Genesis’ view on the National Health Insurance (NHI) Bill


With the signing of the highly contested and controversial National Health Insurance (NHI) Bill into law on 15 May 2024, widespread and significant debate and controversy were sparked. Consequently, members of medical schemes in South Africa may be very concerned about the continuation of their membership and their access to private healthcare.

We would therefore like to take this opportunity to provide our members with more insight into the status quo on the signing of the Bill and the impact it may have on their medical scheme membership over the next few years, or perhaps even decades.

History and objectives of the NHI

The current NHI reform has its origins in the ANC Health Plan of 1994 which included the introduction of a mandatory insurance system.

The Bill contemplates the establishment of a South African NHI system with the aim of “pooling public revenue in order to actively and strategically purchase healthcare services” and creating a single framework for the public funding and purchasing of healthcare services. The NHI Fund aims to establish and maintain a NHI Fund that will serve as the single purchaser and single provider of healthcare services.

The NHI scheme is based on the principles of social solidarity where the rich and healthy will subsidise the poor and sick and where healthcare services will be provided free at the point of delivery, regardless of a patient’s socio-economic status. No private healthcare services such as medical schemes may exist once the NHI has been fully implemented.

Our government is however yet to identify what services the NHI will offer and how exactly it will be funded, except to say it will be through taxes and redirecting tax incentives like medial aid credits.

When will the NHI be fully implemented?

The status quo in the healthcare sector will remain unchanged for a long time to come still, as none of the mechanisms needed to implement the NHI have been formulated as yet.

Our government will have to establish the financial and governance structures for the NHI fund, accredit healthcare service providers and register beneficiaries before it can start providing free services to patients under the scheme. It is widely anticipated that this can potentially be a very long and drawn-out process, as sections of the National Health Act, signed 20 years ago, are yet to be promulgated. Several other laws will also need to be amended, passed, and signed.

Current shortcomings of the NHI Bill

Whilst the majority of South Africans no doubt agree that healthcare is a fundamental human right, the majority of interest groups have grave concerns, and will vehemently oppose, the NHI Bill in its current form. While the intention behind the Bill is to transform our healthcare system and ensure universal coverage for health services is commendable, the vaguely outlined implementation strategy lacks the necessary depth and practicality required to achieve meaningful and sustainable change – at least at this stage. The Bill has also been criticised for not being practical as it rules out private sector collaboration.

The Bill currently promotes a fundamental re-organisation of all healthcare services in SA, potentially placing the entire healthcare system at risk. It is also highly unlikely that private practicing doctors, specialists and other healthcare service providers, including private hospitals, will agree to work for the state at a tariff set by the state.

And lastly, the funding mechanism is criticised as being fundamentally flawed with its heavy reliance on general tax revenue, payroll tax and surcharges on personal income given our country’s high unemployment rate, slow economic growth and shrinking tax base.

Industry opinion

The South African Medical Association (SAMA) has indicated that they will fight for the protection of our healthcare services in relevant courts. As representatives of the medical profession in SA, SAMA remains committed to engaging constructively with government stakeholders to develop a comprehensive and effective healthcare policy that prioritises the needs of patients and healthcare providers alike. They have called upon the President and the relevant authorities to reconsider the NHI Bill in consultation with healthcare professionals and experts to ensure that it aligns with the principles of universality, equity and sustainability.

SAMA furthermore called parts of the Bill “immature”, saying the biggest issue was the certificate of need, which was the backbone of the document. According to the certificate of need, the government will determine where services can be approved to be delivered. This means that doctors will be dictated as to where they can work, which in turn infringes on their rights as doctors.

Various other stakeholders have also criticised and rejected the signing of the Bill and have indicated that they will oppose and litigate the Bill all the way to the Constitutional Court.

According to SA Health Professionals Collaboration (SAHPC) the Bill would have a devastating impact on the country’s ability to deliver quality healthcare. It has been rushed through the legislative process without substantive engagement with healthcare professionals, or due consideration of any of the submissions regarding the standard of healthcare, vulnerability to corruption, limited availability of healthcare services, treatment guidelines, and fund administration made. SAHPC is further of the opinion that the Bill in its current format will worsen health, infringe on people’s rights to quality healthcare access and will drive a lot of healthcare specialists out of the country and in certain instances, out of medicine.

Private doctors recently interviewed by News24 said they were would vehemently oppose and reject the Bill, with many threatening to leave the country or the medical profession altogether. The establishment of free universal healthcare for all citizens would see doctors, nurses, hospitals and all health professionals being paid directly by the state at a rate set by the government. Many of them have stated they refuse to work for the government. Without doctors, we have no healthcare system in our country.

What are the next steps?

The Bill provides that different sectors of the Act will come into force over time, as and when certain milestones have been achieved. None of the provisions of the Bill are however operative as yet. The first sections of the Act, which will most likely become operative, are those relating to the creation of benefit committees who will determine the available benefits under the fund. Whilst medical scheme members may be concerned about the continuity of their cover in its current form, it is expected that medical scheme cover and benefits will not be affected for a long time (possibly decades, if ever) to come. Even Health Minister Joe Phaahla cautioned members of medical schemes not to cancel their membership, as the services to be provided under the NHI “were many years away from being available”.

Future of medical schemes

Section 33 of the Act states that “once the NHI is fully implemented”, medical schemes will only be allowed to cover those services that are not covered by the NHI. Until this happens, there will be no change in members’ current medical scheme cover. “Full implementation”, given the scale and complexity of the inordinately large reforms and restructuring of both the public and private healthcare systems and services needed, could take decades to achieve.

It is also expected that medical schemes will continue to play a significant role after the “full implementation” of the NHI, since it is highly unlikely that the NHI will have sufficient funding for healthcare services, other than the provision of “standard level of care”.

No need to panic

Whilst the signing of the NHI Bill may have caused great concern and uncertainty amongst medical scheme members, it is important to remember that the Medical Schemes Act has not (and will not be for a long time to come) been repealed, meaning that it is still in force. There is NO immediate impact on medical scheme members, their benefits and contributions, nor any tax changes in the foreseeable future.

To this end, Genesis Medical Scheme will steadfastly remain committed to the provision of quality benefits at affordable rates whilst at the same time remaining focused on delivering exceptional service to all our current and future members.

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