The National Health Insurance (NHI) is a government plan which aims to make healthcare available to all South Africans.

President Cyril Ramaphosa signed the NHI Act into law on 15 May 2024.

The NHI Act allows for the creation of a National Health Insurance Fund. The National Health Insurance Fund is often called the NHI Fund or just the NHI.

The NHI promises to pay for a set list of healthcare services so that people won't need to pay when they get care.

From what we understand, you'll need to follow a referral process and clinical guidelines to use the NHI. We think this will start with a GP or clinic, and you'll be referred to a specialist or hospital if needed. If you choose to go outside this process, such as seeing a private doctor or going to a hospital directly, the NHI is unlikely to cover the cost.

We don't yet know which treatments and medicine the NHI will cover or which healthcare providers (doctors, hospitals, pharmacies, etc) will be part of the system.

Unfortunately, it will be very difficult to raise the taxes required to fund the NHI. Because of this, it is uncertain whether it is realistic to promise a comprehensive package of healthcare benefits to everyone or how long it will take to roll-out the NHI.

We've always supported the goal of giving all South Africans access to quality healthcare based on their need rather than affordability (in other words, universal health cover). We believe that the NHI can help achieve this, especially if it works alongside medical aids.

Our main concern is how the NHI will affect medical aids. The law is not clear on what medical aids will be allowed to cover in future. We believe that medical aids should continue to offer benefits alongside the NHI. This would help reduce pressure on the public system and give people more choice. We know that the private healthcare sector has valuable skills, experience and resources that can support the successful rollout of the NHI

Our other concern is that the NHI Act is generally unclear in many respects. Without a clear and realistic funding and implementation plan, stakeholders are still uncertain about the exact implications of the NHI.

We've shared our concerns and suggestions with the Portfolio Committee on Health, the National Council of Provinces and the President. We're disappointed that our input wasn't considered before the NHI Act was signed into law in May 2024.

We will continue to take part in the NHI process in the meantime and look for ways to improve the overall healthcare sector. We are also taking legal steps to make sure that the rights of medical scheme members are protected as the NHI is put into place.

The NHI Act says that when the NHI is fully implemented, medical aids won't be allowed to cover services for which the NHI pays for. This is a concern because the public system may not have enough resources to meet all South Africans' healthcare needs.

The Minister of Health has said that full implementation of the NHI will take at least 10 to 15 years. This is because the NHI is a large and complex plan that will take time to build. There are still many legal, financial and practical challenges to work through. This means that the NHI cannot be set up in the short term. Until then, your medical aid will continue to work as it does now.

In almost all countries with national health insurance systems, people can still choose to purchase private health insurance. We believe South Africans should have the same freedom.

Limiting people from buying the healthcare cover they need, without a proper and sustainable alternative, is unconstitutional and poses the risk of stripping the country of critically needed skills.

We'll continue the extensive work we've been doing to achieve a constructive NHI outcome for all South Africans.

Yes. We've been actively involved in discussions with the Department of Health, the Presidency and other stakeholders. We've made detailed submissions during the legislative process (when they made the law) and will continue to do so to make sure that medical schemes and private healthcare stay part of the overall national health system.

We want to help shape a healthcare system that works for everyone and includes public and private care.

No, the NHI Act does not change or add any taxes. Only National Treasury can change tax and this must go through legal and public processes

The government already spends a large part of its budget on healthcare. Given other priorities and economic challenges, it's unlikely that healthcare spending will increase significantly in the short term. For instance, in 2024, the government spent 15% of its budget on healthcare or 4.5% of gross domestic product on public health. This is in line with international standards, such as:

• The Abuja Declaration and
• The World Health Organization recommendations for universal health cover funding.

South Africa also spends the largest share of its government budget on healthcare compared to other BRICS countries (Brazil, Russia, India and China).

Right now, we don't expect a lot of extra money to come from taxes for the NHI. However, if the economy grows and unemployment goes down over time, government income will increase. This means more public money could be directed towards healthcare.

The Minister of Health has said that no tax changes are planned for the next three years. For now, the focus is on improving efficiency in the healthcare system. Efficiency in this sense means making the healthcare system work better by using time, money and resources wisely so that care is faster, simpler and more effective for everyone.

