It will not be easy for members of the public to visualise National Health Insurance (NHI) until it is being implemented. There is increasing inequity around the world, with the richest 1% of the population now owning half of the world’s wealth. Life expectancy in the poorest countries of the world is appreciably lower than in the wealthiest and living in areas blighted by poverty can mean a shorter lifespan and a lost future. The disparity is observed between countries and between different communities within countries, with the most vulnerable, marginalised and stigmatised being left behind.

Certain things must be said and said very categorically. Do you believe health is a human right and that all human beings should be able to fulfil their potential in dignity and equality in a healthy environment? Do you believe women should not die while giving birth? Do you believe children should not die from preventable deaths? Do you believe people should not be pushed into poverty for accessing health services? Do you believe in a world where everyone can live, healthy, productive lives regardless of who they are and where they live? If you say “Yes” to these questions, then you believe in universal health coverage (UHC).

Implementing UHC that is truly universal means making progress towards equity, inclusion and social justice. It means a people-centred, human rights-based approach and community-led service delivery, as well as a recognition of the need to address the social determinants of health, including necessary reforms of laws and policies and removing stigma and discrimination and gender inequity.

World leaders agreed on 23 September 2019 that every person – no matter who they are, where they live or how much money they have – should be able to access quality health services without suffering financial hardship.

Health is a human right for everyone, at every age. At present, not only does a fundamental human right remain unfulfilled, but it is also increasingly evident that the capacity to detect and respond to disease outbreaks depends on a healthcare system that reaches everyone.

What is NHI?

Apart from being a financing system for the realisation of UHC, NHI is about ubuntu – we all take care of each other, as a nation, in times of need. NHI is the South African way of providing access to high-quality healthcare for everyone.

How does it work?

The NHI will buy quality healthcare services on behalf of the people of South Africa. These services will be provided by healthcare professionals and providers in public and private healthcare facilities and they will be integrated into one healthcare system, serving the needs of all South Africans. NHI will combine the many public and private healthcare funds into one fund that pays for everyone when they need to access healthcare, using the advantage of the size of the fund to reduce healthcare costs.

Who will NHI cover?

Every South African, permanent resident, refugee and prisoner will be able to register for NHI. All children born and living in South Africa will qualify for NHI. Everyone else will qualify for treatment for emergencies and diseases that can cause outbreaks (note: those working for the South African National Defence Force will still have a separate fund).

How can I be part of NHI?

You can register yourself and your family for NHI at your nearest general practitioner (GP) or clinic.

Will I get free healthcare now?

When you see a nurse or a GP, they will attend to you and decide if you need a specialist. You will get the care you need at the level you need it. You will be able to make decisions on your health together with your healthcare workers and professionals, who will guide you to follow the referral pathways. When you are seen in an NHI facility, and if you follow the referral pathway, you will never have to pay any cash or medical aid contribution. The services will be free at the time you are attended to.

What about medical aids?

Medical aids will still exist, but will not be able to offer cover for the same services as NHI.

I have medical aid because I don’t want to wait in queues or be seen in a “dirty” public hospital. Can NHI guarantee the same standard of care if I stop my medical aid?

The government will upgrade all facilities to ensure that there is no difference between a public and private facility – all NHI facilities have to be the same standard because they will have to follow the rules of the Office of Health Standards Compliance to be part of the NHI. The objective is to ensure queues are reduced and facilities are clean, providing safe healthcare services.

What if I don’t want to follow the referral pathways or my preferred clinic or hospital is not registered with the NHI?

Under NHI you will still have access to your preferred clinic or hospital. If you seek treatment in a facility that is not registered with the NHI, or if you do not wish to adhere to the referral pathway, your expenditure will not be reimbursed. This may necessitate that you pay cash or out-of-pocket for the services rendered by that particular facility.

Will I have to pay more tax for NHI?

Initially, there will be no tax for the NHI. The government will pool the funds that already exist in the public sector to start the NHI. When the NHI is up and running, Treasury may introduce a small tax to augment the money allocated through the public budget.

What will happen between now and when the NHI starts?

Before it can become a law, the NHI Bill must be passed by Parliament. In the next five years, the government’s efforts will be concentrated on preparing the NHI infrastructure that will administer the fund and provide services.

At the same time, government will give priority attention to refurbishing clinics and hospitals, train and employ more staff, improve the quality of health care, implement systems to ensure medicines do not run out of stock in our facilities, and ensure that maladministration and corruption is uprooted so that all facilities will be ready for NHI. MC

Popo Maja is head of communication and a departmental spokesperson in the National Department of Health.