Important message for South Africans with medical aid

The NHI is still unworkable in its current form and far from becoming a reality, and South Africans with medical aid should continue with their schemes to ensure reliable healthcare coverage for years to come.

This is the message from the Health Funders Association (HFA)—an organisation representing stakeholders involved in the funding of private healthcare—and one of South Africa’s biggest medical aid schemes, Bonitas.

At the beginning of February, it was reported that the African National Congress (ANC) and the Democratic Alliance (DA) had reached a “compromise” that could ease fears about the future of private medical schemes under the NHI.

Media reports noted that certain sections of the NHI Act that specifically threaten the existence of medical aids—such as section 33, which disallows medical aids from covering services the NHI will cover—could be changed.

NHI opponents, including healthcare groups, medical professionals, business organisations and the DA, found this particular section of the laws to be the main problem with the Act.

The parties reportedly agreed on a proposal ensuring that the NHI would not dismantle medical aid schemes.

However, relief was short-lived when Health Minister Aaron Motsoaledi distanced himself from the supposed informal deal.

This cast the future of medical aid back into doubt, along with other concerns, such as funding, administration and continued freedom of choice as set out in the Bill of Rights.

While they do not agree with the NHI’s approach, the HFA and medical schemes support the goal of universal healthcare.

Bonitas Principal Officer Lee Callakoppen said that universal healthcare (UHC) is a right, not a privilege, in South Africa.

He added that the medical aid fund is not opposed to the reasoning behind the Bill, in principle, and agrees with the notion of the right to access quality healthcare services.

However, both Bonitas and the HFA told BusinessTech that the NHI Act, in its present form, is unworkable and denies freedom of choice.

The big issue for medical aid schemes

The HFA believes that restricting the role of medical schemes would be counterproductive to the success of the NHI.

The association explained that South Africa simply cannot afford to meet the healthcare needs of the entire population.

Forcing those who can afford private medical coverage into the NHI system would increase the financial burden on public funds, which taxpayers must sustain.

“The HFA believes that limiting people’s right to purchase additional health insurance—after they have already contributed to the NHI through tax—is unnecessary to achieving the NHI’s objectives.

“Such restrictions are globally unprecedented. In almost every country with some form of NHI, citizens are still free to purchase private healthcare, even for health conditions that are covered by the national health system,” it said.

Beyond limiting individual choice, the association added that the current envisioned policy could have serious consequences for the country.

“It risks driving skilled healthcare professionals away, eroding confidence in the healthcare system, and damaging both local and international investor sentiment. Instead of strengthening healthcare, it could weaken the system as a whole,” it said.

Callakoppen added that it’s imperative that measures are put in place to allow medical schemes to work in tandem with the NHI so that duplication of costs is prevented.

“We [South Africa] need to focus on public and private enterprises working together, strong leadership, accountability, and dealing with social-economic issues as an integral part of the process.

“We also believe that a citizen-centric, multi-funder, multi-provider system is the best way forward for universal healthcare to succeed in South Africa.

“It is equally important attention is given to the systemic structural challenges across the healthcare system,” said Callakoppen.

He also believes the path to UHC through the phased implementation of NHI must start with covering vulnerable groups before it is expanded to cover better-off sections of the population.

This implies that medical schemes as they currently function and the NHI Fund will inevitably coexist.

“In this scenario, the NHI Fund should start by offering comprehensive primary healthcare services before adding higher-cost items, such as hospitalisation.

“This would allow time to develop the necessary purchasing capability within the NHI Fund,” said Callakoppen.

Message to South Africans with medical aid

Both the HFA and Bonitas agree that the NHI will take years to implement, but there is still no clear information on its cost or which health conditions it will cover.

Even the health minister Motsoaledi has acknowledged that full implementation of the NHI could take decades.

Considering this, both the HFA and Callakoppen have stressed the importance of maintaining private medical schemes, arguing that the NHI, envisioned in its current form, is not equipped to provide the same level of coverage and quality.

The HFA pointed out that South Africa has a robust private healthcare sector that serves as the first choice for around 20 million people, including those without medical aid.

This preference is largely due to the superior quality of care and quicker access to treatment compared to the public sector.

The HFA argued that instead of abandoning private medical schemes for an uncertain NHI system, meaningful reforms within the private sector could expand coverage and enhance affordability.

These proposed reforms include Low-Cost Benefit Options (LCBO), a review of Prescribed Minimum Benefits, value-based contracting, and a risk-adjustment mechanism.

According to the HFA, such measures could provide financial protection to at least six million more South Africans, thereby easing the burden on public healthcare resources.

“We urge South Africans not to prematurely opt out of their medical schemes. Doing so could leave them without reliable healthcare coverage for years to come,” the HFA warned.

Callakoppen echoed these sentiments, arguing that limiting the role of the private sector would be detrimental to the NHI’s objectives and would place even more pressure on an already struggling public healthcare system.

“Medical schemes offer a number of benefits that are immediately available to members, allowing them to access care when they need it,” Callakoppen said.

Both the HFA and Callakoppen underscored the importance of integrating medical schemes with the NHI to avoid duplicating costs and to promote a more efficient healthcare system.

Callakoppen stressed that a citizen-centric, multi-funder, multi-provider model is essential for achieving universal healthcare in South Africa.

He also warned against undermining the role of medical aid, noting their significant economic contribution, including job creation and fiscal revenue.