South Africa’s National Health Insurance (NHI) Bill: Why it is controversial

The National Health Insurance (NHI) scheme advocates the creation of a state fund to cover the medical costs of all South Africans – most of whom are not currently covered.

It goes further to bar people from taking out private health insurance for treatment paid for by the fund, which is proving very controversial.

“Once the NHI fund covers a benefit, the medical schemes will not cover the same benefits,” the government says.

This is unlike countries such as the UK, which has the state-funded National Health Service (NHS), but where people are free to take out medical insurance to receive any treatment they want from private doctors and hospitals.

“South Africans will no longer be required to contribute directly to a medical health scheme to get quality health care,” an explainer on the parliamentary website says, external.

Once the NHI scheme is fully implemented “the role of medical schemes will change as they will provide cover for services not reimbursable by the NHI Fund”, it says.

South Africa’s private health insurer Discovery says the scheme is “globally unprecedented , externalas in virtually every other country with some form of health insurance, citizens are free to purchase additional private health insurance cover, including cover that overlaps with services covered by the national system”.

In a post on X, formerly Twitter, external, the government says that everyone will be able to “access NHI-contracted GPs, clinics or hospitals closest to them, whether in the public or private sectors”.

“This means that when you feel unwell, you can go to your nearest GP or clinic that has a contract with NHI and not worry about the cost of care,” it adds.

The government has not specified the treatments that NHI-accredited private hospitals and GPs will have to provide, but says it will include emergency services, mental heath services, palliative care and rehabilitation services.