The prescripts of the National Health Insurance (NHI) Fund were canvassed in a gazette published on Thursday, 16 May 2024, and in this article, we will provide a comprehensive explainer of its structure.
What is the purpose of the NHI Fund?
The primary purpose of the NHI Fund is to achieve universal access to quality healthcare services for all South African residents.
This initiative aligns with Section 27 of the South African Constitution, which guarantees everyone the right to access healthcare services.
The NHI Fund is designed to pool resources to ensure equitable and efficient utilisation, aiming to reduce disparities in healthcare access and quality.
Additionally, the Fund seeks to prevent unethical and unlawful practices within the healthcare system.
How the fund will be established
The NHI Fund will serve as the single purchaser and payer of healthcare services in South Africa.
It will collect funds through mandatory prepayments from all residents and distribute these funds to healthcare providers.
This system is intended to ensure that all individuals receive the healthcare they need without facing financial hardship at the point of care.
The Fund will work to streamline healthcare services and ensure that resources are used effectively to benefit the entire population.
Who will govern and administer the fund?
The governance and administration of the NHI Fund will be overseen by a Board and a Chief Executive Officer (CEO).
The Board, appointed by the Minister of Health, will provide strategic direction and oversight to ensure the Fund operates effectively and efficiently.
The CEO, also appointed by the Minister based on the Board’s recommendation, will manage the day-to-day operations of the Fund.
Various committees, including technical and advisory groups, will support the Board and CEO by providing expertise in specific areas such as health technology, pricing, and benefits.
How the NHI Fund will be financed
The NHI Fund will be financed through mandatory prepayments made by South African residents.
This funding model aims to pool resources from across the population to provide comprehensive healthcare services to everyone.
Additional sources of funding may include general taxes, payroll taxes, and contributions from various stakeholders.
The Fund will maintain transparent financial records and undergo regular audits to ensure accountability and proper use of resources.
Annual reports will be prepared to inform the public and stakeholders about the Fund’s financial status and operations.
How the NHI Act will be enforced
The NHI Act includes several provisions to ensure its effective implementation and enforcement.
The South African Police Service (SAPS), the Department of Labour, the Department of Infrastructure, and an independent structural engineering firm appointed by the Western Cape Government will conduct official investigations into compliance and related matters.
The Act also includes measures to protect confidential information and outlines penalties for offences.
Additionally, a formal process for handling complaints and appeals has been established to address any grievances related to the Fund’s operations.
Will foreign nationals benefit from the NHI Fund?
The NHI Fund will extend healthcare services to various groups, including South African citizens, permanent residents, refugees, and inmates.
Asylum seekers and illegal foreigners will have access only to emergency medical services and treatment for notifiable conditions.
Children, including those of asylum seekers and illegal foreigners, will be entitled to basic healthcare services.
This inclusion aims to ensure that vulnerable populations receive necessary healthcare while maintaining the focus on South African residents.