NHI stands for national health insurance, a health financing system that aims to provide universal health coverage.
The idea is to pool funds from general taxation and new, mandatory pre-payments from those who can afford them, and use the resources to buy health services from accredited public and private providers on behalf of the population.
The government says NHI will ensure that everyone has access to high-quality healthcare, regardless of their income or health status, and that it will reduce inequality and inefficiency in the health sector. It is based on social solidarity principles, with the rich and healthy subsidising the poor and the sick.
To access NHI services, every citizen and legal resident will have to register and obtain an NHI card, which will grant them free healthcare at accredited facilities.
How will it be implemented?
NHI is being implemented in phases over a 14-year period that started in 2012, and is already behind its original targets. The NHI Bill, which provides the legal framework for the plan, was passed by the National Assembly on June 13 2023. It still needs to be approved by the National Council of Provinces and signed by the president before it becomes law. The current target for full implementation set out in the bill is 2028, but the health department has indicated it may well take longer than that.
Why is it controversial?
NHI is controversial because it envisages systematically dismantling medical schemes, which provide cover to close to 9-million people and enable them to access private healthcare services.
Trust in the government is at an all-time low, and critics fear its plan to create a central NHI fund that will be the sole purchaser of healthcare services will result in wide-scale corruption. A series of state hospital scandals has eroded public confidence in the state’s capacity to provide healthcare.
SA has a high unemployment rate and a small tax base, which critics say means NHI is unaffordable. The government says pooling the resources of the public and private sector, removing duplication and improving efficiencies will save money and that that will enable it to provide better services to everyone.
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