The National Health Insurance (NHI) system has been mooted in recognition of the fact that the country’€™s public health system does not meet the needs of South African citizens. Some would rather get gravely ill than go to a public health facility, due to problems such as drug shortages and bad attitudes of health care workers. Those who have money opt to go to the private health sector.  

‘€œPeople do not use public sector facilities because they are not happy with the quality of services they access. What we are saying with this health reform is that we would like to improve the quality of services. But we would also like to ensure that these services are affordable, meaning NHI is aimed at increasing coverage, ensuring that people can access quality services at affordable costs’€, says Precious Matsoso, the Director-General of the national Health Department.

Matsoso says the NHI seeks to ensure that every South African has access to decent quality health care. She says it’€™s like creating medical aid cover for every citizen.

‘€œWe are going to make sure that every South African is covered. At the moment, only 7 million South Africans have access to medical cover. Population coverage that is universal means every South African can have access to services that are styled like services of a medical aid. It’€™s almost like saying every South African has a medical aid cover’€, she says.

According to Health Minister, Dr Aaron Motsoaledi, the National Health Insurance will cover everyone regardless of their financial status.      

‘€œNHI is a financing system that will ensure provision of essential health care to all citizens of South Africa and legal long-term residents, regardless of their employment status and ability to make a direct monetary contribution. The goal is to try and finance health for everybody’€.

Motsoaledi says the principle of the NHI system is based on health care as a right that every person is entitled to.

‘€œThis right should not depend on how rich we are or where we happen to live. 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 health care services. There are still serious challenges mainly caused by skewed health care financing systems. Without NHI the burden of disease in the country will not be reduced because the majority of the population and the sections suffering greatest ill health will not access good quality care on time’€, he says.                  

Financing for the first year of the NHI system will come from Treasury. The conditional grant will be put in what is called the NHI Fund. From then on a section of the population will be required to make a direct contribution towards the Fund.    

‘€œIf you earn above a certain income level, you will be required by law to contribute to any form of health care financing system. It won’€™t be possible to opt out of that responsibility’€, says Motsoaledi.

Minister of Finance, Pravin Gordhan, says there will be four ways in which every South African will contribute to the NHI Fund.

‘€œThe one is through the fiscus, that is, the tax that everybody contributes. Secondly, through mandatory contributions from employers’€¦ Employers are already contributing to those people who have medical scheme membership. There are ideas around how we build on that. The third is co-payment and user charges from the individual himself or herself. So, if you want the Botox treatment, you’€™ll have to pay it yourself. But, also, there are certain instances where we could enter into public-private partnerships, for example, on the infrastructure side. You could bring in funding from the private sector as well’€, Gordhan says.        

Early projections of what the NHI will cost indicate that the project will cost about R125 billion to implement over nine years. The figure is set to rise to R255 billion over 14 years. The first phase will commence in April 2012 with a pilot project involving 10 districts. The national Health Department is currently carrying out an audit of the country’€™s 4 200 public health facilities, including clinics, before choosing the 10 pilot districts.      

‘€œConsideration will be given to a number of factors, such as district health profiles, demographics, income levels and other social factors impacting on health, health delivery performance, management of health institutions and compliance with quality standards’€, says Health Minister, Dr Aaron Motsoaledi.

The release of the Green Paper or discussion document marks the beginning of a consultation process between government and various sections of the population over a three-month period. After this public process, a policy document or White Paper will be finalised and then laws to govern the NHI will be drawn up and go before Parliament.