What is National Health Insurance?
National health insurance (NHI), sometimes called statutory health insurance (SHI), is a system of health insurance that insures a national population against the costs of health care. It may be administered by the public sector, the private sector, or a combination of both.
National Health Insurance In South Africa
South Africa is facing numerous challenges when it comes to healthcare costs and services.
The country spends huge amounts of money for health care on very few people. Many health care professionals only serve a few people who have money and the rest of the public is serviced by very few professionals.
Access to health is a right according to our Constitution. National Development Plan also
indicates that the country should deal with expensive cost of private health care and also
address the problems of quality of public health care.
10 REASONS WHY NHI IS GOOD FOR THE SOUTH AFRICAN COUNTRY
Our country believes that access to healthcare is a human right. This means every single one of us
is entitled to receive healthcare. It should not depend on how rich we are or where we happen to
live. The right to obtain healthcare is written into our Constitution.
Our government health budget keeps on increasing and our network of public hospitals and
clinics have grown but still, there are communities in rural areas that cannot easily obtain care.
Many residents in our major cities rely on overcrowded public health facilities with very few
health professionals and poor equipment.
The amount spent on the health care for each person with a medical aid scheme is five times
the amount that is spent on each person who relies entirely on public health facilities.
The standard of health care gap between the rich and poor continues widening, which is against
the equality policy the country is driving in other sectors.
While eight out of 10 patients use public clinics and hospitals the bulk of the country’s doctors,
dentists and specialists work in the private healthcare sector serving a small section of the
population living the biggest population in public hospital is unattended.
The two-tier system of paying for healthcare has failed to guarantee good quality healthcare
for all. Government pays for the health facilities that assist the poor and it also provide tax
subsidies for medical scheme contributions used by the wealthier families, who use private
doctors and hospitals. This system has locked out the poor who cannot afford a large number
of health professionals and facilities in the private sector.
Every citizen deserves better value from our healthcare spending. Even for South Africans who
earn a good income, healthcare has become a burden because private medical costs have
skyrocketed in recent years. Working people are spending a large chunk of their salaries on
medical aid and this often causes financial constraints in their household income.
NHI will reduce the cost of private healthcare. It will still provide a good income for health
professionals and health institutions in the private sector, but will use a more cost- effective
method of payment than that currently used by medical aid schemes.
The quality of care in public hospital is continuously deteriorating in the areas of staff attitudes,
waiting times, cleanliness, drug stocks out, infection control and safety and security of staff
and patients. This may also be largely attributed to the high burden of disease and increased
patient loads without increased staff.
Increased out of pocket payments are draining the disposable income of many South Africans,
patients are exposed to three forms of out of pocket payments namely:
a) Every time a patient has to pay cash when they seek healthcare whether
in the public or private sector;
b) Additional payments (co-payments or levies) for those on medical scheme
but whose benefits option does not cover all the costs; and
c) Cash payment for those on medical schemes whose benefits are
prematurely exhausted before the end of the year.
Examples of what the NHI package will exclude:: » Cosmetic surgery that is not necessary or medically indicated but done as a matter of
choice
» Expensive dental procedures performed for aesthetic purposes and eye-care devices
such as fashionable spectacle frames
» Medicines not included in the national essential drug list
» Diagnostic procedures outside the approved guidelines and protocols as advised by
experts groups
The NHI benefits provided will cover preventive, promotive, curative and rehabilitative
healthcare services. The emphasis will be on preventing disease and promoting
health. NHI is a fund that pays for health care for everyone in South Africa.
CAN SOUTH AFRICA AFFORD NHI?
South Africa already spends a very high amount on healthcare. If we add private
and government spending together this amounts to more than R200 billion a
year. A large slice of this is spent on private care for only 16% of the population.
Private care at present is often needlessly expensive.
NHI Fund will be able to count on:
» All the present government funding for public healthcare
» All the money government spends on tax subsidies for medical scheme members
» Contributions from people who are presently members of medical schemes
» Contributions from those who earn well but have avoided joining medical schemes
The NHI Fund income will amount to at least as much as present healthcare
spending. But it is possible that government will be required to further boost
this amount.
The NHI Fund will have strong buying power which will enable it to purchase
health services at a reasonable rate:
» The rate at which the NHI Fund will pay healthcare providers will be higher than the
present cost of public health services but lower than the most rates in the private sector.
» The NHI Fund’s method of payment will encourage healthcare providers to operate
efficiently and provide effective care.
» The NHI Fund will be a non-profit body and will keep administrative costs low.
Can National Health Insurance work in South Africa?
NHI will be for all South Africans in keeping with the fact that health is a right in the Constitution and hence cannot be for a selected few.
In NHI your socio-economic status will not matter but your health needs will determine what form of service you get.
How does National Health Insurance work?
The national health insurance model uses public insurance to pay for private-practice care. Every citizen pays into the national insurance plan. Administrative costs are lower because there is one insurance company. The government also has a lot of leverage to force medical costs down.
Why is NHI good for South Africa?
The NHI benefits provided will cover preventive, promotive, curative and rehabilitative healthcare services. The emphasis will be on preventing disease and promoting health. NHI is a fund that pays for health care for everyone in South Africa.
What are the benefits of national health insurance?
Health insurance protects you from unexpected, high medical costs. You pay less for covered in-network health care, even before you meet your deductible.
You get free preventive care, like vaccines, screenings, and some check-ups, even before you meet your deductible.
How will NHI be funded in South Africa?
Section 49 of the bill states that the NHI will be funded from the reallocation of medical scheme tax credits, general tax revenue, payroll tax and a surcharge on personal income tax.