South Africans warned not to cancel their medical aid

Despite President Cyril Ramaphosa signing the National Health Insurance (NHI) Bill into law, South Africans are advised to keep their medical aid due to concerns about doctor availability, coverage clarity, and potential disruption during implementation.

This is the view of Consult by Momentum’s franchise principal and financial adviser, Shaun Meintjes, who said the goal of equitable healthcare is extremely important 

The NHI Act, signed into law earlier this month, provides a framework for providing universal care through a state-run fund and will ban the private sector from financing treatment covered under the plan. 

“South Africa has committed to implement universal health coverage for all, with the desired outcome being that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship,” Meintjes said.

The NHI is a fund from which the government will buy healthcare services for South Africans from providers in the public and private sectors.

“The purpose of the NHI is to make healthcare more affordable by reducing the cost of healthcare for all,” he explained. 

“It acts like a medical aid for everyone, and South Africans will contribute to this fund through taxes and special contributions in line with what they can afford.” 

“It will ensure that everyone is entitled to free healthcare when they need it. There will be no fees charged at the health facility because the fund will cover the costs of care.”

Meintjes said the goal of equitable healthcare is extremely important and something South Africa should work towards. However, there are a couple of concerns with the NHI Bill in its current form.

The NHI Act dictates that medical health schemes will not be able to offer any services covered by the NHI and will only be able to provide complementary or top-up cover that does not overlap with that which is already provided by the NHI.

Meintjes said that, as a result, health professionals fear that the NHI will pose a threat to private health insurers, who are still not sure exactly which treatments, health products and services will continue to fall under them and which will be covered by the NHI. 

In its current form, the legislation has also been rejected by the South African Medical Association, multiple court cases have been launched against it, and different voices, mostly in the political sphere, have been raised, warning of its pitfalls.

Meintjes, who has over a decade’s worth of medical health experience, said South Africans should not view the NHI as a quick-fix solution to the current state of the South African health sector.

“If you can afford it, I would strongly caution against cancelling your current medical health cover any time soon,” he said.

Meintjes gave the following four reasons for this –

1. A worrying doctor-patient ratio – The current estimated ratio in the public health sector is one doctor to around 2,457 patients, while in the private health sector, the estimated ratio is one doctor to 571 patients. With the introduction of NHI – and people rushing to cancel private medical health coverage – these ratios might only worsen, as there remain insufficient resources to meet the needs of all South Africans. He said there is a real risk of overburdening the system, leading to longer wait times, decreased attention to individual patients, and potentially a diminished quality of care.

2. Lack of clarity around what the NHI covers – Currently, there is no clear definition of services covered by the NHI, and it appears that this definition will only be expanded on an incremental benefit and geographic basis. Because so many important aspects are still unclear, the NHI will likely take many years to be fully implemented. Those with specialised healthcare needs may find that their treatments or procedures are not adequately covered under the NHI, especially in its early stages. This could result in individuals having to seek out-of-pocket payments or forgo necessary medical interventions, potentially worsening their health outcomes.

3. Administrative complexity – The transition period from private medical schemes to the NHI may introduce administrative complexities and uncertainties. Members may face challenges in accessing the same level of care they were accustomed to under their private medical schemes, especially during the initial stages of implementation.

4. A possible slowdown in innovation – The potential impact on healthcare innovation and medical technology advancement is a significant concern. Private medical schemes often drive innovation by investing in cutting-edge treatments and technologies. With a shift towards a single-payer system like the NHI, there may be less incentive for innovation, ultimately limiting access to the latest medical advancements for South Africans.

Meintjes said there is still a great deal of uncertainty around the NHI’s roll-out, and this ambiguity is expected to persist in the near future. 

“I would advise holding onto your cover while any teething pains are addressed over the coming months or possibly years, ensuring that you have access to quality healthcare when you need it,” he said.