Legislation: NHI Bill leaves key issues to regulations

The long-awaited draft National Health Insurance Bill gazetted yesterday for comment within three months focuses on institutional and governance arrangements associated with the creation of a national health insurance fund ‘as a purchaser of health care services through a system of mandatory prepayment’, reports Pam Saxby for Legalbrief Policy Watch. To that end, according to clause 54 (transitional arrangements) government has until 2022 to promulgate national health insurance legislation and the necessary amendments to existing Acts. While clause 52 (regulations) provides some insight into what this may eventually entail, at this stage – as framework legislation – the proposed new statute is largely silent on nuts and bolts matters. This notwithstanding, ‘health system strengthening initiatives’ already under way will continue, including those involving the ‘alignment of human resources’ to the requirements of services to be offered ‘under the fund’. An accompanying media statement provides interesting perspectives on the challenges entailed.

Against that backdrop, it will be left to secondary legislation to prescribe the ‘legal relationship’ between the proposed new fund and ‘medical insurance schemes registered in terms of the Medical Schemes Act, other private health insurance schemes’ – and ‘various categories’ of health establishment, service provider and supplier’. Other ‘relationships’ to be regulated by the Minister include those ‘between public and private health establishments’, and those involving private healthcare providers opting to contract into the national health insurance system. The scope and ‘nature of health (care) service benefits and programmes’, the ‘manner in, and extent to, which they must be funded’, and ‘how’ healthcare providers will be paid will also to be prescribed in regulations.

According to clause 46, annually determined revenue allocations to the fund will be informed by ‘the size of the population served’ and ‘the average cost of providing health (care) service benefits to registered users’. Sources of income will include money appropriated by Parliament, interest or returns on any investments made by the fund, bequests and donations – and ‘movable or immovable property purchased or otherwise acquired by the fund’. Clause 7 provides that, in addition to South African citizens, permanent residents and their dependents registered as users of the fund, national health insurance beneficiaries should include refugees, asylum seekers and temporary residents. However, non-citizens and residents in those categories would only be eligible to receive emergency services, ‘services for notifiable conditions of public health concern’ and ‘paediatric and maternal services at primary health care level’.