National Health Insurance (NHI) Pros & Cons

National Health Insurance (NHI) South Africa: Pros & Cons

Love it or hate it, the National Health Insurance (NHI) is here to stay. Preparations for this controversial health care system entered their second phase in 2017, and it’s apparently still on track to roll out across the country in 2026.

The NHI has left a lot of South Africans feeling nervous or downright concerned. It’s going to require ridiculously vast amounts of funding and be run by our sometimes inefficient, less-than-scrupulous government.

Our public health sector has seen ongoing problems: waiting times are painfully tedious, infrastructure is crumbling, and hospitals are notoriously overcrowded or even dirty. Contrary to what Tannie Sarie down the road firmly believes, many of these problems aren’t due to carelessness or corruption. They are simply happening because our public healthcare system is underpaid and understaffed. On multiple occasions, I personally have witnessed clinic nurses or doctors at the local hospital skipping lunch to help rows of waiting patients. When they finally do grab a bite to eat, it’s to a chorus of muttered complaints.

The NHI hopes to fix many problems by pouring fresh resources into our public healthcare sector. Here’s the rub: the public will be paying for it. According to the booklet, many South Africans won’t feel the pinch; only taxpayers will be funding the NHI. And (the booklet claims), even if you earn significantly more than average, you’ll probably still spend less on the NHI than you otherwise would on your health insurance… which will be obsolete.

So, what will life with the NHI be like?

Let’s take a look at the drawbacks and advantages of the nationally-funded health insurance here in South Africa.

National Health Insurance – NHI: The Cons

  • The lack of competition could make room for problems. Having a competitive medical marketplace keeps standards high, innovative ideas sparking, and corruption at bay. When a single entity (in this case the government) is responsible for managing a particular service for the whole country, massive-scale corruption and ineptitude can set in… as we’ve witnessed with Eskom.
  • Taxes could become more burdensome. The NHI is going to require a phenomenal amount of funding: possibly around R500bn just at its start. Most of this is going to come from taxpayers. In fact, a large segment of it is going to come from top tier taxpayers who are already pouring around half of their income into the government. Financial authorities are predicting a rise in taxation for many citizens.
  • No one knows what the NHI is actually going to cover. This is because the NHI’s healthcare coverage depends primarily on the funding available. Of course, more coverage is better… but will probably also translate into higher taxes.
  • There may be fewer healthcare facilities and providers available. The NHI has high standards for cleanliness and the other essential elements of good healthcare, which is wonderful… but unfortunately, tons of public hospitals and clinics don’t make the grade. So, you may have to wait significantly longer to be seen, and there may be fewer hands ready to help in the event of an emergency.
  • If you’re used to private care, you may have to settle for lower standards while still paying a similar amount. Under the NHI, health insurance will only be allowed to offer “complementary” coverage, or non at all. But for those within a certain income bracket, monthly payments towards healthcare will still be mandatory. And due to the concerns we’ve mentioned above, the standard of what was once private healthcare may drop to somewhere between private and public level.

National Health Insurance – NHI: The Pros

  • The growing inequality between the first and second-tier healthcare will be cut short. So many of our citizens come from disadvantaged backgrounds and currently have no hope of getting good quality medical care for themselves or their family members. Meanwhile, the private sector is continuously improving: after all, most of the money goes there, as do all the best nurses, doctors and specialists. Hopefully, the NHI may remove some of that inequality, and this will be good news for a huge percentage of our population.
  • The overall standard of healthcare in this country may actually improve. The NHI has higher standards than those that are currently governing many of this country’s clinics and hospitals. If we can continue to make headway against corruption, then South African citizens with poor or average incomes will enjoy better healthcare than ever before. They’ll have access to facilities and expertise which they previously could never afford.
  • Many public clinics and hospitals will upgrade their services. They will be required to do this by the NHI in order to meet their standards. Hygiene, safety, respect and quality of care will hopefully improve at that infamous public hospital near you.
  • You’ll know exactly how much you need to pay. If you’re currently paying for private healthcare, there’ll be no more enormous, unexpected costs in the already awful event of an emergency, and no more running out of medical aid funding when your scheme falls short during a tough year. You’ll pay a set amount, and it will cover anything you can get via the NHI.
  • If you work in the public health sector, you may enjoy a pay raise. The NHI will be pouring extra money into public health facilities.

The NHI is here for good… so let’s count our blessings.

It’s difficult to predict exactly what life under the NHI will be like. However, it’s going to happen, whether or not we support it.

At this point, our best hope remains in keeping positive. Hope, and the desire to change for the better, has already sustained our beautiful country through multiple crises. Personally, I believe that things can only continue to improve.

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