New NHI bill will change which hospitals you can use

The Department of Health published the long-awaited National Health Insurance Bill on Thursday (8 August).

The bill promises universal health coverage for all South Africans and is set to bring big changes to the country’s health industry – including how South Africans pay for health coverage and a changed role for medical aids.

One industry which is also likely to see a major shake-up is private hospitals.

The bill states that all South Africans covered under the bill must register as a user with the NHI fund at an accredited health care service provider or health establishment.

Whenever users need to access healthcare, they will first need to visit this primary facility. This facility may then refer the user to a specialist or another facility.

The bill states that if these ‘referral pathways’ are not followed, users will not be covered by the NHI fund and will have to pay out of pocket or make use of a medical aid.

While the NHI bill does not specify if ‘accredited health care service providers’ will be limited to public hospitals, it does set out a minimum set of requirements that need to be followed before a hospital is given accreditation.

These requirements include:

  • A minimum required range of personal health care services as specified by the minister; 
  • Allocation of the appropriate number and mix of health care professionals;
  • Adherence to treatment protocols and guidelines, including prescribing medicines and procuring health products from the formulary; 
  • Adherence to health care referral pathways;
  • Adherence to the national pricing regimen for services delivered.

Also, as previously covered, medical aids will also be prevented from covering services that will be covered under the NHI, limiting options for those seeking private healthcare.

Impact on industry

The Hospital Association of South Africa has previously warned that the NHI could lead to the loss of up to 132,000 jobs, and impact the industry’s investment in South Africa.

According to the group, close to R180 billion is spent on private healthcare in South Africa each year – a third of which is spent on private hospitals.

The three JSE-listed hospital groups – Netcare, Mediclinic and Life Healthcare, which make up about two-thirds of the sector – contribute about R55.5 billion to GDP a year.

It warned that if the state did not purchase any private hospital services under the NHI, 99,600 jobs may be lost in the private sector, and R31 billion could be shed from the GDP.

In a situation where the prices are capped at 23% lower than they are at present, 132,000 jobs may be lost, it said.


Read: The end of medical aid as you know it in South Africa

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New NHI bill will change which hospitals you can use