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What Is The National Health Insurance In South Africa

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Overview Of South Africas Healthcare System

South Africa National Health Insurance Plan

South Africa does not have universal healthcare. Instead, a private healthcare system and a public healthcare system operate beside each other. The majority of the public, up to 80% of the population, relies on the public system for their care. Fees are determined by using the Uniform Patient Fee Schedule or UPFS as a guide for billing and payments. This system categorizes the different fees for every kind of patient and medical situation.

There are three categories of patients under the UPFS system. Full paying patients are either being treated by a private physician, are externally funded, or are non-citizens. Partially subsidized patients are eligible to have the cost of their care partially covered on the basis of their income. Finally, fully subsidized patients are those who are referred to a hospital by the Primary Healthcare Services. Additionally, there are also some occasions in which certain medical services are free.

African Vision And Eye Health

1School of Interdisciplinary Research and Graduate Studies, University of South Africa, South Africa

Correspondence to:

PO Box 392, Pretoria 0003, South Africa

Dates:Published: 30 Apr. 2015

How to cite this article: Sithole HL. An overview of the National Health Insurance and its possible impact on eye healthcare services in South Africa. Afr. Vision Eye Health. 2015 74, Art. #18, 6 pages.

Copyright Notice:© 2015. The Author. Licensee: AOSIS OpenJournals.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution,and reproduction in any medium, provided the original work is properly cited.

An overview of the National Health Insurance and its possible impact on eye healthcare services in South Africa
In This Original Research…



The National Health Plan for South Africa


The National Health Insurance and eye care


According to the South African Department of Health,8 the NHI will be implemented over a period of 14 years and in three phases. During the implementation phases, the NHI will cover five key areas that are integral to its success. These key areas will also have a direct bearing on how eye care services in South Africa will be delivered, and include the following aspects:

Service provisionPopulation coverageFinancingGovernanceInstitutional arrangements


Current progressChallenges

What You Need To Know About Processes

Registering for healthcare in South Africa is straightforward. You can sign up at your local doctors clinic. You just need to fill out a form, provide your address, personal identification, and proof of address. There is no monthly fee nor payroll deductions. Patients pay according to the Uniform Patient Fee Schedule.

The Uniform Patient Fee Schedule acts as a kind of sliding scale. That means that low income and unemployed individuals pay only a modest fee for their treatment. Expats are considered to be in a high-income bracket. As a result, theyre responsible for paying their healthcare costs out of pocket at public hospitals.

However, all this is expected to change if the proposed National Health Insurance plan is put into place. The NHI is expected to rely on funds from general taxation and some kind of patient contribution, possibly a payroll deduction. In the future, the public healthcare system might look very different in South Africa.

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What Will It Cost

Again, there is no exact projection, but government mentions a figure of R125 billion in the first year and R214 billion in 2020. With taxpayers expected to spend less on medical insurance, raising this amount should be an attainable goal. But the policy document notes, No amount of money will be sufficient to ensure sustainability of National Health Insurance, Not unless the countrys healthcare systems undergo radical surgery to address systemic shortcomings.

The Treasury and the South Africa Revenue Service have their work cut out coming up with the tax figure to be levied on individuals and collecting it. One of the strategies suggested in the NHI policy document to achieve the ambitious collection target is to widen the revenue base as much as possible. This would mean that individual contributions would be lower.

The government-owned NHI fund will run the scheme, which will fall under the ministry of health.

How Does Private Health Insurance Work

NHI prompts decline in private healthcare share price ...

Private health insurance providers in South Africa are regulated by the Medical Schemes Act, and healthcare packages are available for individuals and families.

In some industries, health insurance is offered as an employee benefit, with the costs shared between the employer and employee.

Some insurers prefer their customers to give notice before getting treatment, and your provider might offer rewards if you lower their likely liability by exercising or having regular medical check-ups.

With so many different options available, it is important that you take your time to find the right provider some have a better reputation when it comes to paying out than others. Once you have signed up for a plan you should get a healthcare card you will need to show this when applying to see doctors or specialists.

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Other Forms Of Healthcare In South Africa

Traditional medicine still plays a large part in South African healthcare. In fact, around 80% of the local population report using a traditional healer for some form of health issue usage rates are even higher in rural areas.

Healers, as well as other alternative and complementary therapists in South Africa, are regulated by the 1982 Associated Health Service Professions Act. All healers and therapists must be licensed and registered, holding the relevant qualifications.

