The National Health Insurance (NHI) Bill, which was passed by the National Assembly of South Africa in June and signed into law by the president, is a step closer to realising the provision of universal access to health care to everyone in the country. It may, however, take years to complete, given how it first needs to be passed by the National Council of Provinces.
The provision of universal access to health care has long been envisioned by the South African Constitution, stating in section 27 that everyone has the right to have access to health care. This is also highlighted by the National Health Act of 2003.
The bill aims at ensuring that all South Africans have access to quality health-care services, and to provide for the establishment of a fund that will be utilised to pay for almost all medical treatments from accredited providers, with rates to be determined by the state. Private health insurers will thus only be able to pay for treatments, health products, and services that are not covered by the fund.
The current two-tier system of health-care provision has not sufficiently catered for good, quality health care for all.
Regardless, this bill has been contentious and has been fought against from its inception. This is seen in the fact that a mere two weeks before the passing thereof in the National Assembly, the South African Medical Association (Sama) rejected the bill in its current form. There have also been multiple court cases launched against the bill, and different voices have been raised against it.
Despite this, the bill will most probably become law in some shape or form at some point in time.
It is thus perhaps pertinent to examine that which it espouses: national health insurance; as this concept is a noble one at its core and indicative of a more equitable society’s achievement in context of health-care access.
For South Africans who do have medical aid, the NHI may be a shock to the system.
The NHI has some properties that include lower overall health-care costs by having the government determine and control the price of health care by decreasing administrative costs; finite determination of costs related to health-care procedures with no unexpected costs or depletion of medical aid benefits; potential improvements in health-care due to the higher standards being set for hospitals and clinics; and possible improvement in available services, general hygiene and safety practices in public hospitals.
The disadvantages of NHI include a blow to autonomy, as all South Africans will be forced to make use thereof, whether they want to or not; the healthy paying for the sick with an increased burden on taxpayers; unemployment potentially rising as those previously employed by medical aid schemes may be retrenched due to entire departments within these enterprises becoming redundant; medical practitioners seeking greener pastures and more financially lucrative employment overseas, leaving South Africa with a human resource deficit in context of health care.
) Dr Larisse Prinsen is a
senior lecturer in the Department of Public Law
at the University of the Free State (UFS).
