President Cyril Ramaphosa has signed into law the National Health Insurance (NHI) Bill which directs the transformation of the South Africa’s health care system to achieve universal healthcare coverage for ALL. Many employed South Africans contribute towards medical aid subscriptions for years. However, when they become unemployed, they no longer can afford the medical aid subscriptions and must use the public healthcare, the writer says. – Picture: Kopano Tlape / GCIS / May 15, 2024
By Zelna Jansen
In my younger years, I spent many hours at was then known as the “day hospital” to obtain healthcare. Later, as a professional, a good salary allowed me to experience the luxury of medical aid. I call it a “luxury” because the majority do not have access to it.
However, since the Covid-19 National Lockdown, my business crashed. This left me without an income and inevitably without the luxury of a medical aid. Things picked up again and I was able to afford medical aid again. However, illness struck, and my medical aid told me that I must wait a year to access the funds needed to help me heal and recover from my illness.
Understandably, I was furious at the private medical aid companies. I had paid medical aid subscriptions for all those years, and now that I desperately needed the medical aid cover, it was not available to me. I therefore had no choice but to resort to the public healthcare system for assistance.
But this is not an isolated thing that only occurred to me. Many employed South Africans contribute towards medical aid subscriptions for years. However, when they become unemployed, they no longer can afford the medical aid subscriptions and must use the public healthcare.
I am aware of many people who pay medical aid premiums for years while working and when they retire, can no longer afford it. They also then make use of the public healthcare facilities.
Having been on private medical aid for many years, using the public healthcare facility took some adjustment on my side. The waiting times are unbearably long. I have had to endure many fights with the nursing staff. I now have a more cordial relationship with the nursing staff. Going forward, as the healthcare regime is restructured, more focus should be added to the nursing staff. Particularly, oversight in terms of how they engage patients.
I must point out that I was impressed with the medical practitioners and the expert advice they gave. In the end, I received my treatment, and I am well on my way to recovery.
My experience leads me to therefore conclude that the two-tier healthcare regime is not sustainable for South Africa.
I am, along with many other South Africans, elated that President Cyril Ramaphosa signed the National Health Insurance (NHI) Bill, 2019 into law today. The Bill, now Act, seeks to provide for the universal access to healthcare services in the Republic in accordance with the National Health Insurance White Paper and the Constitution of South Africa, 1996. This will be implemented through the establishment of a National Health Insurance (NHI) Fund. The NHI Act also sets out the powers, functions, and governance structures of the NHI Fund.
The NHI Fund will be funded through a mandatory pre-payment system and other forms of taxes collected by SARS and allocated to the Fund by Parliament.
The NHI Fund will thus purchase services on behalf of all South Africans. All users will be able to access healthcare services without paying anything at the point of care, regardless of their socioeconomic status.
Medical aid companies have emphasized that the NHI Fund will force South African taxpayers to pay much higher taxes but cut their healthcare entitlement by 72% and that this is likely to cause a tax revolt. It was also pointed out that South Africa has a very small tax base that funds nearly all government expenditures.
It is not clear how a tax revolt will take place in South Africa as the tax deduction towards the NHI Fund will be made at payroll. There have been concerns raised that employed people will deliberately stop working. Other statements are that there are people who will abuse the system. It is not unlikely for this to happen.
It should be noted that in terms of the 2019 National Health Insurance Bill, private medical aids will only be allowed to provide complementary healthcare services not provided for by the NHI. This is likely to be implemented through regulations later.
Another argument put forward against the NHI Fund, is that it will lead to an exodus of medical practitioners, seeking better and greener pastures and more financially lucrative employment overseas. The reason for this argument is that the NHI Fund will assign primary healthcare practitioners a designated population that will be under their care and will be paid on a capitation basis. The medical practitioner will not be able to determine his or her own fee or cost. This is a serious concern, which the NHI Fund Stakeholder Advisory Committee should handle expeditiously.
Daily the media highlights corruption in government and government organizations which makes it a real threat and concern to South Africans. The NHI Fund is going to be a huge organization and there would need to be governance structures to fortress the Fund against corruption. The NHI Act makes provision for this. South Africa does have the necessary government bodies in place to act against corruption.
As with any government institution, the NHI Fund must table its annual reports, financials, etc., to Parliament. These reports and documents are discussed in committee meetings, which are open to the public. One can be assured without a doubt that the media will continue to play the role of watchdog. Monitoring what is happening and keeping us informed.
South Africa is a deeply divided society. Many who live below the poverty line and do not have access to healthcare, applaud the signing of the NHI Act into law. Our duty now as South African citizens is to vote on May 29, 2024, for political representatives who we believe will help implement the NHI Fund and ensure that this happens without corruption.
Zelna Jansen is a lawyer and CEO of Zelna Jansen Consultancy
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