Our position
Discovery has always been steadfast in its support for universal health coverage (UHC), recognising the urgent need to expand access to quality healthcare for all South Africans. We believe that a well-designed National Health Insurance (NHI) system is key to achieving this. With this in mind, Discovery remains committed to engage constructively with government, healthcare professionals, and civil society to shape a practical and sustainable NHI. To help South Africans navigate this complex and evolving landscape, we have developed Understanding NHI - a reliable source of factual, up-to-date information on the NHI Act and developments and what these means for individuals, healthcare providers, and businesses.
- The Act was signed into law by President Cyril Ramaphosa on 15 May 2024.
- The Act aims to establish the NHI Fund. The Fund will pay for a set of pre-determined healthcare services for all South Africans which will be free at the point of care.
- Until the NHI is fully implemented very little to nothing will change in relation to medical schemes.
- It is also unlikely that there will be any changes to your personal taxes to fund the NHI soon due to macro-economic constraints and other pressing socio-economic demands.
- It will therefore be important for you to retain your current medical scheme membership to ensure that you remain protected for the cost of your healthcare events.
- The NHI Act specifies that once the NHI has been fully implemented, medical schemes will not be allowed to cover the healthcare services that the NHI Fund covers and so their role (and benefits) will be limited.
- The NHI Act states that the NHI Fund will be funded by taxes and will centralise public healthcare funding which currently flows through the provinces
- National Treasury has indicated that there is no room to increase taxes in the short-medium term due to economic constraints and other pressing socio-economic demands
- Government has not published any updated costing
- Healthcare services will be accessed according to a defined treatment pathway and referral pathways.
- Where a person chooses not to follow the NHI pathways, and chooses to use their own doctor or hospital, they will not receive cover from the NHI.
- We don't know which treatments and medicines will be covered by the NHI Fund, and which will not be, although the focus is likely to be on primary care.
- We also don't know which healthcare facilities and practitioners (private or public) will be contracted to the NHI Fund (they will need to meet accreditation standards and be willing to contract with the NHI).
- The NHI is a massive reform that will require significant change to the financing and provision of healthcare services. The Minister of Health expects that it will take at least 10-15 years to roll-out.
- The NHI Fund will contract on a voluntary basis with private providers to supplement the current public sector delivery system, with the focus being on GP services.
Frequently Asked Questions
We have received many questions and comments from medical scheme members and the public. Here we answer some of these questions and provide our views on it.
What we don't yet know
- There is no clarity on the proposed benefit package
- Although it does appear that a starting point will be screening and primary care benefits
- Government has not published any costing
- Although the Department of Health has indicated they would require at least another R200bn in tax funding
- The NHI Act refers to raising taxes through personal income taxes and payroll levies but no amount has been specified
- National Treasury has indicated that there is no room to increase taxes in the short-medium term due to poor economic constraints and other pressing socio-economic demands
- The NHI Act specifies implementation by 2028 but this is not feasible given the scale of what needs to be put in place
- The Minister of Health has indicated that medical schemes will not be impacted for at least another 10-15 years
- It appears that the initial focus will be on rolling out a narrow primary care benefit package to the most vulnerable due to financial constraints
- This will be constrained by the amount of funding available. Given the current economic constraints, it is unlikely that the NHI will be able to afford a package as comprehensive as what medical schemes cover
- The initial package is likely to focus on screening and primary care cover
- The NHI Act specifies that services will be provided by accredited healthcare providers but it is not clear if any assessment has been done of whether South Africa has sufficient healthcare providers for the whole population and who meet the accreditation standards
- We understand that there will be strict referral pathways, clinical protocols and formularies that patients will have to adhere in order to receive NHI benefits
- Policy documentation has indicated that the NHI Fund will be publicly administered
- There is a large amount of work to be done in setting up how users will be registered, how referral pathways will be determined and managed, how providers will be reimbursed and the related data and systems management
HFA Litigation
Discovery Health is a member of the Health Funders Association (HFA) which has launched litigation against the NHI Act with the aim of protecting the economy and health system from further harm and promoting a workable approach to NHI for South Africa where medical schemes play a collaborative and supportive role.
NHI Resources
NHI Act 2024
The NHI Act 20 of 2023 was signed into law on 15 May 2024 and published in the Government Gazette on 16 May 2024.
NHI Policy Papers
The NHI Green Paper (2011) and White Papers (2015 and 2017) show the evolution in the policy framework to the NHI Act.
NHI Green Paper 2011
NHI White paper 2017
NHI White Paper 2015
Perspective
Our submission highlights our position and recommendations relating to the NHI to the National Council of Provinces process in 2023.