Health minister Dr. Zweli Mkhize officially released the NHI Bill to the public in Pretoria this morning ahead of its presentation to Parliament.

The much-vaunted and long-awaited National Health Insurance Bill aims to contain the cost of comprehensive public health care by prioritising primary and preventative services.

The bill is the first piece of legislation towards realising the government’s plan for universal health care and aims to ensure that all those who qualify receive free health care of a professional standard within a reasonable time. 

The proposed new law introduces a “gatekeeping” mechanism on referrals to specialist care and is accompanied by a memorandum setting out a timeline for a phased implementation process.

Under its provision, an NHI fund and it’s executive authority will in the near future begin to bid for money from the national budget and it also moots new taxation options as a source of revenue, including a surcharge on income tax or a “small payroll tax.”

The health department’s DDG Dr Yogan Pillay says National Treasury had earlier estimated that the NHI will cost R256 billion but that Treasury plans to release a revised paper with a revised costing.

Mkhize also introduced the the so-called Friends of the NHI grouping.

“You don’t wait for the system to be perfect. It is through the NHI SA will learn,” said World Health Organization (WHO) representative Rajesh Narwal.

The memorandum further flags the affordability and sustainability of national health insurance as a legitimate concern.

It proposes placing increased emphasis on preventative and primary health care, contending that most health care problems can be diagnosed and treated at this level.

Primary health care must, therefore, be made the foundation of the national health service, the bill stated.

Under the legislation, the state would introduce a system where patients would access higher-level services on the basis of referral networks to keep costs down. 

Various pieces of legislation would have to be amended.

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A health care user would be denied free treatment should they deviate from the prescribed referral pathway.

The bill provides for a patient to be denied care should there be “no cost-effective intervention for the health care service” as determined through a technological assessment. 

It seeks to extend free health care to all South Africans, permanent residents and refugees. Asylum seekers will only be entitled to emergency health care, and for health conditions of notifiable public concern.

However, all children, including those of asylum seekers and illegal immigrants, will be entitled to basic health care in terms of section 28 of the Constitution.


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