(WHY)

Everyone deserves equal access to quality and affordable healthcare.

Access to health care is a human right as provided for in section 27 of the Constitution. As such, every individual has a right to receive essential healthcare of good quality, regardless of his or her ability to pay for care.

·Ensuring that every person gets the health care they need, when they need it, where they need it, and without incurring financial hardship is the basis of Universal Health Coverage.

·To achieve Universal Health Coverage means reforming South Africa’s health systems and how they are financed.

·Universal Health Coverage is about the right to health. Everyone – rich or poor should get the health care they need without suffering financial hardship.

·Currently the private sector serves only 16% of the population while the public sector serves the majority of the population (84%). About R27 000 is spent each year on people who use the private sector while only R5 200 is spent each year per person who is dependent on the public sector.

More than 2 out of every 3 medical specialists works privately to care for fewer than 20 out of every 100 people who live in the country. This competitive space has led to overservicing and often bad health care.

South Africa’s health system is very complicated and expensive. Both the public and private sector have challenges that make the healthcare delivery system unsustainable, and unable to match the needs of our people.

·As a nation, we spend huge amounts of money for healthcare – our total spending on healthcare is far more than any other country of similar size and economic activity to ours.

·Healthcare costs in the private sector are high and continue to rise. It only services a small portion of the population which will continue to get smaller as the costs rise.

(WHAT)

The National Health Insurance (NHI) is a fund that will make healthcare more affordable for all.

·A change is needed to make our health system more simple and more efficient. This change will take time and partnerships.

·NHI will be the financing system to reform and improve the health system of the country. It is supported by laws that will be passed over time to gradually make the changes needed.

·The NHI will create a public fund that will pay for healthcare services on behalf of the entire population.

 Every citizen will be entitled to benefit from the services that the NHI covers.

·The NHI Fund will be funded through a mandatory pre-payment system and other forms of taxes collected by SARS and allocated to the Fund by Parliament.

The NHI Fund does not intend to replace the private or public health system that we currently have. It aims to make both more effective, and more efficient to meet the needs of all South Africans and improve health outcomes for all people.

·Individuals will be free to continue with their private medical scheme membership for services not covered by the NHI Fund but will not be able to opt out from making contributions to the NHI fund.

·The NHI will purchase personal health service benefits for all South Africans from NHI-contracted public and private health facilities.

·Once fully realised, the Fund will cover a range of comprehensive services:

o   Primary Health Care services: visits to clinics, community health centres and accredited multi-disciplinary group practices and centres at a non-specialist level, community health care outreach workers, integrated school health services.

o   Hospital services: outpatient and in-patient visits at all accredited hospital levels, using a referral system (requiring a letter from a PHC centre/ provider unless in case of emergency)

o   Rehabilitation health services

o   Palliative Care

o   Mental health services

o   Emergency medical services: For example, no one will be refused emergency medical treatment.

o   Transportation for patients who are referred to and from another health facility.

Over time, more and more health care benefits will be added to the NHI package. South Africans still have the option to supplement their NHI package with private medical aid cover should they wish to increase the number of benefits covered.

Once the NHI Fund covers a benefit, private medical schemes may not be able to cover the same benefit, to avoid duplication.

(WHERE & WHO)

The NHI will reduce the cost of healthcare in South Africa for the benefit of all.

The intention of NHI is to ensure citizens are able to use the closest NHI accredited facility and service within their reach, whether it be public or private.

The National Health Insurance Fund will cover the costs of health benefits for every South African, employed, or unemployed, poor or rich, rural or urban, without any of us having to pay when we need the services.

The NHI will ensure that no one is chased away because his/her benefits and funds are exhausted.

Healthcare service providers and establishments will only be part of the NHI system if they meet the required minimum standards of care, are certified by the Office of Health Standards Compliance and accredited by the NHI Fund.

·The NHI will bring skilled healthcare professionals from both public and private facilities to deliver health services for the benefit for all.

·The NHI will enter into contracts with private and public health care providers to provide services to the entire population.

· Whatever benefits the Fund covers at any point in time will be available to every person irrespective of the salary you earn or even if you are unemployed.

·Planned patient transportation will be provided free of charge when you are referred to higher level specialist services because there are no specialist care facilities in your particular area.

Patients will be able to access any NHI-contracted service provider near to them, and no upfront payment will be required by the doctor or hospital.

·When the vision is fully realised, ambulances for example, will be required to assist anyone who is injured at the scene of the accident, irrespective of whether you have a medical aid, credit card or cash as it is the current state.

(HOW)

The NHI is a partnership between the private and public healthcare systems.

·There is room for the private and public healthcare space to work together.

·Our country’s health resources (our hospitals and clinics, our doctors, nurses and specialists) can be shared to support the needs of all our people.

The COVID-19 National Vaccination Programme has proven how the NHI will work to ensure equity in healthcare service when public and private work together.

·The NHI envisages a future where public and private healthcare providers share resources, but not to the disadvantage of any group.

· We call on doctors and the private sector to join us, and the Government is committed to supporting all South African healthcare workers as we embark on this journey.

·The NHI will put laws in place to prevent private hospitals and professionals charging patients at unfair prices.

·Under NHI people will no longer be expected to pay additional fees (called co-payments) because the Fund will pay the health care providers the full prescribed fee.

(WHEN)

The NHI is a journey to transform South Africa’s health sector. It will take many years to be fully realised and requires input from all sectors to ensure no one is left behind.

·The NHI journey progressed from 2011 when the NHI Green paper was published for public consultation. This was followed by NHI pilot projects in 2012 with a focus on health system strengthening initiatives. The NHI White paper was published in 2015 laying the foundation for the NHI as the vehicle to achieve universal health coverage and a unified health system.

·In August 2019, the NHI Bill was introduced to National Assembly. After many public hearings in 2021 and 2022, the Bill was brought to National Assembly with various amendments. The NHI Bill was then passed by the National Assembly in June 2023. It is currently with the National Council of Provinces’ (NCOP) Select Committee on Health and Social Services, which involves provincial public hearings for review and input. Once it is passed by the NCOP, the draft bill will be referred to the President who must assent and sign it into law.

·The journey includes development of NHI legislation and amendments to other legislation.

· Government encourages the public to share their views on the provision of quality and affordable healthcare for all.

· The opinions of ordinary citizens during this process are vital to the all-encompassing healthcare system that we wish to build.

· Our democratic space allows all South Africans to have their say on issues that concern them.

· All of us have a stake in the future of our nation; make your voice heard and contribute to strengthening our democracy.