The National Health Insurance Green Paper was published in August 2011. A White Paper followed in December 2015, and the national Department of Health (NDOH) published draft legislation for comment in June 2018, with a closing date for comments in September. The legislation is not before Parliament yet, and it seems unlikely that it will be passed before the election next year. Since National Health Insurance has implications for medical schemes, a draft Medical Schemes Amendment Bill (MSAB) was published at the same time as the National Health Insurance Bill (NHIB).
The release of the Medical Schemes Amendment Bill was not accompanied by an explanatory memorandum, so it is difficult to see what the government is intending to achieve by its provisions. There are some useful provisions in it. Strengthening the governance of medical schemes, an improved complaints procedure, and strengthening the position of children are all measures the HSF supports. On the other hand, there are grounds for concern. The provision for reduced contributions for young adults between the ages of 18 and 30 flies in the face of the principle that healthy people should subsidize those needing more medical assistance. Moreover, the MSAB excludes the Consumer Protection Act from applying to medical schemes matters, and it removes limitations of the waiting period for adults, both reducing rights.
In the HSF’s response to the White Paper on National Health Insurance (to read, click here), we made the point that, given the managerial problems in the public health system, it would be counter-productive to impose the extensive task of creating new links with the National Health Insurance Fund, including contracts between all public health service providers and the Fund. Rather, efforts should be devoted to strengthening existing management. We are particularly alarmed by the Office of Health Standards Compliance 2106/17 report. Only seven out of 851 inspections found health establishments fully compliant with requirements, with a score of above 80%. By contrast 532 establishments were assessed as non-compliant or critically non-compliant, with scores of below 50%. On this showing, most public health service providers would simply be ineligible to enter into contracts with the NHI Fund.
Despite the problems discussed here, and elaborated in our submissions, the government seems determined to press ahead with national health insurance, and promises about it are likely to emerge in the coming election campaign. Accordingly, further developments can be expected during the life of the Sixth Parliament. The views of key constituencies will have to be considered carefully. No system not based on consensus can proceed.
For instance, the treatment of A’s TB reduces the chances of B being infected buy it.
 ‘National Health Insurance’ is a misnomer, but no matter.