Dailymaverick logo

Maverick News

This article is more than a year old

Maverick News

NHI fund will take decades to roll out — we answer your burning questions

Daily Maverick readers have sent us many questions — some excited, some anxious about the National Health Insurance fund plans announced on 15 May.
NHI fund will take decades to roll out — we answer your burning questions

We want to stress an important fact. The law’s implementation is years away and its final implementation — when the truly big changes happen — is three decades away. Information is important and understanding vital, but worry is not. In the following months, we will bring you good information and solid facts, taking counsel from the finest thinkers across our country.

In Financial Mail this week, the National Treasury’s Mark Blecher, who has led the team in health financing for years, said he thought it would take three decades to fully implement the NHI. He made it clear that any tax increases required would be funded gradually. What is also clear is that various parts of the law’s implementation will be taken to court by various bodies and that the finalisation of the court battles will also be long drawn out.

Read more in Daily Maverick: Avalanche of litigation likely to follow Wednesday’s signing of contentious NHI Bill

Here are your questions answered.

Question: What was President Cyril Ramaphosa thinking?!


Answer: About power. The ANC is facing a tough election battle — the toughest in 30 years. It will do all it can to win a majority in the 29 May elections. And the final push over the next fortnight is crucial for the party.  You have to understand the passage of the NHI Act in this context. The ANC’s final squeeze is working, as Stephen Grootes reported.

How will the NHI work? Will it improve the quality of healthcare services?


Takudzwa Pongeni reported from the signing ceremony where President Cyril Ramaphosa said the government wants to build a ‘Rolls Royce’ healthcare system for all. He said that (some) South Africans had been fearful of universal suffrage in 1994 and again when the right to strike was enshrined in law, but these fears had proved baseless, as fears about the NHI would too.

Read more in Daily Maverick: ‘We want to build a Rolls-Royce healthcare system for all,’ says Ramaphosa on signing NHI Bill into law

Bhekisisa’s Mia Malan has written an excellent primer on how the NHI will work and its purpose.

Will ANC politicians be prevented from going abroad for treatment?


Unlike the practice in much of our continent, there isn’t a widespread practice of leaders going abroad for treatment because the health systems they create are so bad. South Africa has excellent doctors and great hospitals across the public and private spheres. Political leaders get treatment at the military hospital in Pretoria, and health ministers have made a point of using the public system. Like all civil servants, they belong to the Government Employees Medical Scheme (Gems), the government medical scheme and use the private system. Once fully implemented, Gems will no longer exist in its present form, and neither will all medical aids.

How will the NHI be funded?


The NHI philosophy is to pool all the spending in the private and public health systems which together come to 15% of GDP. It’s still not enough and calculations from Discovery show that the new system will require hefty increases in VAT, personal income tax or corporate income tax.  Some details are included in this article — this is a long, long way off so don’t lose sleep on it yet.

Read more in Daily Maverick: In a surprise move, Ramaphosa to sign NHI Bill into law before 29 May elections

Can I continue to go to my (private sector) doctor?


Yes.  The system will take decades to kick in and once it does, healthcare professionals will register with the NHI and presumably be able to still see their patients. The difference is that you won’t pay your doctor but the NHI Fund will. There are many questions of how this system will work and it will be years before there is clarity.

How will the NHI affect medical aid schemes and private health insurance options? 


Once fully implemented, in about 30 years, medical aids will only be able to offer top-ups to what is offered in the NHI system. The National Treasury says full implementation will take three decades, so don’t lose sleep about it now. “Even when the NHI is ‘fully implemented,’ medical schemes will still be able to provide cover for benefits not covered by the NHI,” wrote Discovery CEO Adrian Gore in a note to members this week.

How will the NHI prevent healthcare corruption? 


We wrote this in 2019 about what the era of State Capture taught us about why the NHI in its current form is so risky for grand corruption.  It’s still true.

Read more in Daily Maverick: Ambitious National Health Insurance plan stalked by the shadow of State Capture 

South Africans are punch-drunk with corruption in the general governing system and also in the public healthcare system. This explains why trust levels on the announcement of the NHI law this week revealed themselves to be so low. We have suffered through the Sarafina Aids play when hundreds of millions of rands were lost; the ignominies of the Aids denial era, which saw health leaders toying with quacks selling Virodene and with health ministers touting garlic, lemon and beetroot as cures for Aids. More recently, Daily Maverick has revealed the Digital Vibes scandal, where funds meant to communicate the NHI were misappropriated by the Health Department and, of course, the theft of billions meant to fight Covid-19.  See the full Digital Vibes story here.

The murder of Gauteng health official Babita Deokaran has also revealed the layers of graft in provincial health procurement systems as Jeff Wicks has shown in News24.  See his documentary Silenced here.

There is ample reason to be very sceptical of our government’s ability to ensure the NHI does not become a huge feeding trough. We also have a very strong civil society, media, and judiciary that has repeatedly stopped health corruption. Hope, trust, and solidarity are important currencies to hold at this time. DM

Subscribe to Your Questions Answered, our monthly newsletter, where Ferial Haffajee addresses your inquiries and provides insightful answers to your pressing questions.