As well as traditional South African healers, you can find various different forms of alternative medicine in South Africa including:

  • homeopathy
  • chiropractic
  • naturopathy

Most private insurance packages dont include alternative and complementary medicine as part of their standard package. If you want coverage for this, you will need to shop around and find a provider who is willing to offer it as an add-on.

The Bottom Line The Status Quo Is Unacceptable

Finally, there is also an understandable lack of trust in government when it comes to managing and legitimate governance concerns given the last decade of extensive misuse of public funds and weak governance. But this should not prevent efforts to make substantial progress towards fulfilling the Constitutional commitment that everyone has the right to have access to healthcare services.

Instead, the focus should be on how to ensure good governance. Governance and accountability structures should not only be seen to be important at the level of the NHI Fund but also at the service-delivery and management levels.

The health system status quo is not acceptable 25 years since our first democratic elections, very little has changed for the worst-off in our society. Indeed, inequalities in income and across many sectors have increased. Taking explicit policy steps to move towards a universal healthcare system will not only improve access to quality healthcare for all but will contribute to the redistributive agenda of the country.

We must recognise that many of the criticisms of the proposed reforms are coming from the perspective of seeking to protect vested interests or a privileged position and are generally at odds with the principle of social solidarity that underpins universal healthcare.

The focus of the public conversation should be firmly centred on how best to achieve a universal healthcare system.

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Doctors And Specialists In South Africa

Doctors and specialists work both publicly and privately in South Africa. Private doctors work out of individual or group practices, clinics, day centers, and hospitals. Private consultation costs are around R350-400, compared to around R55 through state healthcare.

If you have private health insurance, you will be able to choose your own doctor. You will also likely have a shorter waiting time for an appointment and should be able to access specialist healthcare without a referral.

Major cities in South Africa boast many private healthcare facilities from day clinics to large medical centers, which are affiliated with the private hospitals. As a fee-paying customer, you should be able to see your doctor or a specialist quickly rather than waiting a number of weeks.

For more information and advice, read our full guide to doctors in South Africa.

South Africa Puts Initial Universal Healthcare Cost At $17 Billion

South Africa healthcare: Health minister pushes for national insurance scheme

By Onke Ngcuka

4 Min Read

PRETORIA – South Africa published its draft National Health Insurance bill on Thursday, with one senior official estimating universal healthcare for millions of poorer citizens would cost about 256 billion rand to implement by 2022.

The bill creating an NHI Fund paves the way for a comprehensive overhaul of South Africas health system that would be one of the biggest policy changes since the ruling African National Congress ended white minority rule in 1994.

The existing health system in Africas most industrialized economy reflects broader racial and social inequalities that persist more than two decades after apartheid ended.

Less than 20 percent of South Africas population of 58 million can afford private healthcare, while a majority of poor blacks queue at understaffed state hospitals short of equipment.

Anban Pillay, deputy director general at the health department, told reporters an initial Treasury estimate of 206 billion rand costs by 2022 was more likely to be 256 billion rand by the time final numbers had been reviewed.

The bill proposes that the NHI Fund, with a board and chief executive officer, also be funded from additional taxes.

The day we have all been waiting for has arrived: today the National Health Insurance Bill is being introduced in parliament, said Health Minister Zweli Mkhize at the briefing, adding that the pooling of existing public funds should help reduce costs.


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The National Health Insurance Fund

In the last few years, the South African government has been pushing forward plans to set up a new state healthcare system, called the National Health Insurance fund . The government says the new system would create a higher healthcare budget and offer better standards of care for residents.

The NHI would involve combining public and private healthcare systems into one organisation. Critics say that introducing a new system would be highly complicated and would mean raising taxes at this stage a full roll out seems years away.

In August 2019, a report by The South African found that the cost of bringing in NHI could be anything from R165bn to R259bn meaning that individual taxpayers would need to contribute from between R7,850 and R12,300.

Refugees And Asylum Seekers

The South African Constitution guarantees everyone “access to health care services” and states that “no one may be refused emergency medical treatment.” Hence, all South African residents, including refugees and asylum seekers, are entitled to access to health care services.

A Department of Health directive stated that all refugees and asylum seekers â without the need for a permit or a South African identity document â should have access to free anti-retroviral treatment at all public health care providers.

The Refugee Act entitles migrants to full legal protection under the Bill of Rights as well as the same basic health care services which inhabitants of South Africa receive.

Although infectious diseases “as prescribed from time to time” does bar entry, grant of temporary and permanent residence permits according to the Immigration Act, this does not include an infection with HIV and therefore migrants cannot be declined entry or medical treatment based on their HIV status.

