'NHI will only be freely available in four years' - health minister

If you do not have medical aid, you will have to wait at least another four years before you can access a private healthcare facility, despite President Cyril Ramaphosa's official signing of the National Health Insurance Bill into law on Wednesday.

According to health minister Joe Phaahla, the signing paves the way for you to get healthcare services anywhere but the government is still in the first phase of implementation of the NHI Act.

This means that those with medical aid cannot discard them just yet and those without will continue getting services from public facilities.

"...That first phase [from 2023 to 2026] is to deal with the establishment of the institution [NHI Fund], accelerating strengthening of the health platform and all other basic instruments which we have not gone into a lot of detail. We have implemented various quality improvement programmes in all provinces. In terms of the various improvements which are being rolled out from primary health levels right up to specialised services," said Phaahla.

"From 2026 to 2028, in terms of the [NHI] Act, it commits us to more intensive conclusion of actual implementations programmes in terms of contracting of services in the public sector it is much more easier to accredit.

"We do acknowledge that even though the second phase will be focusing on actual implementation of the programmes, the purchasing of services will be built up even in the first phase."

The legislation has faced opposition from big business, medical aid schemes, healthcare professionals and some unions.

While Phaahla said the signing was significant, it does not immediately change the status quo but gives the department power to go to National Treasury to say it must allocate funds for the programme.

He urged those on medical schemes to keep them, adding that they would be told when they were no longer relevant.

Those opposed to it said it would damage the health system and overburden private healthcare facilities. 

There have been threats of litigation.

“The NHI is a commitment to eradicating the stark inequalities that have long determined who receives adequate health care and who suffers from neglect,” Ramaphosa said at a signing ceremony at the Union Buildings in Pretoria.

“The financial hurdles facing the NHI can be navigated with careful planning, strategic resource allocation and a steadfast commitment to achieving equity,” he said.

According to Phaahla, come 2028, if you don't have medical aid but are registered with the fund, you will get services wherever you/they are, no matter your financial status.

But in an emergency, it does not matter if you are registered or not – you can go to any facility.

According to the act, it is compulsory for users to access services at primary healthcare centres as the entry to the system.

Here is what you need to know about the NHI:

What does the NHI aim to achieve?

The NHI wants to ensure that all South Africans, irrespective of their socioeconomic status, are able to access quality healthcare. The fund aims to achieve sustainable and affordable universal access to quality healthcare services. But you will not just rock up at a private healthcare facility without a referral. You would first need to access the primary healthcare level such as a clinic or a GP. If a healthcare provider is unable to provide the necessary healthcare services, you will be referred to another healthcare service provider capable to render those services.

Who will the fund cover?

The fund will cover SA citizens, permanent residents, refugees, inmates and certain categories or individual foreigners. An asylum seeker or illegal foreigner will only be entitled to emergency medical services, and services for notifiable conditions of public health concern. However, all children including children of asylum seekers or illegal migrants will be entitled to basic healthcare services. In addition, a foreigner visiting the country for any purpose would have to have travel health insurance.

How much will it cost you?

It is free of charge at any point of care.

Who will fund the NHI?

The insurance will be largely funded through general tax revenue, so this means South Africans will contribute towards the fund. It states that the money will come from payroll tax, this is between employer and employee. In addition, there will be a rise in personal income tax. It will also include shifting funds from the provincial equitable share and conditional grants.

What happens to other medical schemes?

Once NHI has been fully implemented medical schemes may only offer complementary cover to services not offered by the fund. Medical aid schemes will be voluntary to those who wish to continue having them. This is because the NHI will purchase comprehensive personal health service benefits from contracted public and private health facilities. The cover includes hospital visits – inpatient and outpatient, rehabilitation and mental health services as well as emergency medical services. The government hopes medical aid will be significantly cheaper because they will only cover you for any additional benefits that the NHI does not pay for.  

How does it affect medical professionals?

The fund will pay public and private healthcare providers (nurses, doctors and hospitals) on the same basis and expect the same standard of care. This means that healthcare professionals will not set their own fees for the insurance-funded benefits but the government will decide the rate. Private healthcare providers will continue to operate privately and have an opportunity to be contracted with NHI to provide healthcare to everyone.

Who will be responsible for the fund? 

The fund will be run by a board which consists of 11 people. There would be a call for public nominations of candidates to serve on the board. The board will advise the minister about the management and administration of the insurance fund, including operational, financial and administrative policies and practices that the government believes would assist in detecting any incidents, including corruption.