EXPLAINER | National Health Insurance: What benefit; for whom, where and how? | Business

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What will the taxpayer get for their 'mandatory prepayment' into the National Health Insurance fund? Neil Kirby and Helen Michael explain.

As has widely been reported in the media, the National Health Insurance Bill[1] or the bill has been passed by Parliament.

un-usefully sub-clause of the definition simply refers to"health care services". However, sub-clause also refers particularly to both reproductive health and emergency medical treatment;medical treatment for those incarcerated; andThe term"basic health care service" is also provided with a dedicated definition in clause 1 of the bill.

…health care services that are managed so as to ensure a continuation of health promotion, disease prevention, diagnosis, treatment and management, rehabilitation and palliative care services across the different levels and sites of care within the health system in accordance with needs of users. In order, potentially, to understand the application of the various definitions referred to above, one would turn, primarily, to the powers of the Benefits Advisory Committee in order to understand what it is precisely that the committee will be determining as a basket of benefits for users.

Nowhere in clause 25 is there a reference to the various definitions of services provided for in clause 1 other than for a health care service. Therefore, one is left with a distinct sense of dis-ease with what the mandate of the Benefits Advisory Committee is going to be when formulating the benefits that the scheme is to reimburse or not, as the case may be.

the deletion from the definition of"relevant health service" of sub-section , which currently allows medical schemes to provide for cover for"the giving of advice in relation to, or treatment of, any condition arising out of a pregnancy or the termination thereof". Therefore, only the fund will be entitled to reimburse for such benefits.

 

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