National Health Insurance
The Future Role of Private Health Insurance
Download full PDF Document
The purpose of this series of policy briefs on National Health Insurance (NHI) and the related IMSA web-site is to put in the public domain material and evidence that will progress the technical work of developing a National Health Insurance system in South Africa. This includes tools for costing NHI and evidence on where savings could be achieved in moving to a future mandatory system with universal coverage.
This policy brief deals with considerations of the role of private health insurance (PHI) alongside a public health system or public health insurance system. This has critical relevance to the future role of medical schemes under a National Health Insurance system in South Africa. The debate on this design issue is in its early stages and this material is designed to assist stakeholders and policy-makers as they grapple with the issues.
The February 2009 draft NHI proposal from the African National Congress (ANC) task team consisted of some 200 pages in which the phrase “medical scheme” cannot be found. Comments from that time suggested that private health insurance, that is medical schemes, could be closed down completely.
The June 2009 NHI proposal from the ANC task team, reduced to some 64 pages, deals with medical schemes extensively and their perceived role in the problems in healthcare financing in South Africa. This proposal envisages that medical schemes will continue but on a voluntary basis, as at present. It is proposed that members will pay for NHI AND for any medical scheme they join. “While the NHI calls for mandatory membership for all South Africans through mandatory contributions and social solidarity, it is up to the general public to continue with voluntary medical schemes cover after they have contributed to the NHI Fund.”
The contribution to NHI is envisaged to be through general taxes and “will be supplemented by a mandatory, payroll-related contribution. This mandatory contribution will be progressively structured and it will be collected by the South African Revenue Services (SARS). Everyone earning above the income tax threshold (adjusted annually) would be required to make this contribution (i.e. no one may ‘opt-out’ of the NHI), which will be shared between employers and employees.” The amount of this mandatory contribution had not been determined in the June 2009 report.
|
