Officials from the health department briefed the National Council of Provinces (NCOP) on the National Health Insurance (NHI) today. The NHI aims to provide access to quality and affordable health services to meet patients’ healthcare needs.

Last week, the National Assembly passed the bill with more than 200 members of Parliament (MPs) voting in favour of its implementation. 125 MPs voted against the bill. The National Council of Provinces must now approve the bill before the President signs it into law.

Here are 10 things you need to know about the NHI

1.The NHI will cover every South African citizen irrespective of race, sex, and employment status. Users (including children) will be required to register with accredited healthcare providers or establishments. Newborn babies will be automatically registered at birth.

2. The NHI fund will purchase healthcare services on behalf of all beneficiaries. Treatment will not be funded if it is not cost effective or not a medical necessity. If the Fund declines a benefit – it will provide reasons and allow the opportunity for an appeal by the beneficiary.

3. Private and public hospitals, as well as private health practitioners and public clinics, will enter into NHI contracts to provide services.

4. The NHI will be funded through mandatory general taxes and prepayments made by pooling funds both from current private and public sources for the purchasing of healthcare goods and services.

5. Patients will have access to both public and private healthcare providers on the same basis and receive the same standard of care from both. 

6. For their regular health needs a patient will visit any healthcare facility close to home that has a contract with the NHI. Where providers or establishments are unable to provide a registered service, a transfer to use another provider will be applicable. 

7. To ensure quality care, the Office of Health Standards Compliance will inspect facilities for factors like hygiene and safety before admitting them into the NHI for a maximum of five years. Conditions of renewal will be determined by inspection thereafter. Providers who have been refused accreditation will have the opportunity to appeal.

8. Medical aid schemes will still exist and citizens who currently use private health services and are on medical aid will be able to continue doing so. However, there will be a mandatory contribution to the NHI fund for those who meet the affordability criteria. Once the NHI is fully implemented, the Minister of Health will introduce regulations limiting benefits to services not reimbursable by the Fund. 

9. NHI contracted facilities will offer a range of services from primary health care to specialised tertiary levels of care. This will include essential and non-cosmetic surgeries already offered by public tertiary hospitals. Referral pathways to specialists will still be applicable.

10. Documented and undocumented foreign nationals will have to have their own medical insurance. Refugees will be covered in line with Section 27 (g) of the Refugees Act 130 of 1998 as amended. Asylum seekers with valid permits from the Department of Home Affairs will access emergency healthcare services. However, all children’s healthcare needs will be covered by the fund, irrespective of who they are and whether or not they have documentation.

What’s next?

Nicholas Crisp, the Deputy Director General of Health says the ‘the next step from now until the time that the NHI is implemented in 2026 is to ensure that administration is running, the foundation for a functional fund is set, and the information of what the NHI intends to do is in the public domain.’ Phase two will be to strengthen and further roll out the provisions of the NHI by 2030. – Health-e News