• Government has proposed new legislation which paves the way for National Health Insurance (NHI).
  • This will probably mean that by 2022, all South Africans will become members of the NHI fund.
  • This could mean massive changes to the way you will be able to access doctors, and specialists in particular.


Ultimately, the entire South African healthcare system will be overhauled with the introduction of two new proposed bills – the National Health Insurance (NHI) Bill and the Medical Schemes Amendment Bill – this week.

The bills are open for public comment for the next three months, and may look different in their final iteration.

But while the details remain sketchy, it is certain that the new legislation will mean the end of medical schemes as we know them by 2022, when the NHI is expected to kick in.  

These are the expected ways it could affect you:

1.       You will become a member of the NHI Fund.

This will be a massive state-run medical scheme, and all South Africans will be members – you won’t have a choice.

2.       If you earn an income, you will contribute towards the NHI fund.

It has not yet been decided how this will be deducted; it could be a monthly membership contribution, or a tax on your income, says Neil Kirby, director of Werksmans Attorneys. Previously it was speculated that a “NHI tax” of between 3.5% and 5% could be levied on your salary.

3.       All contributions will go into a pool.

Government will use the money to buy healthcare from public and private doctors, specialists, and hospitals that are accredited with the state. If the contributions aren’t enough, government is expected to pay the rest.

4.       The fund will cover a range of medical services, treatments, and procedures.

“(For now), the range of medical services, treatment and procedures remains unknown," says Kirby. But you will get all of these for free, without any co-payments.

5.       You will probably have to register with a GP who is contracted with the state.

Each contracted GP may have a set number of patients who they will “service” for the NHI Fund. You could be limited to how often you see a GP.

6.       There will be strict rules about seeing specialists.

You won’t be able to go directly to a specialist, but will have to get a referral first. A visit to specialists, like paediatricians or gynaecologists, may require longer waiting lists, as all South Africans – including the 83% of the population who are not currently medical scheme members – will now have access to private-sector specialists.

It could also, for example, mean far fewer Caesarean sections in South Africa, as the health system is expected to rely more on non-specialists like midwives. In 2017, some 69% of South African babies were delivered via C-section in private hospitals. (The World Health Organisation advises a maximum of 15%, and in public hospitals, only 26% of births are C-sections.) Also, you may not be able to get easy access to a private hospital that is accredited with the state, given that more people will be admitted.

7.       Wealthier people will probably remain members of private medical schemes – on top of their NHI contribution every month.

This will give them access to specialists and help them avoid waiting lists for hospital procedures. But they probably won’t earn tax deductions for medical contributions. Also, new specific types of top-up medical schemes – for orthodontics, or for cancer treatment – will probably be created.

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