SA healthcare at the crossroads

Although the National Health Insurance (NHI) Bill has been tabled, there is still much confusion and speculation about the future of healthcare in South Africa

Since the first article on the NHI Bill in Issue 4 of ROLLING INSPIRATION for 2018, there has been a great deal of discussion around this much-anticipated piece of legislation. It was tabled in August this year, but instead of providing relief, it caused more confusion and speculation about the future of healthcare in South Africa.

On August 18, Penelope Mashego wrote in the Sunday Times that medical aid service provider Discovery stated that the plan to curtail the role of medical aid schemes by the NHI would undermine its objectives – this after Discovery’s share price took a beating for a week.

This intrigued me enough to look at both these factors: the role of medical schemes as per the bill, and the NHI objectives. The first one was easy. A single sentence in Chapter 8, Clause 33, on the role of medical schemes states: “Once NHI has been fully implemented as determined by the minister through regulations in the Gazette, medical schemes may only offer complementary cover to services not reimbursable by the fund.”

Thus, medical schemes registered in terms of the Medical Schemes Act or any other voluntary private health insurance scheme will be restricted to providing cover only for services not included in NHI. There is some uncertainty as to what “complementary cover” will include, as the services included in the NHI have not been determined. Most likely, medical aids will only offer cosmetic healthcare.

I know the importance of adequate healthcare and have a relatively good idea of the current state of our public healthcare. It has me concerned. Maybe the roles of medical aids will change to offering gap cover?

Currently, there are limitations to the amount medical aids will pay for the services of healthcare practitioners. The member often has a co-payment to fill the gap between the charge and the amount the medical aid it willing to pay.

Gap cover can replace this co-payment. The state will pay for healthcare, while medical schemes provide gap cover.

What stands out for me is that the NHI is based on Universal Health Coverage (UHC). The World Health Organization defines UHC as a healthcare system that ensures “that all people have access to needed health services (including prevention, promotion, treatment, rehabilitation and palliation) of sufficient quality to be effective and that the use of these services don’t expose the user to financial hardship”.

This definition embodies three objectives:

Equity: Those who need the services should have access, and not only those who can pay for the services;

Quality: The quality of health services must be good enough to improve the health of those receiving these services; and

Financial risk protection: The cost of using the care shouldn’t put anyone at risk of financial hardship.

UHC brings the hope of access to better healthcare and protection from poverty for millions – especially those in the most vulnerable situations.

Yes, it will be expensive. Yes, there will be cross-subsidisation. Yes, it will change the look and feel of healthcare in South Africa. But, all of us will have equal access to a fundamental right contained in the Constitution: “Everyone has the right to have access to healthcare services.”

The burden is on the state to take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of the right of access to healthcare services.


Raven Benny has been a C5, 6 and 7 quadriplegic since 2000. He is married and has five children, is mad about wheelchair rugby and represented South Africa in 2003 and 2005. He relocated from Cape Town to Durban, where he was appointed the Chief Operating Officer (COO) of QASA from August 1, 2019. email:

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