NGV: That’s how it’s going to work


By Theuns du Buisson

National Health Insurance (NHI) cannot work in South Africa.

We know this; the government knows it; and every salary earner who is going to have to finance it knows it.

Still, the law was signed by the president on May 15 and on May 16 in the government Gazette published. It is now law. But a law, and specifically this one, does not mean much without accompanying regulations. The health minister was extremely evasive about any questions regarding regulations or timelines for the NHS. We can therefore only work with what is in the law itself and with some of the vague timelines that were given.

During the signing ceremony, it was said that the government intends to phase in the NGV over the next four years. However, if one listens to the officials who have to introduce it, it will take at least ten years to get the system up and running. The phasing in is likely to mean that only certain medical procedures or specialist services will fall under the NHI. If we read between the lines, it will be emergencies and child births that will be covered by the NGV first.

This is already creating a big problem.

What is an emergency?

The state’s definition of an emergency will certainly not match the emergencies that are handled at hospitals at this stage. Will the hospital then be forced by the NHS to turn people away if their emergency does not meet the state’s guidelines for emergencies? And how will it be determined where the line is drawn between dealing with the emergency and when the person is admitted and then has to pay for hospitalization themselves, or has to claim from his or her medical aid?

In the coming months, little will likely change in the system itself.

Who will pay?

Rather, the biggest changes will be financial in nature. It will cost billions of rands to implement the NGV and that money will have to be recovered from the taxpayer. Therefore, as proposed in the law, there will certainly be some tax implication.

It will probably be announced in October during the medium-term budget speech that medical aid tax credits will be scrapped from February next year, when the new national budget comes into effect. A further tax may then already be levied. Eventually, when the NGV is fully introduced, an extra income tax of around 14% will be required.

At least the law is more clear when it comes to its full implementation. Almost all medical care will be covered by the NHI. The law prohibits anyone other than the state from paying for medical services. This prohibition comes into effect the moment the NGV covers a service. Therefore, if you are not satisfied with the doctor or the treatment that the state assigned you, you will have no defense.

It would be illegal to attempt to obtain medical care elsewhere. The doctor will also have no freedom to decide what treatment may be applied. The state will decide on this protocol and exceptions will not be made simply.

It is obviously dangerous to entrust the state with such a thing. Just think of the herbal remedies that the army bought to treat Covid-19.

This is how the patient’s path goes

Patients will be at the mercy of a strict referral process as established by the state. A patient will start with his or her local state nurse. The nurse will then decide whether you are sick enough to see a doctor.

She will then assign you a doctor, or send you home with pills. There will naturally be long waiting times. A cold that keeps you away from work for two days, under the NGV, could mean that you have to sit in line at a clinic for a week.

If you need a specialist, you will be placed on a waiting list with the specialist. The specialist will then not have complete freedom as to which tests may be carried out to make a diagnosis. Specialists will only be allowed to function according to the state’s guidelines. The same goes for treatment. Even if the doctor knows which treatment can save your life, it will not be administered if it is not on the state’s list of approved treatments.

This is how it already works in Britain and Canada. People die because the state forbids doctors to apply the right treatment.

Here, the bureaucratic process will also be more important to the state than your life.

What now?

There is therefore no need to panic now or do something drastic such as canceling your medical aid membership. It is indeed time for action. Support Solidarity’s legal action against the NGV. Write to your medical aid and ask what they are going to do about the NHI. Write to politicians to force them to repent.

  • Theuns du Buisson is a researcher at the Solidarity Research Institute.