DA to announce its plan to stop NHI Bill from ‘collapsing SA’s health sector’

Health Minister Dr Zweli Mkhize on Thursday announced the NHI Bill was being handed to the National Assembly for debate.

It could already be made law by July next year and is looking to improve healthcare for more than 80% of the population who are not covered by medical aid and generally don’t have access to superior private healthcare services.

The bill has been published for the public to view. It runs to 88 pages. It aims “to improve the quality of life of all citizens and to free the potential of each person”.

If it gets adopted, the laws governing the health system in South Africa are due to be vastly changed, with the full implementation of the new universal healthcare system set to be completed by 2026. Medical aids as they currently exist will also probably disappear, or at the very least be vastly changed.

The project is set to be one of the most expensive ever undertaken in South Africa, and government intends to introduce a single national pricing regimen for health services and fund it by increasing personal income tax (it uses the term “mandatory prepayment”) and employer tax, among other measures. Medical scheme tax credits that are currently still being paid to medical aid members will now also go towards funding the NHI instead.

Government’s health fund will become the single purchaser of all healthcare services, to pool finances and strategically buy healthcare services, medicine and products from accredited service providers who will have to meet “high standards” in order to be reimbursed for their work.

Patients will in future also only be able to access specialist healthcare after accessing the primary healthcare system through a doctor or nurse.

The plan envisages huge centralisation of healthcare. Academic hospitals will be run by national government and not provincial health departments. All patient information will be kept on a single database, to be called the National Health Information System.

Emergency services will be paid “capped case-based fees”.

Healthcare professionals, particularly in hospitals, will have to keep to prescribed treatment protocols and guidelines as determined by the minister and the fund. They will only be able to prescribe medicine and health products from a government-approved list and all medical professionals will have to keep to a single national pricing regimen.

Asylum seekers and undocumented migrants (which government calls “illegal” people) will only be able to get treatment in emergency situations or if they have conditions “of public health concern”.

Medical aids appear to be largely dismissed by the proposed new law, with the plan apparently to limit their role to only being able to offer complementary cover for the kinds of health services not covered by the NHI Fund. In effect, this means they will only be a top-up service.

The NHI will be implemented over three phases. The first was for “health system strengthening activities”, which apparently already took place between 2012 and 2017.

We are now in the second phase, which ends in 2022. The third phase is meant to happen between 2022 and 2026, at which point the fund will effectively be the only entity that can buy healthcare services in South Africa.