Jacqui Nel of Aon South Africa looks at some of the issues surrounding the implementation of the NHI Bill.

On 12 June 2023, Parliament passed the National Health Insurance (NHI) Bill, and many stakeholders in the healthcare industry are concerned as to what the implications are.

The reality is that there is a long and challenging process ahead, and the NHI Bill has many years to go before all of its provisions could be implemented.

Jacqui Nel, business unit head of healthcare at Aon South Africa, highlights the salient points that are at the heart of the matter.

“First and foremost, I would like to affirm that the private healthcare sector needs to focus all its efforts on objectively collaborating with all parties concerned to achieve a stronger and affordable healthcare solution for all South Africans,” says Nel.

“The concept and ideals of providing universal health coverage should not be in dispute. The overarching principle of the NHI bill is to provide universal health coverage and social solidarity, providing all South African citizens with access to the same essential healthcare benefits, regardless of their financial means,” she adds.

However, the road to successfully implementing NHI is a long and costly one, with many experts saying it could take up to 15 years to achieve, if not more.

Purely from a legislative point of view, there are at least 10 pieces of legislation that will need to be amended to align with NHI objectives. These include:

• National Health Act
• Mental Health Care Act
• Occupational Diseases in Mines and Works Act
• Health Professions Act
• Traditional Health Practitioners Act
• Allied Health Professions Act
• Dental Technicians Act
• Medical Schemes Act
• Medicines and Related Substances Act
• Nursing Act

There are also various provincial health acts that would need to be amended. As we all know, amending legislation is an onerous process.

The first of many court cases are already making headlines. On the constitutional front, one of the pieces of legislation requiring amendment is the National Health Act, which governs the ‘Certificate-of-Need’ (CoN), a piece of legislation that would dictate to private-sector doctors where they are permitted to practice and what services they may provide.

“This ‘CoN’ is essential to government to control doctors under the NHI plans and is being challenged by trade union Solidarity and six other parties,” says Nel.

About the NHI Bill

The NHI Bill lays out the duties and functions of the NHI Fund, which are primarily to strategically purchase healthcare services based on the principles of social solidarity.

All permanent residents and citizens of South Africa will be eligible as beneficiaries of the NHI Fund. Temporary residents and foreigners will have access to emergency medical treatment and access to other health services as determined through a mandatory travel insurance.

“The Bill states that eligible beneficiaries will be able to access health services through registering as a user of the NHI Fund. Each member will have a number that is unique to them and their dependents. The Fund will then reimburse healthcare providers directly for services rendered, provided they have met the accreditation requirements.

“It is envisaged that comprehensive health services benefits must be made available and these services will be determined by the Benefits Advisory Committee,” explains Nel.

The Bill also refers to the establishment of the Board of the Fund, and the remuneration and reimbursement of the members of the Board which will be determined by the Minister of Health in consultation with the Minister of Finance.

“There are various other functions of the Fund for which further administrative departments will need to be set up to address planning, benefits design, price determination, accreditation, purchasing and contracting, payments, procurements, performance monitoring, and a risk and fraud prevention unit,” says Nel.

However, there are major points of concern that remain and will need to be addressed to facilitate the implementation of the NHI scheme. These include:

• Ministerial powers, good governance and accountability
• Role of the different spheres of government
• Role of medical schemes
• Tax implications for taxpayers, both from an employee and employer perspective
• NHI funding models
• Health financing expertise
• Training of healthcare providers – consequence management
• Service delivery at state facilities and healthcare facilities
• Infringement on the right of choice
• Lack of detail around major parts of the NHI Bill.

How will NHI be funded?

In summary, this Bill is the roadmap to NHI, but many other pieces of legislation will have to be amended. Furthermore, a crucial element is currently still missing: the cost of NHI and what the basket of services will include.

“An appropriation bill from National Treasury will be needed to detail how NHI is going to be funded. However, detail on this has been slim, while government’s finances are heavily constrained and look likely to worsen in the future with various global and local factors coming into play,” says Nel.

“We fully expect that there are going to be significant challenges to the many technical and restrictive provisions contained within the NHI Bill, and these challenges may well alter its entire substance. There is also the prospect of political shifts that could have a material impact on health policy going forward.  We simply do not see any material shifts to the private healthcare sector anytime soon,” Nel explains.

What is certain is that the Bill in its current shape and format is unlikely to remain as it is today.

“While the NHI Bill raises serious concerns, there is no disputing the need for structural change. There will be much debate and negotiation in the years ahead in unpacking the strengths and weaknesses of current public and private healthcare systems, and we look forward to a rational and workable solution to the achievement of better healthcare and to assist in a workable solution for all South Africans,” Nel concludes.

This post was based on a press released issued on behalf of Aon South Africa.