National Health Insurance (NHI)

Nobody is as yet completely sure as to how the National Health Insurance (NHI) system will work in South Africa. The rollout of a preliminary form of the NHI is a few areas in South Africa thus far seems like nothing more than an upgraded public health system. The promise of such a “true” NHI system has been circling around for well over a decade and will undoubtedly be one of the greatest post-democratic achievements if it can be implemented.

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The poor may finally be able to access quality health and medical services. Public hospitals and service providers will undoubtedly have to up their game to stay competitive. And all South Africans will benefit as a health population is more productive and this has a positive effect on the economy. As the state’s overburdened and understaffed facilities cannot cope with the current health needs of the population, there is concern whether the NHI will really be able to fill in the gaps.

It appears from what  National Health Insurance system should be is that every citizen can access medical services as an NHI member. This is irrespective of your age, employment status, income level or taxpayer status. You will however, have to be a South African citizen. The NHI may mean that you as an NHI member can access some private medical services, although this will probably be very limited, with the remaining services that are required being provided by the state facilities and providers. In all likelihood NHI members will not enjoy the freedom on choice as do medical aid members and in some form or the other they will be at the mercy of state institutions and staff or NHI providers.

Medical aid in South Africa

Medical aid has been the saving grace of the private healthcare system. Had it not been for medical aids, few South African citizens would have been able to afford private healthcare in the country. This means that hospital groups, doctors, pharmacies and other providers and facilities would not have been able to collectively provide one of the best private healthcare systems in the world. Similarly, South Africans would not be able to enjoy a level of medical care that is almost unmatched globally.

South African medical aids are non-profit organisations. They pool the contributions of all the members together and pay out for member;s medical needs from the fund. Administration costs are also funded from this pools. Medical aid works on the premise that the majority of members will be young and healthy and not need immediate medical care on an ongoing basis. Older members who have contributed for years or decades are more likely to need cover but in the whole scheme of things, the contributions of healthy younger members outweigh the usage of older, sicker members. An ever increasing young HIV positive population in South African has of course added a new dimension to this system but South African medical aids continue to thrive.

Medical aid may not be cheap but in the greater scheme of things it offers more benefits than just its costs. Consider that coronary bypass surgery costs about R200,000 with the hospitalization and surgeons costs. How about the limitless chronic medication under the prescribed minimum benefit clause which ensures that members received medication throughout the year for life-threatening ailments? Younger and healthy medical aid members may not truly enjoy the benefits of medical aid on a regular basis but as with any insurance, you appreciate it most when you need it. What medical does offer however, is choice. The right to choose your hospital, doctor, pharmacy and other health care professional. Of course, your choices must make medical sense and be within reason but you are seen as a private consumer with rights rather than another state beneficiary.

How is the NHI Different from Medical Aid?
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