Those with medical aid cover should not rush to cancel their membership as the implementation of the National Health Insurance (NHI) will take several years before it comes into effect, health minister Joe Phaahla said.
President Cyril Ramaphosa signed the controversial NHI bill at the Union Buildings on Wednesday in a ceremony attended by the country’s health MECs, the health ministry, the Council for Medical Schemes, the World Health Organization and other stakeholders.
The signing of the bill will indicate the phased-in project of ensuring all people receive universal healthcare, even private service, at the cost of the government.
While it is not yet clear how the NHI will work for those with medical aid cover, Phaahla said the medical schemes will still be around until the project is fully rolled out.
“This is a process. When that is ready, you will be informed. The chairperson of the Council for Medical Schemes will tell you when your medical scheme is no longer relevant. As it is now ... medical schemes are still there. She still has to regulate them. Even if the scope and responsibility changes, she will make the regulations,” said Phaahla.
The NHI plans to pay for medical health cover for all citizens, including those with medical aid, to receive universal and private health care with no-one expected to pay a cent as the fund will cover the bill.
In due course, the department of health will determine which health services will fall under the NHI, meaning medical aid schemes would not have to fund them.
“[For example], let’s say that all maternity is now covered by the NHI in terms of regulations, it means medical schemes don’t deduct from members for maternity cover as it is covered by the NHI when it comes to primary, secondary and even a caesarean-section.”
However, government will set the price for private healthcare services as there appears to be vast differences in the cost of similar health care across private facilities. He said hospitals will be told how much to charge their patients.
Phaahla explained the project will be rolled out in a phased approach, with the first phase being between 2023 and 2026 to establish the NHI institution and for quality improvement of the healthcare sector in all provinces.
“We will be consulting with the minister of finance to look at some further acceleration, and we have agreed that where we may not only rely on the normal fiscus, we will have to look at other kinds of measures in terms of the funding model.”
The second phase is expected to commence between 2026 and 2028 and will be used to intensively conclude the implementation of the programme.
“We do acknowledge that even if the second phase focuses on the actual implementation of the programme and purchasing services, this will be built up in the first phase.
“Keep your medical schemes. Everything will be transparent the day it reaches certain reduced coverage. Medical scheme councils and the ministry will announce when all basic services are covered, hopefully by 2028. Please don’t throw away your medical schemes and stop your [debit] order,” Phaahla said.
Profmed and the Board of Healthcare Funders (BHF) said the law would have no effect until certain processes are completed.
“When one looks at the complexity and vagueness regarding benefits and available funding (not provided for in the recent budgeted speeches) the NHI will remain a policy with very little pragmatic chance of implementation,” said Profmed CEO Craig Comrie.
“We don’t believe there will be any impact. However, as a scheme we are concerned at the uncertainty expressed by health professional groupings who do not want to work within a NHI environment and effectively become a government employee.”
Comrie urged medical aid users keen to join the scheme to not break their cover but rather take a wait-and-see approach “to see if anything material happens in this regard”.
On the wisdom of keeping medical aid cover above and beyond the NHI, he said section 33 of the bill provided for medical aid schemes to cover benefits, which he expects to remain plentiful for years to come.
If NHI covers the maternity benefit, you have to go to the providers of the service that NHI is contracted to. So if you live in the southern suburbs of Joburg and your doctor is in Park Lane and you want to use [that facility], they might say no, because in your area there's a local public hospital contracted to NHI and that's the one you have to go to.
— BHF's Dr Rajesh Patel
For state patients, “there is the reality that the protocols provided in the NHI bill indicate that your freedom to choose which provider and how to access health will be governed by the NHI and will probably include nurse-based care referral to more extensive care processes, similar to current public health service. This will result in a decline in service experience.”
The BHF's Dr Rajesh Patel echoed Comrie's sentiments, saying that the signing meant very little as government still needed to sort out issues such as resources and budget allocation before implementation.
Patel stressed the importance of correcting misconceptions making the rounds, especially on social media, on when the act will officially be in effect, saying that for those on medical aid, “the bottom line is the status quo continues and there's no change for the people on medical schemes, their benefits continue and the way things operate will continue because the complementary cover hasn't been signed into law.”
This cover would require a proclamation from Ramaphosa and only then would medical aid schemes only be able to offer what the NHI doesn't.
Among those that could be affected is maternity cover, which is now free along with childcare under the National Health Act except if you have medical aid cover.
“If NHI covers the maternity benefit, you have to go to the providers of the service that NHI is contracted to. So if you live in the southern suburbs of Joburg and your doctor is in Park Lane and you want to use [that facility], they might say no, because in your area there's a local public hospital contracted to NHI and that's the one you have to go to.
“In that scenario, you go to that local [facility] and have your service there, but in terms of government, remember they have a means test, you are on a medical aid still, even though it's complementary cover. [So because of the National Health Act], the public sector will charge you the full rate for delivering the maternal service to you. There's a risk ... this is specifically if they get the timing wrong, that you might be out of pocket for maternity care.”
Patel's message to medical scheme members and state patients echoed Comrie's. He urged scheme members not to rush to cancel their membership until all the issues are ironed out and urged patients to not believe the messaging making the rounds on accessing private health care.
“Those in the public sector, if they believe [what they were told] that once NHI comes in, they'll be able to go to a Netcare hospital, that's communicating the wrong message. You might be able to do that if that care hospital is close to you. They want to build that network [first].
