have long queues [in the public sector]? The NHI must make [these doctors] available to the rest of the population.”
Doctors will still be allowed to practice privately, but will have to see public patients at NHI rates. “People must appreciate that we want to be a nation where equality, social justice and social solidarity are the order of the day.” Not necessarily. Even government admits that “irrespective of how comprehensive the NHI entitlements will be, some personal healthcare services will not be covered”. So while you’ll have to pay into the NHI, medical aids will continue to exist, but in a different form: they will offer complementary health coverage or access to services you may not be able to get through the NHI.
In the post-NHI era, you will likely buy this kind of top-up cover from fewer medical schemes offering fewer products, but you’ll still benefit from government-negotiated prices. “Obviously, there will be some services the NHI won’t cover. Say you go for plastic surgery. It’s your choice, [but] that surgeon will still charge you NHI rates,” Motsoaledi said. Motsoaledi says there are two myths about the NHI — that the country can’t afford it and that we should be imagining an NHI built on the public and private health systems as we know them today. “This is a significant policy shift. It necessitates a massive reorganisation of the healthcare system. That reorganisation is already taking place.”
Concurrent with introducing the NHI, the health department has tried to reform the weak public health system and its pricey counterpart, the private sector. As part of this “massive reorganisation”, government has, for instance, tried to kickstart community and clinic-based services to catch illnesses early and prevent the need for more expensive treatment later. In 2014, the Competition Commission launched a probe into private healthcare — a move many believed was an attempt by the government to unravel the drivers of high private healthcare costs ahead of moves to buy services from the sector. Yes, but there will be limits. The white paper says patients will be allowed to “choose a health provider or facility for treatment” as long as their choice doesn’t go against standards or guidelines. But if you want to go to a GP for a cold, you may end up at the nurses’ station first. The NHI — like some medical aid schemes — will try to curb unnecessary costs, so you’ll need a referral to see that ear specialist. It also means that, like medical aid schemes, an expert committee will have to approve any requests for treatment outside of standard guidelines.
That’s the billion-rand question in South Africa and the world over as more countries move towards universal healthcare coverage. Under the NHI, money would be channelled into a single fund to pay for healthcare and this would be governed by a board, which reports to the health minister and Parliament. Among the first cash injections into the fund is one likely to come from the scrapping of about R20-billion in annual medical aid tax credits. Next, expect payroll and surcharge taxes, says the white paper.
In 2016, the country spent R355billion on health, publicly and privately, the document states. Maybe. NHI cost projections have been criticised for using outdated cost bases and growth projections. The white paper predicts a deficit of R27.6-billion by 2025 even under a best-case economic growth scenario. The affordability of NHI is likely to be the biggest question as we head towards healthcare for all.