Sleep paralysis, but the demon at the foot of your bed watching your sleep is the dreaded National Health Insurance Bill. This is how many South Africans have felt about the looming NHI, and earlier this week, Cabinet approved it.

Shudder. 

According to Minister in the Presidency, Jackson Mthembu, input received during public consultation on the Bill last year has been incorporated into this latest version, and it is expected to be tabled for scrutiny-by-parliament before the end of 2019. 

Mthembu went on to state that the new health system will be based on values of justice, fairness and social solidarity, and that the NHI will provide universal quality healthcare services to all South Africans, irrespective of socio-economic background.  

While this sounds fantastic, and will no doubt be of great value to those who can’t afford quality healthcare, it’s worth recapping exactly why the previous version of this Bill was outright rejected by Cabinet last year. 

And then, we’ll have a look at some of the changes that have been implemented.

There were several concerns surrounding the previous version of the NHI Bill, which was mercifully rejected last year. Here’s what you need to know:

Payment and registration for the NHI would be compulsory to all South Africans.

The government was planning on banning medical aids altogether (currently providing cover to around nine million people), or at the very least only permitting medical aids to cover services not being offered through the NHI. This would not only eliminate our right to choose our own healthcare, but completely remove access to high-quality healthcare for those able afford it. 

Not only is the idea of your health, and the health of your loved ones, being entirely at the mercy of the government a notion too terrifying to live with, but it would also put highly-skilled private practitioners under even further financial strain, and will inevitably force them to leave the country and seek stable work elsewhere.

The Department of Health also wanted to regulate provincial health budgets, meaning that regional departments will no longer be able to operate their own, independent healthcare systems.

According to a report released by the Office of Health Standards and Compliance (OHSC) last year, 308 of our public healthcare facilities are non-compliant and 224 facilities are critically non-compliant with the set standards. This means, essentially, that people go to public healthcare facilities to die, and that this is the standard of healthcare that all South Africans can look forward to.

Concerns were also raised about how the NHI will be funded, given that the costs associated with the implementation of such a system have been wildly understated.

Our new Minister of Health, Dr Zweli Mkhize, revealed some details about the NHI in his speech to parliament last week.

“NHI will require a digital health platform that will support the operations of the NHI Fund, and work has already commenced in this regard.”

According to Mkhize, over 42.6 million South Africans have already been enrolled in the Health Patient Registration System, with the remainder of the population due to be registered by the end of this financial year. All new children born will be automatically registered on the NHI patient register upon being registered with Home Affairs. 

Over thirty managers, at various levels of the health system, have been identified and will receive training over the next month. These managers, according to the Minister of Health, will learn all about how ‘NHI is implemented from different parts of the world to ensure sustainability of implementation.’

Right. So, nothing about their actual jobs then. Colour us comforted. 

It has also been suggested that medical aid premiums, paid by those who own medical aid, will be pooled into a single government-run fund and all the money available for healthcare will be shared among all people of South Africa. 

The health benefits that you receive, according to Mkhize, will depend on how sick you are and not on how wealthy you are. Hospitals will not be divided into public or private facilities – all hospitals, clinics, doctors, specialists, dentists, nurses and all other health workers will provide equal services to all.

But, all the public hospitals are underfunded, mismanaged, ill-equipped, dilapidated, understaffed and prone to kill, right? Mkhize has answers. 

‘Creative financing’ will be found to fix these rundown, probably-haunted-by-the-ghosts-of-patients-accidentally-killed-by-incompetent-nurses, hospitals and clinics. Money that had been allocated to fix these hospitals was grossly inadequate, said Mkhize, and other solutions need to be found.  

There is still no word on exactly how the NHI will be funded, but we do know that there isn’t nearly enough money – or staff – to avoid disaster. We reportedly require over 4000 doctors and just under 4000 nurses to fill already-vacant slots in our healthcare system, while we’re inundated with people with a love for paperwork.  

It’s not all doom and gloom, though, for lo and behold, there is reportedly an app being developed for patients to report when medicines are out of stock at their clinic or hospitals. 

The day is truly saved. 

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