Currently, 84% of South Africans are dependent on the state's health services, while the remaining 16% who can afford it or can afford medical aid schemes make use of private medical care. However, skilled professionals follow the financial resources, and according to the Department of Health, 80% of medical specialists in the country are in the private sector.
NHI will create a single pool of healthcare funding for private and public healthcare providers. The NHI Fund will pay public and private healthcare providers on the same basis and expect the same standard of care from both. This would allow people in lower income groups to consult doctors in private practice and use private hospitals and vice versa, with NHI picking up the bill. This will spread the burden of care more equally across the private and public sectors.
The Bill doesn’t specify what services the NHI would cover, but it does mention that there will be "comprehensive healthcare services". These services will be available for free, so there will be no co payments. The money will be collected "in accordance with social solidarity" through payroll taxes for employees and employers, a surcharge on personal income tax, the reallocation of medical scheme tax credits and general taxes.
Our public healthcare system as it is, often fails those who use it not because of a lack of resources, but rather because of poor management and poor use of resources. The issue whether the NHI system can meet the demand if opened to all may be the inevitable contestation about who will ultimately ensure that the country's healthcare system is achieving higher healthcare standards that are merit based appointments, strict accountability for poor performance, and effective action against corruption and wasteful spending.