THE PROPOSED NHI IN A NUTSHELL

The long awaited green paper on the proposed National Health Insurance scheme was recently gazetted. The purpose of the green paper is to outline the broad policy proposals and to call for public comment and engagement for a period of 2 months. After this a white paper will be prepared and draft legislation put forward for further comment before placement before parliament for consideration and approval.

Basic Outline

The model will ensure that all SA citizens and legal residents have access to essential healthcare.

This right is not dependent upon whether or not beneficiaries are able to contribute to the NHI fund.

This will be achieved by the regulation of private healthcare pricing and improvement to the public healthcare system.

The overall emphasis will be on primary healthcare systems with a strong emphasis on health promotion and preventative care.

These services will be delivered via a District Health System incorporating Municipal clinics, schools and accredited private healthcare facilities.

The Cost

The NHI model will be introduced over a 14 year period, the initial cost being estimated at 130 billion Rand increasing to 215 billion by 2020 and 225 billion by 2025. This should be viewed in the context of SA's total healthcare expenditure (including medical aid contributions) of 92 billion in 2010.

The NHI plan assumes that increased expenditure will be partially offset by a decline in contributions to private medical aid schemes as all SA residents will be entitled to NHI services.

The green paper is vague regarding the funding of the scheme and clarity in this regard is expected in about 6 months time.

Membership

Membership is compulsory for all SA residents. Voluntary membership of private medical aid schemes is permitted but the obligation to make contributions to the NHI fund will nevertheless remain.

Implementation

Pilot schemes in 10 districts will be introduced and the results audited. Thereafter additional districts will be added to the scheme. The pilot phase will last for 5 years during which the public healthcare system is to be strengthened and the NHI fund established.

Author: Bruce Lyle