The National Department of Health (NDoH) has finally released the long awaited National Health Insurance (NHI) White Paper for public consultation.

The finalised White Paper will be used to inform the drafting of the NHI Bill, which will have to go through both Cabinet and Parliamentary approval. There will also be a process of public consultation on the NHI Bill.

During his speech at the end of the post-Cabinet briefing on Friday 11th December, Health Minister, Dr Aaron Motsoaledi, said that the NHI White Paper lays the foundation for moving South Africa towards universal health coverage through the implementation of NHI. The National Development Plan (NDP) envisions that by 2030 South Africa should have made significant strides in moving towards universal health coverage to realise the vision of a long and healthy life for South Africans.

“NHI is going to be a real transition. This transition is not going to be a sprint, it’s going to be an ultra-marathon that takes place for a very long time,” said Dr Motsoaledi.

 The White Paper states that the NHI will be implemented over a 14-year period and in three phases.

The first phase extends from 2012/13 to 2016/17, which has already seen NHI pilot districts being established in all nine provinces. This phase has largely focused on improving public health service delivery, strengthening of management and governance systems, particularly to improve the quality of health services. According to the White Paper, all health facilities will be inspected and certified by the Office of Health Standards Compliance using agreed upon quality of care norms and standards.

The second phase will extend from 2017/18 to 2019/2021 and will see the population being registered and issued with the NHI card at designated public facilities using the unique identifier linked to the Department of Home Affairs. This phase will also focus on work to develop and implement a risk identification and fraud management system.

In the early stages of phase two, a transitional fund will be established to purchase primary healthcare services from certified and accredited public and private providers at a non-specialist level.

The third and final phase of implementation will take place over the last four years and will focus on ensuring that the NHI Fund is fully functional.

According to the White Paper, the NHI Fund will be a single fund that is used to pay for all health services at private and public sector. The NHI Fund will be financed by compulsory contributions from all citizens and permanent residents and will be used to buy a basket of health services from accredited public and private health institutions and private health practitioners.  As a result, NHI card holders will not be expected to make any out-of-pocket payments such as co-payments and user fees at the point of healthcare delivery.

The White Paper also notes that the number of medical schemes, which currently sits at 88, will be reduced and government medical schemes will be dissolved so that more money is allocated to the NHI Fund. Also, once NHI is fully implemented medical schemes will offer complementary cover to fill gaps in entitlements not offered by the state, such as for cosmetic surgery.

While the release of the White Paper has been largely welcomed, certain concerns have been raised by commentators on NHI, which include financial constraints of already overburdened taxpayers; the possible exodus of medical staff from the private sector to other countries; the poor condition of many state facilities; the lack of properly trained managers; and the lack of trained medical staff willing to work in rural areas.

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