The role of private hospitals and doctors under the new NHI

 ·14 Aug 2019

Minister of Health, Dr Zweli Mkhize, says that the private sector will still have a role to play under the incoming National Health Insurance (NHI).

In a statement published on Wednesday (14 August), Mkhize said that private practices, pharmacies and hospitals will not be nationalised under the new health system.

He added that under the new system, South Africans will still be able to register their ‘preferred health provider’.

“Those who wish to serve as providers for the NHI will apply for accreditation and the NHI will reserve the right to procure services from private providers as well as the public sector facilities.

“In the current phase, discussions are advanced to enlist private family practitioners to support the NHI. Their positive support is overwhelming,” he said.

What the bill says about hospitals

The updated NHI bill – published on 8 August – 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 bill was originally unclear if these primary facilities would only be state-owned, the above statement from Mkhize seems to confirm that South Africans will also be able to register at private hospitals if they are approved for accreditation

According to the bill, the minimum set of requirements that need to be followed before a hospital is given accreditation 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.

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.

Read: How you will be paying for the NHI, and what happens to your medical aid – everything you need to know

Show comments
Subscribe to our daily newsletter