South Africa’s National Health Insurance Scheme
In 2015 the infant mortality under-five rate in the Republic of South Africa was 40.5 for every 1000 births, a 6.5 decrease from 2011. While infant mortality has decreased in recent years, the Government of the South Africa continues to take important steps to provide access to health care for all citizens. In 2011 it introduced the National Health Insurance (NHI) pilot scheme designed to provide all citizens and residents of South Africa with essential health care regardless of employment status or ability to contribute to the scheme.
The NHI will remain in pilot phase for the first 14 years of implementation with the first five years focused on building processes and preparations for increased usage. After 2014 the NHI will be established as an autonomous public entity reporting to Parliament as well as the Ministry of Health, which manages 4,200 pubic health facilities in the Country.
The NHI is designed to increase access to both public and private health care facilities through the scheme’s agreements with public and private hospitals and specialists. As part of the package, NHI entitles free access to full health care coverage at public clinics for all citizens and legal residents. NHI is funded through tax revenues and mandatory contributions from those with income over USD 5,450 per year.
NHI is currently in pilot phase in 11 sites covering 11 million people, or about 2 per cent of the total population. The NHI’s universal coverage excludes short-term residents, but includes refugees and asylum seekers in accordance with provisions of the Refugees Act of 1998, which entitles refugees to the same basic health services and education as citizens.
The Government of the Republic of South Africa has made achievements in promoting equal access to health care since 1994. The NHI represents a continuation of this progress. The NHI has been realised through a consultative process including health care administrators and professionals, academia and civil society, and through international dialogue among countries moving toward health insurance schemes such as the NHI. Health insurance schemes such as the NHI represents a significant move toward universal coverage, creating part of a national social protection floor that is essential in promoting equality in social services.
Why Only Then Is NHI Now Starting?
The process began in August 2011 when the Green Paper on NHI was introduced and South Africa is roughly in the middle of it. Last year, then minister of health Aaron Motsoaledi said the transition was expected to take about 15 years in three phases. Phase 2 began in 2017 and is expected to end in 2022. In theory, the system should finally be ready by 2026.
What Are The Three Phases Of The NHI Implementation
The first phase, from 2012 to 2017, focused on piloting health system strengthening (HSS) initiatives; the establishment of the NHI Fund and key institutions; and the moving of central hospitals to the national sphere.
Phase 2 of NHI, from 2017 to 2022, will be focused on ensuring the NHI Fund is fully functional and has the required management and governance structures so that the purchase of services and population registration can begin. This involves passing the NHI Bill, which was introduced last week, and making amendments to several pieces of legislation.
Phase 3 of NHI, from 2022 through 2026, will signal the introduction of mandatory prepayment and the contracting of accredited private hospital and specialist services as well as the finalisation of the Medical Schemes Amendment Act.
What Needs To Happen Between Now And 2026?
First off, the bill will have to go through the normal parliamentary process, which will include a public participation phase, which might inform some changes to the bill, before it is put before the National Assembly for a vote. If the National Assembly passes it, it will be referred to the National Council of Provinces (NCOP), for a similar process. If the NCOP passes it, it will be referred to the president who must sign it to enact it.
According to the department of health, they will busy themselves with the following in the meantime:
The department will begin preparing for implementation by continuing to register patients into a master patient register to prepare for the implementation of NHI.
The Ministry of Health will set up an NHI Implementation Office to prepare for the introduction of the NHI Fund.
The Presidential Health Summit Compact, signed by the president and stakeholders, will be incrementally implemented. Some of the key interventions include the filling of vacant posts for health personnel, improving and maintaining hospital and clinic infrastructure, improving access to medicines, equipment and medical products.
The Office of Health Standards Compliance will certify health facilities that will become part of NHI.
The National Quality Improvement Plan will be implemented in preparation for the accreditation of providers and establishments to provide NHI services.
