What you need to know about National Health Insurance Bill being signed into law

The National Health Insurance (NHI) Bill is a proposed healthcare reform aimed at providing universal health coverage in South Africa. Picture: Pixabay

The National Health Insurance (NHI) Bill is a proposed healthcare reform aimed at providing universal health coverage in South Africa. Picture: Pixabay

Published May 15, 2024


THIS afternoon, President Cyril Ramaphosa is set to make a historic change to South Africa's healthcare system, just weeks ahead of the most anticipated elections since 1994.

South Africa’s current healthcare system is marked by massive disparity. Many agree that change is needed to improve the quality of life for millions.

Enter the National Health Insurance (NHI) – a vision for equal access to quality health care for all citizens. However, this ambitious goal faces significant hurdles for effective implementation.

What is the NHI Bill?

The National Health Insurance (NHI) Bill is a proposed healthcare reform aimed at providing universal health coverage in South Africa. It ensures that all citizens, regardless of their financial status, have access to quality healthcare services.

Who will fund the NHI?

Funding for the NHI will come from various sources, including general taxpayers, mandatory payroll deductions, and possibly additional revenue streams collected by the SA Revenue Service.

Essentially, it will be financed collectively by the population, aligning to provide healthcare services to all citizens.

What happens to my medical aid?

Once fully implemented, the NHI will cover services that are currently covered by medical aid schemes. This means that medical aid schemes will no longer cover those services.

However, the timing and extent of NHI implementation remain uncertain. For a while, medical schemes will likely continue to cover existing services.

While medical aid schemes won’t be banned, the NHI will reduce the number of services they offer.

What does this bill mean for a healthcare provider?

Under this new system, healthcare providers will need to deliver services to patients enrolled in the NHI programme, with the government setting the rates for reimbursement.

This change could alter how healthcare services are delivered, organised, and managed, which might affect workload, staffing and resource distribution in healthcare facilities.

Why is everyone worried?

A major worry among critics is that corruption under the NHI could greatly affect healthcare providers in South Africa.

Mismanaged resources and funds intended for improving healthcare facilities and buying supplies could be diverted, leading to shortages and lowering the quality of care.

Resource shortage in South Africa

South Africa already struggles with limited resources in the public healthcare sector, especially in rural areas where infrastructure is scarce. While the NHI aims to pool funds to improve access to quality care, this alone won’t automatically reduce disparities or promote equitable health care.

To achieve these goals, it’s important to use existing private sector infrastructure. Nationalising it could lead to the same challenges faced by the current public system.

@zethugqola #stitch with @Zethu Ramaphosa to sign the National Health Insurance Bill tomorrow. #tiktoknews #southafrica #cyrilramaphosa ♬ original sound - Zethu

The new NHI Fund will use these resources to buy healthcare services for everyone, drawing from both public and private sectors.

Though the bill aims to provide universal health care, it raises concerns about how resources will be allocated and the quality of care.

Supporters of the bill point out that the public health system currently has about R250 billion to serve 84% of the population.

In contrast, the private sector, supported by medical aid, has a similar budget but serves only 16% of the population. They argue that the private sector can take on more responsibility, especially since the public healthcare system is already overloaded.

The president has signed the bill into law, prompting many South Africans to share their thoughts on social media about what this change could mean for them.

Popular TikTok influencer and aspiring doctor Nonhlanhla Siwela shared her thoughts on the passing of the NHI Bill.

@ayoungpoetsmind How is it going to be regulated ? Why don’t they work on improving the current system first ? I have so many questions…. #nhi #bill #healthcare #satiktok🇿🇦 #tiktoksouthafrica #fyp #trending ♬ original sound - Nonhlanhla👩🏽‍⚕️🩺

“As a future doctor and as an informed citizen of this country, I do not agree at all with the NHI Bill that has been passed.

“Firstly, I do not understand how we are headed towards elections, yet the current ruling party is still able to enforce such revolutionary changes to our legislature that will quite literally dictate the future of our health care.

“Health care is so crucial to how a country functions because sick people can’t work. Nationalising health care has been implemented in many first-world countries and has failed miserably. How is it going to work in South Africa, a third-world country?

“No one is running away from the fact that our healthcare system is very unequal and it’s collapsing but the NHI Bill isn’t the magic wand it’s purported to be.

TikTok screenshot. Picture: June Hlongwane

Another user, June Hlongwane, had this to say: “I terribly oppose the view of the notion that the NHI Bill has anything to do with morality because it doesn’t.

“One, there is no free lunch in this country and, of course, the healthcare system is about money. But if we want to argue why that fact when it is in fact about saving lives.

“What do you then say to medical professionals who spend years and money studying in their respective fields?”

@Drogon Omen commented: “We don’t have enough tax-paying individuals in the country to fund the bill.”

@Tlotlo wrote: “Love the idea on paper, don't trust the ANC to implement it.”

@Kamohelo added: “I’m a junior Dr and to be honest I don’t know what this means for me and my career.”

Speech Therapist @Laperry wrote: “As I prepare to move to the UK because this is the smelliest rubbish to happen to the health sector”