Comments

Tim Price May 16, 2024, 02:20 PM

The Dunning -Kruger effect is palpable in Ramasofa and the rest of his beaming incompetent ministers. I wonder how much opportunity for corruption there will be as it is implemented, never mind once its actually operational...

mfsw May 16, 2024, 02:23 PM

Ferial, do you honestly believe that the tax paying population of this country must remain in limbo for the next 30 years to see if the NHI is fundable from the tax base? Universal medical coverage in the UK and Canada to name some has relied on poaching medical staff from other countries who do not have and never will have, like South Africa the tax base to afford a national health insurance. The whole approach to socialized health care is incorrect because there is no incentive whatsoever for individual to be proactive about their health such as dont smoke or severely limit your drinking of alcohol. Recently in the The Daily Mail UK it was stated by the NHS that if Britains ate fish once a week it would result in a GDP 70 million saving to the NHS. I have a problem sharing the burden of ill health from someone else who simply is self destructive in their eating habits and exercise regime.

ST ST May 16, 2024, 04:59 PM

It is true about not wanting to subsidise others bad habits. No one does. But it’s simplistic in my view. We assume: 1. That there’s nothing we do that puts our lives at risk. Unlikely. 2. That we will always use what WE contribute and not dip into others contributions who may be well at the time you’re gravely ill with something that costs R50k a month to manage. Hopefully both unlikely 3. That the ‘unsocialised’ version is better and fairer. Not true. The US has some of the most expensive if not the most expensive with not much to show for it in terms of quality and value for money. A lot of administrators must paid before you get your cut..amongst other things. Some of people who argued against Obamacare are the people who probably needed it the most. Arguments likely based on ideology than logic. We would have to save several lifetimes earnings to have enough to pay for all healthcare eventualities. People in the US and SA know it when the medical aid cuts care coz moneys run out. People in the UK know it especially when they learn about other systems. We all depend on eachother.

mfsw May 17, 2024, 07:42 AM

Your point 3 does not resonate with my experience in South Africa of medical aids over the last fifty years of working. Leave the USA out of the debate it is irrelevant. Schemes like Discovery and Momentum Health have gone out of their way to promote the adage the Prevention is better than Cure.

Kanu Sukha May 16, 2024, 08:17 PM

Given that "fish and chips" is Britons staple food, and not just consumed once a week .. they should have spare money from the billions they save .. to fund the health services of other countries ? Unless it is the "chips" that is the problem ?

Hidden Name May 16, 2024, 02:27 PM

So your answer to everything is dont worry - its 30 years away? Thats a terrible answer. The fact that this travesty was ever even considered to be viable is what we should all be worrying about. Its clear the legislation is contrary to the constitution and will be shot down in its current form. What needs to happen is that a CLEAR, UNAMBIGUOUS message needs to be delivered to the ANC and all the other half wits who think this is a workable, moral idea. Its not. Wrecking working systems in the name of helping the destitute is just stupid. Further crippling your tax payer base is extremely stupid. Rather focus on fixing the damned economy than pursuing any more hairbrained schemes.

Graeme May 16, 2024, 04:23 PM

I think you miss Ms Haffajee's point. The ANC isn't going to be in power in 30 years. And the NHI isn't going to exist either.

Pet Bug May 16, 2024, 07:51 PM

I’m not that sure. For anyone now in their twenties and slowly getting round to thinking of their future, - in thirty years time they’ll be in their fifties. Just about the time they will be really thinking about what their golden years will hold in store for them - and health insurance wise, most definitely not anything good. We will see the biggest loss of bright young things this country has ever seen. Thereafter a country with only a connected super-wealthy elite - and desperately poor 100 million people. No middle class, no aspirations, nothing. A friend returned from Zimbabwe last week and that was his observation. And that really scared. So the author might want to start panicking right about now.

Sid Peimer May 16, 2024, 02:34 PM

It's not that the NHI as a disruptive system is the concern. It's just the lengths the ANC will go to, to stay in power. If he was serious about improving healthcare for all, he would do something serious. It's not the bill. In the same way that the visit to Iran coincided with their bailout from bankruptcy, and the same move that the German Nationalist Socialist Party did in the 1930's: find a reason for everyone's problem: the Jew. We are headed for an ANC/EFF coalition. So when asked what I felt about the upcoming election, I responded with "Sad".

BillyBumhe May 16, 2024, 02:38 PM

This article fails to address the elephants in the room in any meaningful way. One of the major concerns would lie in the fact that the private sector will mostly likely end down investment at this juncture because there is no certainty about whether the prices the NHI will dictate to providers will be fair or sustainable. The answer to Will ANC politicians be prevented from going abroad for treatment? is terrible. We know Zuma and Mabuza were going to Russia for treatment all the time. You can be sure that the ANC cadres and crooks will not suffer with the rest of the population when the NHI turns into a train wreck. It's a weak article all around.

Sid Peimer May 16, 2024, 02:41 PM

When you want to buy a fancy car, you first save the money before signing the bill. If you want to build a 'world class' healthcare system - you first build it , and then you sign the bill. But we don't see that faux pas - no wonder South Africans have the worst savings rate in the world. We spend before we've earned it. As demonstrated so aptly by our President.

