For South Africans without medical aid or in lower income groups, the NHI will be beneficial as it will offer more equitable access to healthcare services and will allow for these people to consult private healthcare practitioners and make use of private healthcare facilities and practices with the NHI footing the bill.
Not only will it provide health insurance to those not currently a member of a medical aid, but the NHI purports to improve the resourcing of public hospitals and healthcare services as the burden of care will be more evenly distributed.
For South Africans who do have medical aid, the NHI may be a shock to the system. Those who are accustomed to private care may have to settle for lower standards while continuing to pay a similar or higher fee.
South Africans within a certain income bracket will have to make mandatory monthly payments towards healthcare in addition to carrying a higher tax burden.
Implications for medical aid schemes
Once the NHI is implemented, medical aid schemes will not be able to offer any services offered by the NHI and will only be able to provide for “complementary or top-up cover” which does not overlap with that which is provided for by the NHI. South Africans will be able to use their free NHI cover for healthcare needs and no co-payments will be charged.
The bill does provide for gap cover but the relevant section of the bill is greatly understood and interpreted as meaning medical aid schemes will cease to operate since current members will be obligated to make use of their NHI.
Arguments have been made that negating and destroying the role of medical aid schemes is counterproductive to universal healthcare as there simply are not enough resources to meet the needs of all South Africans and that limiting the right to choose to purchase health insurance is unprecedented, inappropriate and might even constitute a limitation of rights similar to making use of private education or private security.
The private sector, for now, will not be nationalised and as such private practices, pharmacies and hospitals will continue to be available and South Africans will be able to register with their preferred healthcare provider.
Dr Larisse Prinsen is a senior lecturer in the department of public law, University of the Free State.
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OPINION | The pros and cons of the National Health Insurance Bill
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Universal access to healthcare and the ideal of a national system of health insurance are important concepts which relate directly to core human rights and as such are noble and necessary. However, as is often the case, an ideal may be fine in theory but falls short when it must be put into practice.
The National Health Insurance (NHI) Bill is no exception and many concerns and critiques have been lobbied at the bill and its implementation, ranging from the migration of hospitals to semi-autonomous entities, the structure of the contracting unit for primary healthcare needs, establishment of the fund, the Health Patient Registration System, accreditation issues, purchasing of services, the amendment of other pieces of legislation to make room for the NHI and payment concerns.
Thus far, satisfactory solutions have not been offered to all these problems. For the NHI to be beneficial to all and truly live up to its potential for betterment, it should not be rushed.
Background
Last month the bill was passed by the National Assembly. From there it will be sent to the National Council of Provinces. If also passed there, it will be signed into law by the president. This process may, however, take years to complete.
The provision of universal access to healthcare has long been envisioned by not only the constitution, which states in section 27 that everyone has the right to access to healthcare, but also by the National Health Act, which in its preamble declares an aim of the act as providing for a framework for a structured uniform health system within the Republic. The NHI bill is the manifestation of this statement.
The bill aims to ensure all South Africans have access to quality healthcare services and to provide for the establishment of a fund which will be used to pay for almost all medical treatments from accredited providers with rates to be determined by the state. Private health insurers will thus only be able to pay for treatments, health products and services not covered by the fund.
Malema’s concerns about the NHI bill
This bill, however, has from the inception been contentious and has been fought against from the start. This is seen in the fact that a mere two weeks before the passing thereof in the National Assembly, the South African Medical Association rejected the bill in its current form. There have also been multiple court cases launched against the bill and different voices have been raised against it.
In spite of this, the bill will most probably become law in some shape or form at some point in time and it is thus pertinent to perhaps examine that which it espouses, national health insurance, as this concept is noble at its core, and the achievement of a more equitable society in context of access to healthcare.
Advantages of national health insurance
Proposed and hoped-for advantages of the system include:
Disadvantages
Disadvantages of the system include:
What does it mean for South Africans?
The current two-tier system of healthcare provision has not sufficiently catered for good quality healthcare for all. This system has precluded the poor or those without medical aid from accessing a large number of health professionals, services and facilities. NHI will establish a single pool of healthcare funding for private and public healthcare providers and will pay both these providers on exactly the same basis while expecting the same standard of care from them.
Overall, a system of NHI may impact South Africans in the following manner:
'It's time all South Africans are afforded the right to healthcare': Cosatu welcomes passing of NHI Bill
For South Africans without medical aid or in lower income groups, the NHI will be beneficial as it will offer more equitable access to healthcare services and will allow for these people to consult private healthcare practitioners and make use of private healthcare facilities and practices with the NHI footing the bill.
Not only will it provide health insurance to those not currently a member of a medical aid, but the NHI purports to improve the resourcing of public hospitals and healthcare services as the burden of care will be more evenly distributed.
For South Africans who do have medical aid, the NHI may be a shock to the system. Those who are accustomed to private care may have to settle for lower standards while continuing to pay a similar or higher fee.
South Africans within a certain income bracket will have to make mandatory monthly payments towards healthcare in addition to carrying a higher tax burden.
Implications for medical aid schemes
Once the NHI is implemented, medical aid schemes will not be able to offer any services offered by the NHI and will only be able to provide for “complementary or top-up cover” which does not overlap with that which is provided for by the NHI. South Africans will be able to use their free NHI cover for healthcare needs and no co-payments will be charged.
The bill does provide for gap cover but the relevant section of the bill is greatly understood and interpreted as meaning medical aid schemes will cease to operate since current members will be obligated to make use of their NHI.
Arguments have been made that negating and destroying the role of medical aid schemes is counterproductive to universal healthcare as there simply are not enough resources to meet the needs of all South Africans and that limiting the right to choose to purchase health insurance is unprecedented, inappropriate and might even constitute a limitation of rights similar to making use of private education or private security.
The private sector, for now, will not be nationalised and as such private practices, pharmacies and hospitals will continue to be available and South Africans will be able to register with their preferred healthcare provider.
Dr Larisse Prinsen is a senior lecturer in the department of public law, University of the Free State.
TimesLIVE
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