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Medihelp Medical Scheme: our view on the National Health Insurance Act

14 MAY 2024


As an organisation that has and will always have the best interests of the members of our medical scheme at heart, we also deeply care for the communities in which we operate and thus all South African citizens.

We agree that health is a fundamental human right as entrenched in the United Nations (UN) 2023 agenda as part of the Sustainable Development Goals (Goal 3). And thus, in its purest form, the conviction of universal health coverage or national health insurance, which is widely recognised as a means to facilitate health for all, is noble and one worth striving for. In the words of the UN, “access to healthcare goes beyond health and well-being, it also contributes to social inclusion, equality, ending poverty, economic growth, and human dignity”.

Says Varsha Vala, Medihelp’s Principal Officer, “Many developed and developing countries around the world have successfully implemented national health insurance or have health care policies in place. How they implement them does, however, differ significantly. South Korea, for example, covers a maximum of 60% of citizens’ medical expenses. About 77% of South Koreans then supplement this cover with private insurance to pay for the remaining costs. Brazil, on the other hand, provides free medical care (from primary care to surgery to medication) to citizens, tourists, refugees, and undocumented immigrants (source: Wikipedia). In India, a public private partnership contributes to the success of its national healthcare policy: The government partners with private hospital chains to manage and run public hospitals. Here are a few more examples of how countries structure their national health insurance.”

South Africa’s national health insurance will be structured as a fund, as established in terms of the National Health Insurance (NHI) Bill. The legislation provides that different sections of the Act will come into force over time, as and when certain milestones are achieved. So even though the Act will be signed tomorrow, the provisions of the Act are not operative. The first sections of the Act, which will most likely become operative, are those relating the creation of benefit committees and the like. These committees must then sit and determine the benefits. “This process itself will most likely take a significant period of time as evidenced in other countries,” says Vala.

Further, the law does not do away with medical schemes but simply says that schemes cannot offer cover for services covered by the NHI, which at this stage is not defined as the NHI’s committees have not been formed and no decisions in this space have been taken. Also, the limitation on the offering of medical schemes only comes into operation once the NHI is “fully implemented”.

“In our view, the implementation of the NHI will rest heavily on the readiness of the existing healthcare infrastructure and the healthcare workforce, public education and engagement, the political landscape, and the financial resources of which we are cognisant is a mammoth task requiring many hands and minds to address.

“In conclusion, we believe that by fostering collaboration, leveraging complementary strengths, and prioritising patient needs, private and public healthcare systems can coexist successfully, ultimately leading to better healthcare outcomes for individuals and communities. Medihelp is committed to providing security of healthcare funding to our members and confirm that we will monitor the developments in the NHI and confirm that for the foreseeable future it will be business as usual,” Vala concludes.


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