The NHI bill becomes an Act.

President Cyril Ramaphosa signed the NHI Bill into law on 15 May 2024, making the Bill an Act. In theory, it is somewhat of a milestone in the progress of the National Health Insurance; however, practically, several challenges remain before South Africa reaches a point of quality healthcare access for all.

The President stated, ‘At its essence, the NHI is a commitment to eradicate the stark inequalities that have long determined who receives adequate healthcare and who suffers from neglect.’

There has been uproar, as stakeholders in the healthcare industry are alarmed that the President, despite extensive public engagement, signed the NHI bill into law without significant change.

What does this mean for medical schemes and members?

The short version is that your benefits will not be impacted for a while and will continue in their current form.

Of particular importance is Section 33 of the Act, which sets out that once NHI is fully implemented, medical schemes will only be able to offer services that are not covered by NHI. Many industry experts believe that the version of a ‘fully implemented’ NHI is at least a decade away, with the government estimating ten to fifteen years as a likely timeline.

One consistent comment is that NHI will be implemented in stages. So, for now, and in the near future medical schemes will continue to operate in the manner which we are familiar with, perhaps with the introduction of Low-Cost Benefit Options (LCBOs).

What’s next?

The comments from President Ramaphosa’s speech at the signing of the NHI Bill speak to a more harmonised journey toward universal coverage:

“NHI recognises the respective strengths and capabilities of the public and private health care systems. It aims to ensure that they complement and reinforce each other. Through more effective collaboration between the public and private sectors, we can ensure that the whole is greater than the sum of its parts.”

In contrast, while medical schemes continue to lobby for a collaborative approach to universal health coverage, the Act in its current form alludes to affecting the continuity of medical schemes once NHI is ‘fully implemented’.

The Act in its current form will likely be faced with many legal challenges, further compounded by the legal reforms required to align existing legislation with the NHI framework. Critical areas such as funding mechanisms, human resource reallocation, infrastructure, and implementation processes require clarity.

In essence, the signing into law of the NHI Bill can be viewed as a commitment to universal healthcare coverage rather than implementation being an overnight event. We will continue to update you on the progress of the development of NHI.