OPINION | NHI Bill: Big questions ahead for healthcare in SA | Business

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A great deal still remains unknown about the NHI. As such, it is not clear what medical schemes will or will not be able to offer. What is clear is that the impact will be profound, as medical schemes are fundamentally sidelined, writes Neil Kirby.

While the National Health Insurance Bill gives a great deal of attention to the construction of a National Health Insurance Scheme, aspects of the bill also implicate the role that the private healthcare sector will, or will not, play in this context.[o]nce National Health Insurance has been fully implemented as determined by the Minister through regulations in the Gazette, medical schemes may only offer complementary cover to services not reimbursable by the Fund.

The term"healthcare service" is, however, defined in the bill to include such services as emergency care, reproductive healthcare, basic nutrition"and basic healthcare services contemplated in section 28 of the Constitution".

The circumstances impact on the design and applicability of prescribed minimum benefits as currently set out in the Medical Schemes Act No. 131 of 1998, as well as the outcome of the existing process of reviewing the prescribed minimum benefits being undertaken by the Council for Medical Schemes - a process that has been protracted and extended so as, what now appears to be, a potential alignment with the formulation of benefits to be provided by a National Health Insurance Scheme.

The definition is therefore very broad in its scope and application and will include general practitioners and large hospitals in both the public and private sectors.

 

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