The National Health Insurance (NHI) Act is now a reality in South Africa. However, there is hope that the national dialogue process, as envisioned by the unity government, will lead to more positive and constructive discussions. In his recent address to Parliament, President Cyril Ramaphosa emphasised that achieving universal healthcare for all South Africans will require the resources and capabilities of both the public and private sectors.
NHI aims to provide universal healthcare access, but stakeholders across the healthcare system have ongoing concerns about its impact on both public and private sector patients. While some see the NHI as a step towards more equitable care, members of medical schemes—about 17% of South Africa’s 60 million people—have questions about how it will affect the quality and personalisation of their care.
Many wonder if they will become another number in a potentially struggling healthcare system. These concerns are not unfounded but are based on real experiences with South Africa’s public healthcare system, which is often plagued by staff shortages, ageing infrastructure, and unequal resource distribution.
One of the most pressing questions from medical scheme members is whether they should cancel their memberships in anticipation of the NHI. The clear answer is “no.” A few weeks ago, the former Health Minister urged members not to consider dropping their medical aid coverage.
Concern about the level of choice under NHI
Even if universal access is achieved, there is a significant concern about the level of choice that will be available under the NHI. Patients are worried they may be limited to designated NHI providers, losing the freedom to choose their doctors and healthcare facilities.
The doctor-patient relationship, built on trust and personalised care, is essential for effective health outcomes. Both doctors and patients are concerned about potential limitations on treatment options and constraints on decision-making.
As the healthcare sector looks forward to more transparent communication and fresh engagement from the government, it is widely understood that implementing the NHI will be a gradual process, likely taking a decade or more to complete.
Opportunities support the development of elements that will be part of universal healthcare coverage
In the meantime, there are significant opportunities for the private sector to innovate to help manage costs and support the development of elements that will be part of universal healthcare coverage. A collaborative approach involving public-private partnerships is crucial to overcoming the challenges associated with the NHI.
Such alliances can enhance service delivery, negotiate better rates, provide supplementary insurance, and expand healthcare access in underserved areas. Private sector involvement is vital to building on the existing strong foundation, further improving infrastructure, supporting research and development, and increasing delivery efficiency.
Successful examples of public-private collaboration already exist. The Central Chronic Medication Dispensing & Distribution (CCMDD) programme is a partnership between the private sector and the national health department, where private capacity is used to provide chronic medications to stable patients in the public healthcare system.
Under NHI, the private sector is expected to be crucial in leveraging advanced technological solutions
Under NHI, the private sector is expected to be crucial in leveraging advanced technological solutions to bridge the gap between outdated systems and modern healthcare demands. For example, hyper-automation systems could integrate decision engines, robotic process automation, artificial intelligence, and natural language processing to improve efficiency, accuracy, and service delivery.
These partnerships will help ensure seamless data exchange and interoperability, ultimately improving healthcare access and quality for all South Africans as the NHI framework takes shape. Policymakers and implementers in South Africa have a significant responsibility to clarify what the NHI Act means for healthcare access and choice, both now and in the future.
The success of NHI depends on prioritising patient needs and concerns. Addressing these issues head-on is crucial for building trust and ensuring that the NHI delivers its promise of universal healthcare. As President Ramaphosa has called for, it is essential to continue promoting and driving genuine collaboration between the private and public health sectors to improve healthcare outcomes.
- Van Wyk is group CEO of the AfroCentric Group.