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The National Health Insurance System In South Africa

South Africas healthcare system could change dramatically in the coming years. The government is working to establish a national health insurance system. This change is meant to address inequalities in care among different socio-economic groups. It also intends to make healthcare more affordable for everyone. At present, however, this is still in the very preliminary stages of development.

How Will It Work

Statements â Page 2 â South African Federation of Trade ...

The crux of National Health Insurance is that the higher income earners would pay for other South Africans to access healthcare. They would have to do so through higher taxation. The health ministry must still work out a threshold above which the extra tax applies, or how much this extra tax will be.

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Criticism Of National Health Insurance In South Africa

There has been much Criticism of National Health Insurance in South Africa, a proposed new government policy that has been heavily condemned by many people.

The National Health Insurance is a proposed financing system whose stated purpose is to give SA citizens essential healthcare, regardless of their employment status and ability to make a direct monetary contribution to the NHI Fund.

Criticism of National Health Insurance has increased dramatically in the past week. The NHI has attracted a huge amount of disdain and condemnation from many different sectors of society. Generally, people accuse it of being an attempt to solve government corruption and inefficiency by raiding the private sector. Below is a selection of recent criticisms of the proposed NHI bill.

What Will Happen Between Now And When The Nhi Starts

Before it can become a law, the NHI Bill must be passed by Parliament. In the next five years governments efforts will be concentrated on preparing the NHI infrastructure that will administer the fund and provide services.

At the same time government will give priority to attention to refurbishing clinics and hospitals, train and employ more staff, improve the quality of health care, implement systems to ensure that medicines do not run out of stock in our facilities, and ensure that the maladministration and corruption is uprooted so that all facilities will be ready for the NHI.

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This Is Why Health Funding In South Africa Right Now Just Doesnt Work

Once the reforms are fully implemented, medical schemes will only provide complimentary cover, i.e. cover services not funded under the universal health system, such as elective caesarean section deliveries. The intention of a single NHI Fund is to reduce fragmentation in funding pools for healthcare to maximise income and risk-cross-subsidies.

Currently, the money South Africa uses to buy healthcare sits in several different pockets or pools across dozens of individual medical schemes and also in the public purse. When money is split like this over many, smaller pools that in the case of medical schemes are accessible only to a privileged few this limits any one pools ability to enable cross-subsidisation based on income or risk.

In other words, with so many different pots of money the country is unable to effectively use funds from the rich to help cover the poor or payment from more healthy people to offset costs incurred by those of us who are sicker.

But when a single body like an NHI Fund purchases services for the whole population, international experience shows it comes with very low administration costs. In South Koreas model, administration costs amounted to 3.6% of total health expenditure. In Thailand, the figure was less than half that, shows research published in 2016 in the South African Medical Journal.

How Does It Work

National Health Insurance South Africa and the concerns

The NHI will buy quality healthcare services on behalf of the people of South Africa. These services will be provided by healthcare professionals and providers in the public and private health care facilities and will integrate them into one health care system that serves the needs of all South Africans.

NHI will combine the many public and private health care funds into one fund that will pay for everyone when they need to access health care using the advantage of the size of the fund to reduce health care costs.

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The Healthcare System In South Africa

There is a two-tier healthcare system in South Africa with a large subsidized public sector and a small, but very high quality, private sector. With significant funding and the best specialists going to the private sector, there is a major gap between public and private healthcare facilities in much of the country. This means that while reduced price healthcare is on offer to the lowest earners in the public sector, it is still highly advisable for expats to take out a private plan.

Healthcare in South Africa is administrated by the Department of Health. Around 80% of the population uses public healthcare, with the wealthiest 20% opting for private healthcare.

South Africa ranks 49th out of 89 countries on the 2019 Global Healthcare Index. It is the highest-ranked African country, although it ranked below countries such as India, Sri Lanka, and the Philippines. According to 2018 figures, life expectancy is 61.1 years for men and 67.3 years for women . Its infant mortality rate has declined to 36.4 per 1,000 live births this is above the World Health Organization global average of 29 per 1,000 births.

What About Medical Aids

Medical aids will still exist, but will not be able to offer cover for the same services as the NHI.

I have medical aid because I dont want to wait in queues or be seen in a dirty public hospital. Can NHI guarantee the same standard of care if i stop my medical aid??

Government will upgrade all facilities to ensure that there is no difference between a public and private facility all NHI facilities have to be the same standard because they will have to follow the rules of the Office of Health standards Compliance to be part of the NHI.

The objective is to ensure that the queues are reduced and facilities will be clean, providing safe health care services.

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