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