NHI fund will take decades to roll out — we answer your burning questions

We want to stress an important fact. The law’s implementation is years away and its final implementation — when the truly big changes happen — is three decades away. Information is important and understanding vital, but worry is not. In the following months, we will bring you good information and solid facts, taking counsel from the finest thinkers across our country.

In Financial Mail this week, the National Treasury’s Mark Blecher, who has led the team in health financing for years, said he thought it would take three decades to fully implement the NHI. He made it clear that any tax increases required would be funded gradually. What is also clear is that various parts of the law’s implementation will be taken to court by various bodies and that the finalisation of the court battles will also be long drawn out.

Read more in Daily Maverick: Avalanche of litigation likely to follow Wednesday’s signing of contentious NHI Bill

Here are your questions answered.

Question: What was President Cyril Ramaphosa thinking?!

Answer: About power. The ANC is facing a tough election battle — the toughest in 30 years. It will do all it can to win a majority in the 29 May elections. And the final push over the next fortnight is crucial for the party.  You have to understand the passage of the NHI Act in this context. The ANC’s final squeeze is working, as Stephen Grootes reported.

How will the NHI work? Will it improve the quality of healthcare services?

Takudzwa Pongeni reported from the signing ceremony where President Cyril Ramaphosa said the government wants to build a ‘Rolls Royce’ healthcare system for all. He said that (some) South Africans had been fearful of universal suffrage in 1994 and again when the right to strike was enshrined in law, but these fears had proved baseless, as fears about the NHI would too.

Read more in Daily Maverick: ‘We want to build a Rolls-Royce healthcare system for all,’ says Ramaphosa on signing NHI Bill into law

Bhekisisa’s Mia Malan has written an excellent primer on how the NHI will work and its purpose.

Will ANC politicians be prevented from going abroad for treatment?

Unlike the practice in much of our continent, there isn’t a widespread practice of leaders going abroad for treatment because the health systems they create are so bad. South Africa has excellent doctors and great hospitals across the public and private spheres. Political leaders get treatment at the military hospital in Pretoria, and health ministers have made a point of using the public system. Like all civil servants, they belong to the Government Employees Medical Scheme (Gems), the government medical scheme and use the private system. Once fully implemented, Gems will no longer exist in its present form, and neither will all medical aids.

How will the NHI be funded?

The NHI philosophy is to pool all the spending in the private and public health systems which together come to 15% of GDP. It’s still not enough and calculations from Discovery show that the new system will require hefty increases in VAT, personal income tax or corporate income tax.  Some details are included in this article — this is a long, long way off so don’t lose sleep on it yet.

Read more in Daily Maverick: In a surprise move, Ramaphosa to sign NHI Bill into law before 29 May elections

Can I continue to go to my (private sector) doctor?

Yes.  The system will take decades to kick in and once it does, healthcare professionals will register with the NHI and presumably be able to still see their patients. The difference is that you won’t pay your doctor but the NHI Fund will. There are many questions of how this system will work and it will be years before there is clarity.

How will the NHI affect medical aid schemes and private health insurance options? 

Once fully implemented, in about 30 years, medical aids will only be able to offer top-ups to what is offered in the NHI system. The National Treasury says full implementation will take three decades, so don’t lose sleep about it now. “Even when the NHI is ‘fully implemented,’ medical schemes will still be able to provide cover for benefits not covered by the NHI,” wrote Discovery CEO Adrian Gore in a note to members this week.

How will the NHI prevent healthcare corruption? 

We wrote this in 2019 about what the era of State Capture taught us about why the NHI in its current form is so risky for grand corruption.  It’s still true.

Read more in Daily Maverick: Ambitious National Health Insurance plan stalked by the shadow of State Capture 

South Africans are punch-drunk with corruption in the general governing system and also in the public healthcare system. This explains why trust levels on the announcement of the NHI law this week revealed themselves to be so low. We have suffered through the Sarafina Aids play when hundreds of millions of rands were lost; the ignominies of the Aids denial era, which saw health leaders toying with quacks selling Virodene and with health ministers touting garlic, lemon and beetroot as cures for Aids. More recently, Daily Maverick has revealed the Digital Vibes scandal, where funds meant to communicate the NHI were misappropriated by the Health Department and, of course, the theft of billions meant to fight Covid-19.  See the full Digital Vibes story here.

The murder of Gauteng health official Babita Deokaran has also revealed the layers of graft in provincial health procurement systems as Jeff Wicks has shown in News24.  See his documentary Silenced here.

There is ample reason to be very sceptical of our government’s ability to ensure the NHI does not become a huge feeding trough. We also have a very strong civil society, media, and judiciary that has repeatedly stopped health corruption. Hope, trust, and solidarity are important currencies to hold at this time. DM

Subscribe to Your Questions Answered, our monthly newsletter, where Ferial Haffajee addresses your inquiries and provides insightful answers to your pressing questions.