How Does the National Health Insurance Fund Work?

Today, the South African Parliament released the Bill that would act as the framework for the National Health Insurance (NHI) fund. The Bill was adopted by the Cabinet and is set to be debated and voted into law by next year.

To understand the impact of the NHI, it is useful to look at the healthcare systems of all developed countries. In short, the NHI framework has been implemented in all developed countries for several decades except for the US. Among those countries, the US pays several times more for medical services and medications while also having the lowest healthcare outcomes.

To emphasise this point, in an NHI country like Canada, a vial of insulin costs about R300 whereas the same vial costs more than R3000 in the US.

When adopted into law, the NHI will have to be implemented over the next five years and below is a set of Q&As that might answer everything you need to  know after the NHI has been fully implemented (take note that the answers given is partly based on the factual outcomes of NHI frameworks in other countries).

What is the NHI?

It is basically just healthcare insurance, except that the government will manage it.

Will you be able to have private insurance?

Yes, but only for things that the NHI does not cover. For example, the NHI won’t cover things like cosmetic plastic surgery. So if you want a nose job, you will have to take out private insurance.

What does the NHI cover?

It is comprehensive, which means that it covers everything, except for things that have nothing to do with health, like nose jobs.

Can the NHI deny you coverage?

No. Unlike private insurance, the NHI won’t be able to tell you that you cannot get a procedure or medication because you are not covered for a specific medical condition. Of course, once again, a ‘medical condition’ does not include nose jobs.

Is it free?

No. You will pay through an increase in taxes but this increase will be less than your current medical costs. You will not, for example, have to pay for additional costs out of your own pocket. In other words, if you add up your current medical costs (which include your private insurance premiums and out-of-pocket costs), the additional tax that will cover all your medical needs will be much less.

Will the hospitals be nationalised and run by government?

No. The government will pay private hospitals to do what they do best, which is to deliver quality healthcare. Of course, the only difference now is that everyone will access to those hospitals.

Will you wait a bit longer in line at the private hospital?

Yes. Since everybody has access to healthcare, the waiting times at private hospitals will be longer. The great news is that regardless of how long you wait, you are guaranteed the healthcare service that you need. When you get to the reception desk, you will get the healthcare service you need without having to pay additional costs. When you leave the hospital, that’s it. You won’t have to worry about additional costs that you can’t afford.

How long would you have to wait for an operation?

If your condition is life threatening, then you will get immediate attention. However, if you have a condition that is not life threatening, then you will probably have to wait a few months before you get a spot on the operating table. But don’t worry though. The doctors know what they are doing and won’t let you linger in the operating queue unnecessarily.

Does it mean that people who do not pay taxes get free healthcare?

Yes. There are those who are unemployed and those who earn too little for them to pay taxes. These are the persons who are most vulnerable and in a humane society, we do not throw away people because they cannot afford the medical costs. We value the lives of those sleeping on the streets as much as we do those living in mansions. There are no inferior human beings and as a society, we should do our best to help those that are most vulnerable. That is how we make South Africa and the world great.

In short, if you don’t mind waiting longer in the queue to pay significantly less and get significantly more, then the NHI is for you. This is especially true if you value the lives and dignity of others as much as you value your own.