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The Constitution recognizes health care as a fundamental human right and provides that everyone has the right to health care services. It further places an obligation on the State to take reasonable legislative and other measures to achieve the progressive realisation of this right.
In an attempt to provide equal health care for the citizens of South Africa, the government has introduced an innovative system of health care financing which, if effectively implemented, would provide access to appropriate, efficient and quality health care services to all. The system is commonly known as National Health Insurance (NHI), which will be state-owned and, according to the Department of Health, be phased in over a period of 14-years. The NHI Bill (“the Bill”) recognises the need for health care equality and provides a framework for the implementation and operation of NHI in South Africa.
The main aim of the NHI fund is to create universal health care, by establishing a single pool of health care funding for both private and public health care providers, thereby disregarding socio-economic status by covering health costs of all South Africans regardless of race, class, gender or age.
The effective implementation of the NHI fund would benefit South Africans as our healthcare system, which is currently one of the most expensive systems in the world, would be reduced, no fees will be charged when visiting healthcare facilities, as the fund will cover medical costs, and South Africans would not need to contribute to a medical aid scheme to receive quality health care.
The Bill provides that NHI will cover medical costs of South African citizens, permanent residents, refugees, inmates, and certain individual foreigners (determined by the Minister of Home Affairs). Furthermore, the Bill also makes provision for certain health care services for asylum seekers or illegal immigrants.
The NHI fund will derive its resources from general taxes, contributions by persons who earn above the threshold amount (which will be determined), and monthly contributions made by employed South Africans to the fund. Contributions made by employed South Africans will be collected by their employers at the end of each month and submitted to the fund – in a similar manner to UIF contributions.
However, NHI doesn’t replace medical aid schemes and members may elect to continue on any medical aid scheme as they wish. The role of medical schemes will however change as soon as NHI is fully implemented. Medical schemes would play a secondary role in that it would provide cover for services which is not reimbursed by NHI, such as services which is not deemed medically necessary, or services which is not included in the formulary (which comprises of a list of essential medicine, products and equipment and will be reviewed annually in order to take changes in diseases, product availability and prices into account).
The Bill therefore provides a framework for the effective implementation of NHI which will contribute to socio-economic justice and equality by not only providing financial protection from the costs and access to quality health care, but also providing and promoting sustainable, equitable, and effective health care services.
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