First NHI rollout dates revealed – with a deadline hitting soon
The National Department of Health has set out a broad timeline for the rollout of Phase 1 of the National Health Insurance (NHI) scheme – with its first big milestone coming up soon.
Responding to a written parliamentary Q&A from Action SA’s Dr Kgosi Letlape, minister of health Dr Aaron Motsoaledi said that Phase 1 of the implementation of the NHI has been running since 2023 and will continue through to 2026.
During this time, various foundational objectives will be reached, including a key feature for the scheme to function: NHI-specific legislation and governance regulations.
The first important milestone for this is expected at the end of November 2024, with the draft regulations expected to be published for public comment.
The department has long argued that the actual NHI regulations would answer the many questions left open by the NHI Act, such as the phased launch of the NHI Fund, as well as the services the NHI will cover.
The minister did not specify which draft regulations would be coming by end-November, but has set a target of end-March 2025 for the comments to be incorporated and promulgated by April 2025.
Other notable timelines include:
- Establishing foundation institutions – by April 2025 and beyond
- Purchasing personal health care services for vulnerable groups – by 2026/27
- Establishing the NHI Fund as a Schedule 3A entity – board appointments by November 2025, and the entity in operation by April 2026
While these dates and timelines are more specific, they are in line with the vague timelines set out in the NHI Act.
Section 57 of the Act refers to the timelines for implementing the laws, which run from 2023 to 2028.
As stated by the minister, the first implementation phase of the NHI runs from 2023 to 2026, when the NHI Fund will be set up and other groundwork put in place.
The second phase is the key phase, where funding and the questions around costs will come into play.
This phase will see the “mobilisation of resources” and “the establishment and operationalisation of the (NHI) Fund as a purchaser of health care services through a system of mandatory prepayment”, and runs from 2026 to 2028.
As indicated by the Act’s wording, this would ostensibly put the requirement for tax changes and other funding mechanisms into effect from 2026 onward.
Notably, these timelines and tax plans can only be implemented once the NHI Act is promulgated.
The funding question
The funding question continues to hang over the NHI, and coming regulations may finally bring some clarity. For now, however, there is no indication of what the government’s plans will ultimately cost taxpayers—only that there is certainty that taxpayers will foot the bill, whatever it is.
According to the Act, tax hikes and new taxes are clearly on the cards to implement the scheme.
Section 49 of the NHI Act outlines the funding mechanisms for the NHI, which include:
- General tax revenue, including the shifting of funds from government departments and agencies and provincial budgets and conditional grants;
- The removal and reallocation of funding for medical aid tax credits;
- Payroll taxes on employers and employees and;
- Surcharges on income tax through a Money Bill by the National Treasury.
According to Motsoaledi, all associated costs are part of the current Medium Term Expenditure Framework (MTEF) allocations to the department for this period of Phase 1, including conditional grants.
In the latest medium-term budget policy (MTBPS), the Treasury indicated that the country has budgeted just under R3 billion for the NHI over the 2025 MTEF period—R2.5 billion of which is indirect health spending and R460 million of which is direct NHI funding.
The direct grant relates to the National Department of Health’s preparations for the implementation of the NHI, including the testing of reforms, improving services of primary healthcare facilities and aligning infrastructure with national and provincial policy directives.
The indirect financing, which accounts for the bulk of the grant, relates to two projects: health facility revitalisation, and development of health systems. Both of these serve the NHI, but are also independent projects not directly tied to the NHI.
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