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The National Health Insurance and Medical Schemes Amendment Bills

Summary of the National Health Insurance (NHI) Bill and the Medical Schemes Amendment Bill

On 21 June 2018, South Africa took another important step towards the implementation of the National Health Insurance system when the Minister of Health, Dr Aaron Motsoaledi, simultaneously introduced the National Health Insurance (NHI) Bill and the Medical Schemes Amendment Bill. 

The NHI Bill will, for the first time introduce the NHI into legislation while the Medical Schemes Amendment Bill seeks to align the current Medical Schemes Act and the NHI.

 The National Health Insurance Bill

In essence the NHI Bill sets out the legal framework for the NHI and proposes the establishment of the National Health Insurance Fund and its associated governance and advisory structures. It applies to both public and private health establishments and the key features are:

 

  • The Fund is to be the single strategic purchaser and financier of health services
  • The Fund will have a tariff-setting function.  Prices, budgets and revenue allocation will be determined annually
  • There will be accreditation, certification and contracting of service providers by the Office of Health Standards and Compliance (OHSC)
  • A beneficiary registry will be established, and a person seeking health services must be registered as a beneficiary of the Fund
  • Comprehensive Health Service Benefits (which are not defined in the Bill) must be purchased by the Fund
  • Beneficiaries to use their selected General Practitioners as Primary Healthcare Providers where a referral pathway upstream will need to be adhered to in order access the NHI benefit

 The Bill also sets out the three-phase timetable for the implementation of the NHI as follows:  

  • Phase 1 (which has been completed) encompassed a period of five years from 2012 to 2017 and included testing of effective health system strengthening initiatives.

 

  • Phase 2 will run for a period of five years from 2017 to 2022 and will include:
  • Continue with the implementation health system strengthening initiatives;
  • Development of National Health Insurance legislation and amendments to other legislation;
  • Establishing institutions that will be the foundation for a fully functional Fund;
  • Interim purchasing of personal healthcare services for vulnerable groups;
  • Interim committees to be established by the Minister; and
  • Introduction of legislative reforms for 11 laws.

 

  • Phase 3 will run for a period of four years from 2022 to 2026 and will include:
  • Continuation of health systems strengthening activities Mobilisation of additional resources as approved by Cabinet; and
  • Selective contracting of health services from private providers.

 

The Medical Schemes Amendment Bill

 The Medical Schemes Amendment Bill is designed to align the Medical Schemes Act with the requirements of the NHI environment. The key amendments are:   

  • Abolishment of co-payments
  • Establishment of the Comprehensive Service Benefits (not defined by the Bill) which will supersede prescribed minimum benefits (PMBs)
  • Prevention of medical schemes implementing benefit options without the prior approval of the Registrar of the Council for Medical Schemes
  • Prohibition of carrying on of the business of a medical scheme by a person not registered as a medical scheme
  • Creation of a Central Beneficiary and Provider Registry under the auspices of the Council for Medical Schemes
  • Introduction of income cross-subsidisation in medical schemes through income related premiums
  • Medical schemes to pass back savings (in the form of reduced premiums) if a member uses a designated service provider (DSP)
  • Cancellation of membership and waiting periods between joining schemes and accessing benefits

Life Healthcare is fully committed to providing quality healthcare to all South Africans and supports the fundamental principle of Universal Healthcare.

As such we support the National Health Insurance which aims to extend appropriate, affordable healthcare to all South Africans, irrespective of their socioeconomic status. The Medical Schemes Amendment Bill is aimed at aligning the medical aid industry to the changes which will come through the National Health Insurance that government plans to implement.

 

Improving the nation’s health outcomes by addressing the challenges within the Public and Private healthcare sectors is a massive undertaking and in this context, Life Healthcare welcomes the opportunity to participate in the public commentary process.