The very mention of the term ‘National Health Insurance’ (NHI) is likely to invoke several emotions in the average South African. For those people who do not have access to reasonable health care, those emotions may be relief and happiness. To those who carry the highest tax burden, the emotions may be frustration, anger or even dread. What is not in dispute though is that the level of health care available to all South Africans has to improve. How that will happen is a contentious issue and the inevitable court challenges are likely to dominate the headlines for many years to come.
On Wednesday the 15th May 2024, the President signed the NHI Bill into law (the National Health Insurance Act), which will take effect on a date proclaimed by the President in the Government Gazette. This Act’s purpose is to create and preserve a national health insurance fund in the Republic with guaranteed free health care services for all South Africans, regardless of whether they seek treatment in private or public health facilities. The basis of the funding of this health care is yet to be determined and will no doubt stir up controversy.
The NHI scheme will provide health care services to South African citizens, permanent residents, refugees, inmates and certain categories of foreign nationals determined by the Minister of Home Affairs. Asylum seekers or illegal foreigners will only be entitled to emergency medical services and services for notifiable conditions of public health concern.
Even though the NHI has been signed into law this does not mean it is operational, so medical aid members should not cancel their memberships.
The plan is to roll out the NHI gradually over time, but no timeline is mentioned in the bill. Additionally, owing to the uncertainty, it is expected that there will be legal challenges which could drag on for a long time. In fact, it is likely that the NHI will be delayed for many years, possibly even decades.
Once the NHI is fully implemented and as per the current legislation, medical aids will not be allowed to cover services that the NHI pays for. In its current form, the bill does not explain what fully implemented means or which services the NHI will cover.
Ultimately in the future, the full implementation and operation of the National Health Insurance Act may have tax and medical health cover benefits implications for employees and employers alike.
South Africans are very concerned about the NHI, particularly those in the middle class and higher income groups who bear the greatest portion of the tax burden. They are worried about the impact this will have on their medical insurance, healthcare and the taxes they will have to pay to fund the government’s ambitious objectives.
One thing is certain – it is going to be an interesting ride!