WHAT IS THE PROPOSED NATIONAL HEALTH INSURANCE (NHI)

In terms of a Green Paper recently released by Government, the proposed National Health Insurance (NHI), is an insurance scheme run and administered by Government. It aims to ensure that all South Africans have access to quality health-care regardless of their socio-economic and financial status. It is proposed that it will work like a medical aid for all, the users will able to consult with private medical practitioners and hospitals that have an agreement with the NHI without paying. The service providers will then claim from the NHI. It is proposed the scheme will come into effect during April 2012 as a pilot project when it will be rolled out in 10 areas/districts  based on demographics and key health indicators.

It will be compulsory for all South Africans to contribute to the NHI. It will be up to an individual to continue to belong and contribute to a private medical aid as well, but there will be no tax subsidies for those who choose to do so. SARS will be responsible for collecting the revenue. Once the NHI Fund has been established, it will be responsible for using it to pay for the services provided by contracted service providers. The NHI will cost R125bn in 2012, increasing to R214bn in 2020 and R255bn in 2025. The current health budget is in the order of R101bn but does not include expenditure by the Correctional Services and the South African National Defence Force.The private sector spent R90bn in 2009. When all expenditure is added up it totals to R227bn spent on health services in South Africa.

In instances, where users require services not covered by the NHI, like cosmetic surgery, fancy dental and eye care or if they fail to adhere to the defined referral system , they will be required to make co-payment for the provided service. Non-insured individuals, like tourists, will be required to pay for services used in full.

District health offices are to be established to deal with contracted service providers accredited in terms of NHI by the office of health standards compliance. Accredited medical service providers will have a contractual obligation to treat patients without payment up front but will then claim from the NHI.

At this stage, it is evident that a great deal of investigation and planning still has to take place before the scheme can be successfully launched.

Pieter Rautenbach