THE SOUTH AFRICAN NATIONAL HEALTH INSURANCE POLICY On 12 June 2023, the National Assembly (NA) passed the National Health Insurance (NHI) Bill. The NHI Bill seeks to provide universal access to health care services in the country in accordance with the policy set out in the National Health Insurance White Paper. The Bill envisages the establishment of a National Health Insurance Fund and sets out its powers, functions and governance structures. The fund will purchase health care services for all users who are registered with it. The Bill will also create mechanisms for the equitable, effective and efficient utilisation of the resources of the fund to meet the health needs of users and preclude or limit undesirable, unethical and unlawful practices in relation to the fund. It further seeks to address barriers to access. The NHI Bill was initially tabled in Parliament and introduced to the Portfolio Committee on Health on 8 August 2019 for processing. Following are a few notes on Government’s policy, which gave effect to the drafting of the NHI Bill: · The NHI is a Fund, paid by our taxes, from which the government will buy health care services for all of us who live in the country from health care providers in the public sector and private sector. · Providing health care for all: South Africa is a member of the United Nations community and we have committed that we will implement universal health coverage for all. We believe access to healthcare is a fundamental right for all.\ · The government has the legislative mandate to realize this right. And the government has the responsibility to implement universal health coverage to ensure that all people are able to access health care when and where they need it without suffering financial hardship. · The public sector has constrained budgets that are not sufficient to provide health care services for the 84% of the population that relies on public sector for health care. This results in an overburdened public sector that is characterised by underservicing. The private sector, that serves 14% of the population, is characterised by rising costs of care and overservicing without demonstrating much improvement on health outcomes. Both sectors need reform to ensure that quality of health is improved. The pooling of funds into one fund will improve quality of services and therefore improve health outcomes. · Extending health coverage for all South Africans will improve access to care, quality of care and continuity of care. NHI reforms will contribute to the health system having a co-ordinated and well-structured response to burden of disease. · The NHI Fund will protect individuals from financial hardship when they need to access healthcare services. Financial hardships take place when you need to pay out-of-pocket payments such as user fees at facilities and co-payments for individuals insured by medical schemes. Contribution to the Fund will be through prepayment methods such as taxes. Services will be paid for by the Fund and the patient will not have to pay at the point of care. · Economic development and growth: A healthy population can work more effectively and efficiently and contributes to economic growth. A productive workforce contributes to the economy through growth of local business, attracting foreign investors and growing the domestic economy. An investment in health is an important safety net against poverty by providing financial protection for everyone. · The fragmented, two-tiered system undermines principles of equity and social solidarity and leads to a health system where resources are distributed unfairly. The NHI will promote equitable access to care, and this will be achieved by crosssubsidisation among the population. The NHI fosters social cohesion and contributes to developing a society that is compassionate across all socio-economic groups.QUESTION 5 (20 Marks) Policy legitimation refers to the process by which a policy or decision gains acceptance and is perceived as valid or legitimate by the individuals or groups affected by it. It involves establishing and maintaining the authority and credibility of the policymaker or institution responsible for the policy. Discuss how the South African Government can legitimise the NHI public health care policy.