The NHI will be a state-run national health fund to provide essential healthcare and general cover for all South Africans on an equal footing.
The state will compile a basket of services, and everything in this basket will be dealt with by the state only.
The state will deal with the total administration of the fund.
In this regard the state is making no secret that rationing will indeed be applied in the event of shortages.
The NHI will buy and provide “all” health services on behalf of consumers / patients.
The package to be provided is based on basic benefits currently being provided by medical aid funds, but it is not yet clear what exactly is going to be provided. See Annexure A.
The latest information looks somewhat different and “areas” of focus during the implementation process have been mentioned. See Annexure B.
Doctors, equipment, medicine and support services are going to be distributed to ensure equal access for all.
This means that health practitioners, as part of their accreditation, will be allocated to the areas or wards where the need is highest, that they will be allowed to work in a specific ward only and that all their patients will come from that ward.
Everybody pays a compulsory progressive and proportional contribution – according to their ability to pay. All will therefore have the same medical cover and benefits regardless of socio-economic status.
The NHI will be funded by means of taxation. This tax will come in the place of normal payments to medical aid funds. It is not yet clear to what extent private medical aid funds will continue to exist once the NHI has been established. If they continue to exist, it will be to provide supplementary services not included in the NHI basket.
The NHI fund will pay all doctors and healthcare providers in the public and private sectors. At this stage, the role of private health practitioners and hospitals is not clear at all. It could be that they will provide only supplementary services.
The remuneration of health practitioners therefore will also be determined according to the need in the ward concerned. What the calculations are going to look like is still unclear, but mention has been made of a capitation system in terms of which medical practitioners will be remunerated according to the number of people living in their ward.
The NHI will buy all medication and equipment and will pay for it from the fund.
Hospitals, medical practitioners and other institutions will not be allowed to buy their own equipment and medication. All purchases will take place only through the fund, as administered by the state.
The state will decide what treatment may be given, what diagnostic tests may be used and what new technologies may be allowed.
Public and private healthcare providers will have to be accredited by the NHI and will be regulated by state inspectors.