Complete overhaul of health insurance on the cards

12 December 2015 - 10:37 By Katharine Child

The health system will be massively restructured and there will be only a handful of medical aids‚ if the National Health Insurance (NHI) plan in its current form is implemented. On Friday‚ Health Minister Aaron Motsoaledi released the policy document on how the NHI would work. It has been approved by cabinet and is open for public comment.The NHI is to offer free high quality health care for all but will only be fully functional in 2026.The policy document suggests a “massive reorganisation of the health systems – both in the way health is paid for and in terms how it is offered”.The National Health Insurance Fund envisions one single fund that is used to pay for all health services at private and public sector.Paying into the fund will be mandatory". It states: "Individuals will not be allowed opt out of making the mandatory prepayment towards NHI‚ though they may choose not to utilise the benefits covered by the NHI fund."What may worry middle class users is that it states that‚ by 2026‚ medical schemes will not exist the way they do now. There will be a reduction in the number of schemes – there are currently 88 schemesThe document is critical of the fact that medical schemes service only 16% of the population yet earn the same each year as the state health budget that serves 80% of the population.Medical aids will only pay for services that are not covered by the national insurance fund."One NHI is fully implemented; medical schemes will offer complementary cover to full gaps in entitlements not offered by the state‚" the document states.It speaks about restructuring medical schemes to spend more money on the NHI fund. Government medical schemes such as the Government Employees Medical Scheme the scheme for the police‚ Polmed‚ the Parliamentary Medical Scheme and the National Fund for Municipal Workers would reallocate those funds towards a single NHI fund.This could mean the end of medical schemes that serve the government sector.The document says costs of private health care have to come down given that private health care in South Africa is among the most expensive in the world.It suggests an increase in taxes may also be needed because the shortfall in 2026 is estimated to be R71 billion.The policy suggests that medical aid brokers‚ who are paid commission each month‚ will not be necessary and the money they earn - R1.5 billion will go into the NHI fund.Doctors and health workers should also expect to be contracted in the state sector...

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