There is uncertainty over how National Health Insurance (NHI) will affect doctors and patients.
President Cyril Ramaphosa signed the controversial bill into law on Wednesday May 15, just two weeks before the national election, despite concerns from health professionals and the threat of legal action by civic groups and political parties.
It has been slammed as unconstitutional, unaffordable, and impractical by the Western Cape government.
The new bill aims to provide comprehensive and free health-care services to all citizens, regardless of their location or socio-economic status, according to Health Minister Dr Joe Phaahla.
The legislation, according to the government, will gradually be phased in.
The new public fund – which will be managed by a board that has yet to be appointed – will set the fees that private doctors and health-care suppliers may charge for NHI benefits, and once fully implemented, medical schemes will not be able to provide cover for services that are paid for by NHI.
The Southern Mail asked some locals about their thoughts on the NHI, and it was evident that many felt they needed more information about it to give an informed response.
Health and Wellness MEC Professor Nomafrench Mbombo said it was the most significant change to South Africa’s health-care system since the promulgation of the National Health Act in 2003, adding that it was crucial that such legislation reflected all stakeholders’ inputs and created a system that was unified and strategically aligned.
“Unfortunately, this is not the case with the NHI in its current form. For us to truly achieve universal health coverage, we do believe that the current health system needs to be completely overhauled as we are currently trying to run an imperfect system perfectly.”
However, Adrian Gore, chief executive of Discovery Limited, has urged people not to cancel their medical aids as it would take at least a decade for NHI to be fully implemented.
Discovery supported change to improve the health-care system for all South Africans, but it would take a lot to make NHI workable, he said.
According to an analysis by Discovery, he said, raising R200 billion for NHI scheme would require a 31% increase in personal income tax, meaning each taxpayer would need to pay almost one-third more than their current tax payments, or a 6.5% increase in VAT, or a ten times increase in payroll tax, which would require a collection of around R1 072 per employee per month.
That could increase to around R1 565 per employee per month for those employed in the formal sector.
Even when the NHI was fully implemented, medical schemes could still provide cover for benefits not covered by it, he said, adding that it was unlikely the NHI would have the funding for a wide range of benefits.
“Our strong view is that limiting the role of medical schemes would be counter productive to the NHI because there are simply insufficient resources to meet the needs of all South Africans.”
Roscoe Palm, Secretary for the Retreat Health Committee, said the NHI won’t fix the health system and there is a lot of resistance to the bill.
“It’s not going to fix Retreat Day Hospital and other health facilities as these facilities have been neglected for a very long time,” said Mr Palm.
“The filing systems and record keeping outdated, there’s no budget for locum doctors and many other issues that the NHI just wont fix. The only solution is for the provincial and national government to allocate budgets for these specific facilities.
“The bill is a theoretical plan and we definitely hope it can come to fruition but we must be cautious because effectively there will be a big pot of money, billions of rands, that would be at the disposal of government and we hope it will be administered in the correct way so that people and their healthcare are the main objective and not tenders and corruption.”
A nurse, who declined to give her name because staff are not allowed to officially comment without authorisation, said she is unsure of what this would mean for them and the healthcare system as a whole.
“As with a lot of people I don’t know whether this will be a good or a bad thing because we don’t fully understand what all of it means. From the sounds of it, it will take pressure off of government facilities. It’s a good thing because we are overworked and understaffed at many public facilities,” she said.
“As far as how it will affect us currently on medical aid is a bit worrying because I believe we are going to be taxed for the NHI, which would put more pressure on taxpayers but we are already struggling.”
Southern Mail spoke to Liesl Jonkers, whose daughter is a patient at Retreat Community Health, about the NHI plan. Although she also admitted she doesn’t know much about the bill, she is on board with it, if it means more help for herself, children and others without medical aid.
“We can’t afford medical aid so we have to sit for hours at the day hospital to get helped or pay hundreds of rands to see private doctors. If this NHI plan means we can get the urgent medical help we need without having to sit at day hospitals from the morning till night then I am for it,” said Ms Jonkers.
Pensioner Maggie Fortune, believes the bill has the potential to help millions of people if it is done with the right intention.
“We all know with elections coming up the government want to sweet talk us but I hope this is not just that.
“Many people, including us pensioners, can’t afford medical aid and rely on public hospitals and if this is passed and done correctly it could be life-saving for many people because it would mean more services for us. I pray it becomes something we can be proud of as a country instead of another corruption scheme and election ploy,” she said.
Microbiologist Dr Gerry Norris said that before launching a scheme like the NHI in any country, the basic foundations of primary healthcare needed to be in place, including potable water for all, full access to electricity, affordable public transport and working sewage systems.
Many challenges lay ahead for the fund, especially in rural areas with sparse populations and poor infrastructure while its sustainability would depend on South Africa’s economic and political outlook, he said.
