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Q&A: Government med scheme execs on NHI, medical aid & the future of healthcare
Govt medical scheme to align benefits with NHI
I am a
first-generation medical aid member and come from a family which was largely dependent
on public health.
really struggled with inadequate healthcare for all their lives and I wonder if
my dad’s life would have been lengthened with better care.
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My mom, who
is now 89, is on medical aid because the governing ANC forced changes to
medical aid coverage to expand the definitions of dependents from the
industry’s Western notions of what family is. She is now on my brother’s
medical aid. Some years ago, my old lady fell and broke her hip. It was
replaced in two days and she was walking in seven days. The waiting list for
that operation at public hospitals is months long.
also legislated that the private health insurance industry cover prescribed
minimum benefits to provide a guaranteed bottom line of services. The managed
care industry is notorious for limiting its risks, maximising its profits and
cherry picking its clients, so public health regulation has been excellent at
expanding and extending service levels in the private sector.
democratic government introduced free health care for women and children, which
changed many lives for the better and stronger, as I saw when I reported health
just as apartheid gave way to freedom.
extending and health enhancing public health policies have made meaningful
changes in the lives of so many South Africans. But government has decided
these are insufficient as the health imbalances are still acute.
Higher tax burden
Its national health insurance initiative is
a further attempt at health reform but the idea is poorly conceived and will
add to the burden of already stressed income taxpayers who have over recent
years faced the highest tax increases.
more to come once the NHI Bill becomes law, although it’s important to bear in
mind that that is only in 2026 – possibly much later – because the law as it
stands faces many constitutional hurdles, says Wits University health economist
Dr. Alex van den Heever.
READ: Motsoaledi: We can’t wait to improve healthcare before implementing NHI
Bill creates a new architecture for health provision and could effectively
eviscerate the private system, which is why listed company health share prices
are in casualty. It is built on the assumption of an efficient, capable,
tech-savvy and clean government, when the experience of the majority of South
Africans is exactly the opposite, since the era when government first made the
public health changes that made for better lives.
Stripped of choice
individuals of choice, since we will all become mandatory members of the
national health insurance scheme, a gigantic medical aid for the entire
country. But here’s the rub: government envisages that it will be run by a CEO
and an 11-person board appointed by the Minister of Health.
There is no
history of democratic South Africa running either its funds or its state-owned
companies with its people in mind. And the panic that has greeted the unveiling
of the NHI bill is therefore understandable.
means for us is that, as envisaged by the draft law, your personal income tax
bill could shoot up by between 19% to 20%, says Van den Heever, according to
his early calculations.
because the drafters assume enough fiscal space to tax an additional 3% of GDP
and this tax is likely to fall on our (working South Africans’) shoulders.
taxes are reckoned to be at their ceiling, and there is no way government can
push a VAT increase through without inciting a “revolution”, says Van den
law says you can still buy a medical aid policy, but schemes will be highly
constrained in what they can offer because the formative idea is to cover all
South Africans in the national scheme.