New legislation could create universal, state-run healthcare system


Both bills been approved by Cabinet and will go some way to creating the enabling legislative framework to create this single system. But at least 12 more pieces of legislation will need to be amended to make these two bills legal.

A universal healthcare system may reduce the already small number of South Africans going overseas for health care. It may also reduce inbound medical tourism, as, for it to work, the private healthcare businesses will have to be part of it; which in turn will limit the spare capacity they have for medical tourists.

Under the Medical Aid Schemes Bill all public and private healthcare funds will be pooled into one fund run by the state. This fund will act like a state-run medical aid for everyone. The Government seeks a centralised database of everyone who is on medical aid, which will include all personal details and treatment. It is unclear how this will work however since the public healthcare system is still paper based. The bill also aims to regulate medical prices. There will also be no co-payments on fees.

The National Healthcare Insurance (NHI) Bill will give effect to the need for an inclusive, free, quality healthcare system run by the state.

While the NHI is to be phased in incrementally, the medical aid scheme will happen first, as there are many problems with the existing system.

16% of South Africans use private healthcare via medical aid schemes, which is expensive, while the rest use the public healthcare system, which has huge problems. Between 20-40% of the population uses private healthcare in total.

The aim is one system that ensures that everyone has access to good quality healthcare.

NHI is going to be mandatory for health services, and all South Africans will need to contribute to it via compulsory contributions from employers and employees. NHI is planned to begin in 2022 and be national by 2026.

The public health-care system in South Africa is battling doctor shortages, industrial turmoil and growing waiting lists. An NHI Fund will be established as a public entity and be a single public purchaser and financier of health services in the country, to ensure equitable and fair distribution. Healthcare services, medicines, health goods and health-related products from certified, accredited and contracted service providers will be financed by the fund.

The ultimate goal of NHI is to ensure that everyone has the same access and standard of healthcare, regardless of their income.



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