There is uncertainty over how National Health Insurance (NHI) will affect doctors and patients.

President Cyril Ramaphosa signed the controversial bill into law on Wednesday May 15, just two weeks before the national election, despite concerns from health professionals and the threat of legal action by civic groups and political parties.

It has been slammed as unconstitutional, unaffordable, and impractical by the Western Cape government.

The new bill aims to provide comprehensive and free health-care services to all citizens, regardless of their location or socio-economic status, according to Health Minister Dr Joe Phaahla.

The legislation, according to the government, will gradually be phased in.

The new public fund - which will be managed by a board that has yet to be appointed - will set the fees that private doctors and health-care suppliers may charge for NHI benefits, and once fully implemented, medical schemes will not be able to provide cover for services that are paid for by NHI.

The Echo asked some locals about their thoughts on NHI, and it was evident that many felt they needed more information about it to give an informed response.

Health and Wellness MEC Professor Nomafrench Mbombo said it was the most significant change to South Africa’s health-care system since the promulgation of the National Health Act in 2003, adding that it was crucial that such legislation reflected all stakeholders’ inputs and created a system that was unified and strategically aligned.

“Unfortunately, this is not the case with the NHI in its current form. For us to truly achieve universal health coverage, we do believe that the current health system needs to be completely overhauled as we are currently trying to run an imperfect system perfectly.”

Emailed questions to the national Department of Health about how the new fund would be funded and implemented and how it would affect state hospitals were unanswered at the time of going to print.

However, Adrian Gore, chief executive of Discovery Limited, has urged people not to cancel their medical aids as it would take at least a decade for NHI to be fully implemented.

Discovery supported change to improve the health-care system for all South Africans, but it would take a lot to make NHI workable, he said.

According to an analysis by Discovery, he said, raising R200 billion for NHI scheme would require a 31% increase in personal income tax, meaning each taxpayer would need to pay almost one-third more than their current tax payments, or a 6.5% increase in VAT, or a ten times increase in payroll tax, which would require a collection of around R1 072 per employee per month.

That could increase to around R1 565 per employee per month for those employed in the formal sector.

Even when NHI was fully implemented, medical schemes could still provide cover for benefits not covered by NHI, he said, adding that it was unlikely NHI would have the funding for a wide range of benefits.

“Our strong view is that limiting the role of medical schemes would be counter productive to the NHI because there are simply insufficient resources to meet the needs of all South Africans.”

Several health-care providers approached by the Echo declined to comment, saying “it’s early days” and they needed more information.

Former chairman of the False Bay Hospital Trust and general practitioner Dr Peter Jacka said that with scant details about NHI from the Department of Health and the Health Professions Council of South Africa (HPCSA) it was hard to say how it would affect private practices.

Few of his patients were on medical aid so it should not have a significant impact on his business, but other general practitioners and, in particular, specialists, might be greatly affected, “but nobody seems to know how the new system is supposed to work”, he said.

Microbiologist Dr Gerry Norris said that before launching a scheme like the NHI in any country, the basic foundations of primary health care needed to be in place, including potable water for all, full access to electricity, affordable public transport and working sewage systems.

Many challenges lay ahead for the fund, especially in rural areas with sparse populations and poor infrastructure while its sustainability would depend on South Africa’s economic and political outlook, he said.

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