“We did not identify any source of funding. We have just identified several methods of financing the NHI,” says Aaron Motsoaledi.

Motsoaledi: We haven't identified a source of funding for the NHI

Ina Skosana
The National Health Insurance white paper does not stipulate how the scheme will get funded; it only provides five possible scenarios.

Taking part in the National Health Insurance scheme (NHI) is going to be mandatory, not voluntary like belonging to a medical aid, said Health Minister Aaron Motsoaledi at the release of the long-awaited National Health Insurance (NHI) white paper on Friday in Pretoria.  

“Population coverage under NHI will ensure that all South Africans have access to comprehensive quality healthcare,” said Motsoaledi. The NHI will be phased in over a period of 14 years which started with 11 pilot districts around the country in 2011.

By using their NHI card, South Africans will have access to medical treatment, including pharmacies and emergency medical services without having to pay directly at the point of care. The white paper stipulates that NHI card holders “will not be expected to make any out-of-pocket payments such as co-payments and user fees at the point of healthcare delivery”. 

But the burning question of how the NHI will be financed remains largely “uncertain”. 

“We did not identify a single source of funding. We have just identified several methods of financing the NHI,” said Motsoaledi.

The document outlines “five alternative tax scenarios for funding the NHI shortfall by 2025/26”. These include the “introduction of a payroll tax, a surcharge on taxable income and increases in the rate of value added tax”. 

But nothing is set in stone, as the NHI evolves “the tax treatment of medical expenses and medical scheme contributions will be reviewed,” the white paper states. 

Funding of healthcare services will be overseen by the NHI fund, which will be governed by the NHI commission. Healthcare professionals will need to get accreditation from the fund and medical schemes will “only offer complementary (top-up) cover for services that are not included in the health service benefits and medicines approved by the NHI”.

Motsoaledi said that all of these reforms call for new legislation, as the Health Act does not meet the needs of the NHI. The implementation of the NHI will be led by six task teams that will oversee various aspects such as financing, medical service benefits and the future role of medical schemes.

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