Kevin Schaafsma May 16, 2024, 02:45 PM

How does the government oven to keep medical specialists in the country? I foresee an exodus of specialists out of the country over the next few years to the point where we will have virtually none left. We will be left with a primary healthcare system only. And if course a massive pot of money called NHI is without doubt going to be looted just like the coffers of all government departments, SOE's and the RAF. Look what happened to the COVID fund despite assurances by Mr Ramaphosa that there would be no corruption, that was the first thing that happened.

tshiggo May 16, 2024, 03:15 PM

Ferial... Whether it's 30 days or 30 years away, the looting spree has already commenced... just read the news about the theft that led to the assassination of a whistleblower... Those who hired the hitman remain employed. .. . This years budget set aside R1 billion for ANC recruited cadres to be appointed to "prepare"... Meanwhile thousands of qualified doctors remain unemployed because the ANC government has "no money".

Robert de Vos May 16, 2024, 03:55 PM

I think when making decisions on this kind of thing, one has to use some form of context; has the ANC been successful in any major venture in the economy, like Eskom, Denel, SAA, the SABC, Transnet, the Post Office etc. etc? The obvious answer is a resounding NO! So why should they make a success of this? Or is it simply another promise to beguile the witless voter? Of course it is. Concluding with, Zimbabwe 2.0 here we come!

wonston.popsandogi May 16, 2024, 04:03 PM

genius ! another fund to loot. MS Haffajee says it will thirty years ,thirty the magic number it took the ANC to destroy the country. this time, I think, it will be less .losing the election is not too problematic , except there will be more snouts at the feeding trough ,the coalition partners. there is nothing left for another thirty years.

rwcurtis May 16, 2024, 04:03 PM

In 30 years' time there won't be sufficient taxpayers left to purchase more than 20 bedpans per year. This is cloud cuckoo land stuff, which only the dimwits who form the bulk of the current electorate could possibly expect to work. As for the timing of the signing - as disgraceful as anything else this egregious government has inflicted on the population.

rderooy May 16, 2024, 04:22 PM

Of course, signing the NHO is an election stunt to gain votes, but coming from the ruling (for now) party, it's now (as my kids would say) "a thing." Whether it takes thirty years is cold comfort to the children who will now choose careers with promise for a better future, and not the prospect of being nurses or doctors dependant on a corrupt state bureaucracy for their working conditions and their payment. But of course, it matters not to those at the trough, as their concerns are immediate; staying in power, the tenders, the blue lights and the buffets.

jcscholtz123 May 16, 2024, 05:49 PM

Hah. It took the ANC 30 years to destroy most of the public infrastructure. Another 30 and most of the private bits will be gone also

Geoff Coles May 16, 2024, 06:02 PM

I take any assurances from Ferial with a pinch of salt

reinhard.hiller May 16, 2024, 06:14 PM

I think the majority of commentators are blissfully naive about the degree of stupidity and Machiavellian desire in the ruling party. The prevalent narrative about this has been: 'it will never come'. Now, it has, and the commentariat explains how and why it'll take decades to implement - as if this will make anything better. You have just been told that you must hand over your house and car to the government. But, don't worry, they only gonna come for it in 10-15 years. Great stuff... The other argument is that the thieves may not be around at that time, to collect their loot. Well, that is assuming that whoever comes in their stead is competent and not as mischievous. Assumptions, assumptions... The uncertainty alone this inflicts on health care will be perilous for a sector that is already under severe strain. Good night and good luck to the ones who are growing old right now in SA and will want to rely on quality health care in the sunset days of their lives. You will not go gentle into that good night...

Denise Smit May 17, 2024, 07:43 AM

Where does the writer get the information that the ministers go to the Military and State Hospitals and doctors? This is just not true. Some may, but it is suggested in the article that all do. What is the writer trying to do, blind us to the truth?

William Stucke May 18, 2024, 07:44 PM

Of course she. We're talking about Ferial Haffajee here, committed ANC supporter and regalia wearer and a senior person at DM, which in our naive innocence we once believed to be independent.

Denise Smit May 17, 2024, 07:53 AM

I suggest all politicians and rosy eyed journalist from now on go to Charlotte Makxekhe Hospital and the cancer units of state Hospital for treatment if the become sick and get cancer

Pieter van de Venter May 17, 2024, 11:29 AM

I will ask again - What is the difference between the current provincial hospital and municipal clinic model and the "new NHI" in terms of the new buzz term "Universal Health Coverage" as propagated by the WHO. According to their own description "Universal health coverage (UHC) means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship" Please tell me how the current model (besides the ANC and cadres effect) falls short of this "noble new" approach. We have had this for decades, or am I mad? It should me my choice to spend my money on a medical aid - not some fat cat politician.

Gretha Erasmus May 17, 2024, 07:53 PM

The biggest lie the ANC keeps repeating is that opposition to this particular NHI equates opposition to universal health care. There are many better ways to improve health care coverage in countries like ours. This NHI bill is not it.