NHI – Reasons not to cancel your current medical health coverage

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Shaun Meintjes | Franchise Principal | Financial Adviser | Consult by Momentum | mail me |


With the National Health Insurance (NHI) Bill having been signed by the President, South Africans are more confused than ever before. While most have some level of understanding of what the NHI is, the vast majority are still not clear on what the bill entails.

What does it say? What happens next? And practically speaking, does this mean we should cancel our medical health cover?

The answer to the last question is a resounding ‘no’, but before we discuss the reasons why you should hold on tight to your cover, let’s discuss a bit of context.

The purpose of the NHI

South Africa has committed to implement universal health coverage for all, with the desired outcome being that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship. This is where the NHI comes in.

According to the Department of Health (DOH), the NHI is a fund from which the government will buy healthcare services for South Africans from providers, both across the public and private sectors.

The purpose of the NHI is to make healthcare more affordable, by reducing the cost of healthcare for all. It acts like a medical aid for everyone, and South Africans will contribute to this fund through taxes and special contributions in line with what they can afford. It will ensure that everyone is entitled to free healthcare when they need it.

There will be no fees charged at the health facility because the fund will cover the costs of care. This goal of equitable healthcare is extremely important and something we should work towards, but there are a couple of concerns with the NHI Bill in its current form.

According to Dr Larisse Prinsen, lecturer at the University of the Free State, once the NHI bill has been passed into law, medical health schemes will not be able to offer any services covered by the NHI and will only be able to provide for complementary or top-up cover that does not overlap with that which is already provided for by NHI.

A threat to private health insurers

Health professionals fear that the NHI will pose a threat to private health insurers, who are still not sure exactly which treatments, health products and services will continue to fall under them, and which will be covered by the NHI.

In its current form, the bill has also been rejected by the South African Medical Association, multiple court cases have been launched against it and different voices, mostly in the political sphere, have been raised, warning of its pitfalls. South Africans should not view the NHI as a quick-fix solution to the current state of the South African health sector.

If you can afford it, I would strongly caution against cancelling your current medical health cover any time soon, for the following reasons:

  • A worrying doctor-patient ratio

The current estimated ratio in the public health sector is one doctor to around 2,457 patients, while in the private health sector the estimated ratio is one doctor to 571 patients. With the introduction of NHI – and people rushing to cancel private medical health cover – these ratios might only worsen, as there remain insufficient resources to meet the needs of all South Africans. There’s a real risk of overburdening the system, leading to longer wait times, decreased attention to individual patients, and potentially a diminished quality of care.

  • Lack of clarity around what the NHI covers

Currently, there is no clear definition of services covered by the NHI, and it appears that this definition will only be expanded on an incremental benefit and geographic basis. Because so many important aspects are still unclear, the NHI will likely take many years to be established after the Bill has passed into law.

Those with specialised healthcare needs may find that their treatments or procedures are not adequately covered under the NHI, especially in its early stages. This could result in individuals having to seek out-of-pocket payments or forgo necessary medical interventions, potentially worsening their health outcomes.

  • Administrative complexity

The transition period from private medical schemes to the NHI may introduce administrative complexities and uncertainties. Members may face challenges in accessing the same level of care they were accustomed to under their private medical schemes, especially during the initial stages of implementation.

  • A possible slowdown in innovation

The potential impact on healthcare innovation and medical technology advancement is a significant concern. Private medical schemes often drive innovation by investing in cutting-edge treatments and technologies. With a shift towards a single-payer system like the NHI, there may be less incentive for innovation, ultimately limiting access to the latest medical advancements for South Africans.

In conclusion

There is still a great deal of uncertainty around the NHI’s roll-out, and this ambiguity is expected to persist for the near future. I would advise holding onto your cover while any teething pains are addressed over the coming months or possibly years, ensuring that you have access to quality healthcare when you need it.


 



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