Government to take control of healthcare under NHI: this is how

08 August 2019 - 07:00 By katharine child
Health minister Zweli Mkhize is a driving force behind the NHI Bill.
Health minister Zweli Mkhize is a driving force behind the NHI Bill.
Image: Simphiwe Nkwali/Sowetan

The government is taking control of healthcare under the National Health Insurance (NHI).

TimesLIVE has seen a copy of the NHI Bill, which has been approved by cabinet and will be released on Thursday to the public. After the public release, it will then be tabled and debated in parliament.

The bill is quite different from the draft bill that was released for public comment in 2018.

But, similarly, it states that NHI will be in charge of one single National Health Insurance Fund to buy all healthcare from nurses, doctor's rooms, hospitals, dentists, therapists, clinics and specialists.

The NHI Fund will be primarily paid for from taxes, including an increased income tax and a mandatory "payroll" tax paid by employers.

The fund's purpose is to pool all the resources in country to ensure that government can buy all health services from accredited suppliers, health workers and hospitals.

The NHI also wants to take control of academic hospitals, also known as central hospitals, wresting them back from provincial control.

This will put Groote Schuur in Cape Town and Tygerberg Hospital, near Stellenbosch University, under national government control - but the aim is that each central hospital must be semi-autonomous.

Apart from these two Western Cape-based hospitals, there are eight other central hospitals in SA. These are:

  • Charlotte Maxeke Academic Hospital, Steve Biko Academic Hospital, Dr George Mukhari Academic Hospital, and Chris Hani Baragwanath Hospital in Gauteng;
  • Universitas Hospital in the Free State;
  • King Edward VIII Hospital and Inkosi Albert Luthuli Hospital in KZN; and
  • Nelson Mandela Academic Hospital in the Eastern Cape.

When NHI is fully implemented by 2026, medical aids will only be allowed as top-up cover to pay for services not allowed by the state - meaning government is the main buyer of health services.

The government also wants to set prices for healthcare, with a committee and the health minister in charge.

The fund will also work with a national IT system or database that records everyone's contact details, fingerprints and residential addresses, along with ID numbers and, of course, medical records.

Many layers of bureaucracy are being added to the system to implement NHI.

There will be various teams, committees and units formed, including:

  • A health pricing committee, with the minister determining a "national pricing regimen" to ensure doctors and health establishments and health workers charge certain rates. Non-adherence means the fund won't work with them;
  • A ministerial advisory committee on healthcare benefits, while will advise what benefits will be covered by the NHI. Medical aids will be prohibited from covering those benefits. This committee will become a benefits advisory committee;
  • A ministerial advisory committee on technology assessments will be established to advise the minister on what technology and equipment should be bought, what is efficient, productive and cost effective;
  • A "Contracting Unit for Primary Care" will be formed to decide which clinics and hospitals provide basic or primary (basic and preventative) healthcare to the NHI Fund;
  • The already-established Office of Health Standards Compliance will be required to accredit every single hospital, doctors and other health workers every five years to ensure they meet quality health standards; and
  • An Office of Health Procurement will be established to buy health products, decide which must be procured, and develop a national list and help with buying high-cost technical items.

The NHI Fund itself will be run by a Chief Executive Officer and a board.


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