The funding model for the NHI has not been finalised. The NHI Act mentions payroll taxes and personal income tax surcharges as possible sources, but no details have been given. National Treasury is working with the Department of Health to estimate costs and plan funding.

No. The NHI cannot take any money from your medical aid. Your risk benefits, savings account, contributions and the reserves of the medical aid are safe.

Members contribute voluntarily, mostly from their after-tax earnings to medical aids. The money belongs to the members, and there is no mechanism for the government to access it because it is protected by law.

Even contributions made through your employer come from your salary and cannot be redirected to the NHI.

No. Only National Treasury can change or remove the medical aid tax credits. To do this, they must follow a legal and public process. It's not expected to happen in the short to medium term.

The tax credit helps make medical aids more affordable, especially for lower-income earners. Removing it could make private cover unaffordable for many people and increase pressure on the public system.

The NHI has no immediate impact on your medical scheme benefits or contributions.

According to the NHI Act, medical aids will continue to operate as they are now at least until the NHI is fully implemented, which could take 10 to 15 years or even longer. Once the NHI is in place, medical schemes will offer cover for the services (treatments, medicine, etc) for which the NHI doesn't pay. This is called complementary cover.

In other countries with a national health insurance system, it is common for private healthcare to run alongside state-funded healthcare. This approach is often preferred because the government offers what it can afford, while giving people the freedom to choose and pay for extra private healthcare if they want to.

No, not at all. The NHI will take many years to set up and fund, and we don't yet know what services it will cover.

Healthcare needs can be sudden, unexpected and expensive. Cancelling your medical aid could put your health and finances at risk. Medical aids currently cover a wide range of benefits that the NHI may not offer for a long time.

No. The NHI Act does not require medical aids to change their benefits immediately. Changes will only happen once the NHI is fully implemented, and even then, the changes will be introduced gradually. There will be no impact on medical schemes in the near future.

We're working with policymakers to get clarity on how medical aids will work alongside the NHI in the longer term.

The NHI Fund may choose to contract with private hospitals, doctors and other medical service providers to support the public system. This will be voluntary.

We expect the NHI to start by contracting with GPs for specific services relating to primary and preventive care. However, most NHI services will still be delivered by public clinics and hospitals.

Private hospitals and specialists will continue to be funded by medical aids.

South Africa has a valuable, skilled and dedicated community of healthcare professionals who deliver excellent care and are committed to the country. We'll continue to support the private sector, especially the doctors and other healthcare professionals, in their right to work in a well-functioning environment, receive fair pay and stay part of the national healthcare system. We aim to help sustain the industry, improve health outcomes and make sure that patients get the best possible care.

Not necessarily. The NHI will only cover services that fit within its budget. It's not clear yet what those services will be, or which facilities will be included.

To use the NHI, you'll need to register with a primary care facility and follow a referral process. This means that patients will only be covered for services as directed by the NHI, including which facilities they can go to. It's unlikely that the NHI will be able to pay for extensive hospital care, specialist services or medicine beyond the essential medicine list, at least for several years.

The Act says that the NHI will focus first on vulnerable groups and expand as their money allows.

No. Doctors can choose whether they want to contract with the NHI or not. South Africa's constitution protects their right to decide whom they work with and under what terms.

It's not yet clear whether working with the NHI will be financially viable for private doctors.

The President has not yet set dates for when parts of the NHI Act will take effect. We expect the first steps to involve setting up the NHI Fund and making key appointments. This will take some time and does not affect medical aids in any way.

Each part of the NHI Act must go through legal steps before it can be put into action. The government must also change how healthcare funding works across provinces, moving it from the provincial departments to the national level. This will mean major changes to the public healthcare system. The Minister of Finance has asked for a costed implementation plan so that progress can be made at a pace the country can afford.

Right now, the government's focus is to set up the NHI Fund so it can start working with healthcare facilities. Because of limited funding, the priority will be a primary care package for the most vulnerable groups, such as older people, those with disabilities, and people living in extreme poverty. For this reason, we don't expect any changes to the medical scheme industry for the next few years.