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Cape Town – The National Department of Health hopes to have the National Health Insurance (NHI) Bill before Cabinet in November this year after which it will be made available for public comment.
Vishal Brijlal, technical adviser on the NHI at the department, told delegates at the final day of the Board of Healthcare conference in Cape Town that the NHI fund cannot be established without first drafting appropriate legislation.
One such piece of legislation is the National Public Health Institute of SA (Naphisa) Bill for the establishment of the National Public Health Institute of South to provide among other things for specialised public health services and public health interventions.
Parliament will be conducting public hearings from August 14 to August 16 to get input from the public and stakeholders in the healthcare industry on the Naphisa Bill.
“There will be two processes going forward,” Brijlal said, “the adoption of NHI legislation through an Act of Parliament and in the meantime a transitional fund, making use of the existing systems and processes in the healthcare sector.”
The transitional fund will come into effect by 30 September and will remain in place until the NHI legislation is finalised.
Briljal explained that the transitional fund will utilise the existing budget allocated towards the Department of Health for the flow of funds and purchasing.
Once the NHI is fully established as a public entity it will be financed through an appropriation of Parliament.
A number of current legislation will need to change along with the new NHI Bill. Priority will be given to the Medical Schemes Act, General Health Amendment Act and other legislation relating to healthcare professionals and the National Health Act.
Brijlal pointed out that all healthcare service providers – whether in the public or private sector – will need to adhere to the new National Health Act.
In preparation for the NHI, the private healthcare sector should start introducing a single service benefits framework and providing quality healthcare delivery models at lower costs.
There will be a number of regulatory interventions following the NHI, including:
- Setting one standard price for services
- Removing differential pricing of services, based on diagnosis
- Changing reimbursement from diagnostic coding to that of the type of service that is provided.
In addition, service providers will not be allowed to balance bill patients. Under the NHI, price regulation will take effect as a means to prevent the growth in co-payments for the services that the NHI provides.
Brijlal acknowledged that there are a number of matters that still need clarification under the NHI. One is the financing of the proposed universal healthcare scheme. "The reason why we have no updated numbers is because we're playing around with different scenarios and the type of services that should be included under the NHI."
Other cost drivers that need to be clarified before the financing structure can be finalised are reimbursement structures and whether public sector or private sector cost structures should be used for pricing.
During question time, a conference delegate asked Brijlal when government intends to phase out tax refunds for medical expenses as mooted in the NHI White Paper.
"To be fair, I cannot say," Brijlal responded. "That's a question we need to ask National Treasury."
He added that there should be more clarity around the phasing out of tax refunds around September or October this year.
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