NHI Bill set to reshape the medical sector

The National Health Insurance (NHI) Bill would, if passed in its current form, completely disrupt the medical sector and inevitably reshape the role of medical schemes, as well as gap cover.

However, the implementation of the Bill does not necessarily mean that medical aid and gap cover will no longer have a role to play.

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It is important to understand your current cover so when the NHI does come into effect, you can make an informed decision about what would best suit your needs.

Given the potential for the current NHI Bill to face legal challenges, the risk of lengthy court battles cannot be underestimated, as they may inadvertently prolong the uncertainty and affect the timely implementation of essential healthcare reforms.

According to Andre Jacobs, marketing manager at The People Company and vice-chair of the FIA Health exco, these challenges include constitutional, funding, affordability, policy and supply side demand issues.

“There are also conflicting points of information within the current Bill that need to be resolved,” said Jacobs.

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“For example, in Section 33, the Bill states that once NHI is implemented, medical schemes can play a top-up role, which could mean different things.

“It could imply they may only provide cover for anything that is not primary care, or they may only provide specialised dentistry cover or advanced oncology treatment.

“However, if one reads the definition of a health service and a health product with Section 2(a) of the NHI Bill, it states that all health services will be provided by the NHI fund and that they are the single purchaser and provider of health services.

“Therefore, whilst Section 33 provides a role for medical schemes, it would be impossible to operate.”

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The reality is that it is yet to be determined what benefits the NHI Fund will provide.

“This means the role of medical schemes and, therefore, the role of gap cover, is a matter of speculation.

“The structure of the current medical scheme and gap cover range may need to be adjusted to align with the NHI offering that is enacted.

“This may lead to the design of products moving toward a defined benefit structure, where a particular medical intervention, such as a broken leg, has a defined benefit that is paid out irrespective of the amount of cover provided by the NHI.

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“This amount could then be utilised to pay for a private procedure.

“It is also likely that high-cost treatments such as specialised dentistry, or advanced cancer treatment, or biological medicine will not be provided by the NHI fund.

“However, the regulations post-NHI will dictate what can be offered.

“The goal of expanding universal healthcare should be supported, but rather than abolishing private healthcare, South Africa should leverage the private sector to expand the level of universal health cover.”