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National Health Act, 2003 (Act No. 61 of 2003)


National Health Insurance Policy towards Universal Health Coverage

Chapter 7 : Financing of NHI

7.11 Linkages to Broader Social Security Reforms


269. A key pillar within the social protection framework is an equitably funded health system that promotes social solidarity, affordability and fair access to needed health services that cover the full spectrum of health promotion, prevention, curative and rehabilitative care. In countries where social protection and health are pivotally important in the developmental programme of the State, this has played a significant role in reducing high poverty levels and improving overall population health.


270. The implementation of NHI is part of government’s broader programme of action as outlined in the NDP. Health forms an integral part of any country’s developmental programme. The NDP recognises the integral role that social protection plays in reducing inequality and poverty. The NDP focuses on improving the opportunities for South Africans to build good, healthy lives for themselves and strategically focuses on empowering vulnerable groups such as the young, disabled and the elderly. The NDP goes on further to outline the vision for 2030 regarding a broader social protection agenda for South Africa.


271. In recognition of the proposals outlined in the draft Comprehensive Social Security Reform discussion paper, there will be an alignment of medical benefits provided by compensation funds to mitigate the challenge of double dipping. Once fully implemented, NHI coverage will include medical benefits currently reimbursed through the Compensation Fund for Occupational Diseases and Injury Act (COIDA), Compensation Commissioner for Occupational Diseases in Mines and Works Act (ODMWA) and the Road Accident Fund (RAF).


272. During the transitional phase, alignment of the benefits covered through the COIDA, ODMWA and the RAF as well as the reimbursement strategies for contracted providers will be aligned with those of NHI institutional and organisational reforms. In the short term, the NHI will contract with the various benefit funds for occupational health related diseases and injuries. However, at the maturity of NHI, all health services, including services for occupational health, will be provided for by the NHI, funded from relevant social security funds to prevent double dipping.


273. As the single purchaser of personal health services for all South Africans, the NHI Fund will take full responsibility for the pooling and disbursement of funds to strategically purchase health services from accredited and contracted public and private providers. Administratively efficient systems and mechanisms will be implemented to ensure that all funding allocated to existing compensation funds meant for personal health services are appropriately channelled into the NHI Fund as part of the broader pool for financing the purchasing of needed personal health services.


274. The actual process of implementing the shifting of funds will be undertaken through a consultative process with the relevant government departments under which the respective compensation funds fall. This will also require legislative and regulatory changes that will form part of the drafting and gazetting of the NHI Bill.