07 January 2020

NHI: Tracking the bill through Parliament

The NHI Bill was introduced to Parliament in August 2019 and is currently under consideration by the National Assembly’s Portfolio Committee on Health.

According to the government, the NHI aims to achieve the following principles:

-The right to access health care: The NHI would ensure access to health care, as it was considered to be an important service which the State must be able to provide.

-Social Solidarity: The NHI would provide financial risk pooling to enable cross-subsidisation between young and old, rich and poor, as well as the healthy and the sick. This would mean people taking care of each other as South Africans. The solidarity principle would also serve as a guide towards the development of the NHI.

-Equity:  The NHI would ensure a fair and just health care system for all. Those who were ill should get services first.

-Health Care As A Public Good:  Health care should be seen as a social investment and not as a commodity of trade to be sold for profit.

-Affordability:  Health services should be procured at a reasonable cost. Should the cost be prohibitive, this could lead to the NHI not being able to offer health care to the whole country.

-Efficiency: Health care resources should be allocated and utilized in a manner that optimised value for money. The HLP had made it very clear that resources allocated to the NHI should be used appropriately.

-Effectiveness:  The health care interventions covered by the NHI would result in desired and expected outcomes in everyday settings. South Africans traveling through the country and in a need of health care, would see that the same treatment one would receive in Dzidane would not be inferior to the treatment received in the Western Cape.

-Appropriateness:  Health care services would be delivered at appropriate levels of care through innovative service delivery models and would be tailored to local needs. The health care services should take into account the cultural and social requirements within a particular area.

Meanwhile, there are some concerns about how the NHI will be funded and implemented.

The Portfolio Committee invited stakeholders and interested parties to submit written submissions on the Bill from 30 August to 29 December 2019.

At the same time, public hearings on the bill were carried out in Mpumalanga from 25-28 October 2018, in the Northern Cape from 1-4 November 2018, in Limpopo from 15-18 November 2018, in KwaZulu-Natal from 22-25 November 2018 and the Eastern Cape from 29 November-02 December.

See the public hearing programmes here and here

Ahead of the public hearings, PMG interviewed the Committee Chairperson. Read the interview here

Hearings in the remaining provinces – Gauteng, Western Cape, Free State and North West - will be concluded in 2020. See programme here

Watch the public hearings below:

Eastern Cape Public hearing: https://www.youtube.com/watch?v=WXqlxrKHOT4

KZN Public hearing: https://www.youtube.com/watch?v=mbg8wcG71PI

Limpopo Public Hearing: https://www.youtube.com/watch?v=8CBfJRoLhMo&t=22s

Northern Cape Public Hearing:  https://www.youtube.com/watch?v=kv0LkIj74Rw

Mpumalanga Public Hearing: https://www.youtube.com/watch?v=bgPYRrBFwxQ

The Bill was long in the making as ideas to reform healthcare financing in South Africa are not new and date as far back as the late 1920s. We traced the historical timeline of the Bill (only looking at the democratic dispensation) and highlighted key dates and events.

You can also review the relevant policy documents and submissions at the NHI Library (source: Collaboration for Health Systems Analysis and Innovation (CHESAI))

Find the August 2019 NHI District Pilot Evaluation Report here

You can track the processing of the Bill here

Here is a sample of the written submissions:

Section 27 and TAC Submission

HSF Submission

Medecins Sans Frontieres (Doctors without Borders) Submission

SA Medical Association Submission

Outa Submission

Dullah Omar Institute

You can look back at some of the previous parliamentary meetings on the NHI:

16 March 1998: White Paper on transformation of the health system in South Africa: hearings

25 June 2002: Social Health Insurance Policy Development: briefing

7 June 2005: Social Health Insurance: Department briefing

16 August 2011: National Health Insurance Green Paper; Safety and Security in public hospitals: Departmental briefings

23 August 2011: National Health Insurance follow up, Childhood Cancer Foundation on challenges & solutions, Directorate of Radiation Control progress report

24 July 2013: National Health Insurance Pilot Project: progress report from Department of Health; & challenge assessment by Department of Performance Monitoring and Evaluation

26 February 2014: Preparations for National Health Insurance (NHI) pilot districts: briefing by Minister of Health

21 August 2015: National Health Insurance (NHI) Pilot Districts: progress report by Minister of Health

7 November 2018: High Level Panel Recommendations for Health Sector: Prof Shisana briefing

6 June 2018: Hospitals: Western Cape & Gauteng Departments of Health

13 June 2018: Hospitals: Northern Cape, Limpopo, Free State, KZN Departments of Health

12 June 2018: Hospitals: Mpumalanga, Eastern Cape & Gauteng Departments of Health

 

 

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