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HEALTH CARE NL - The National Health Insurance Act: A Call for Action in South Africa's Healthcare Sector

By Transcend | 4 September 2024

The recent gazetting of South Africa's National Health Insurance (NHI) Act 20 of 2023, without an implementation date, has thrown the healthcare sector into a state of uncertainty.
 

Summary: NHI Act (2023) & BEE Readiness — TL;DR

  • Status: NHI Act 20 of 2023 is gazetted with no implementation date, creating planning uncertainty.

  • Aim: Centralise funding and equalise access so all South Africans get quality care (private serves ~20% today).

  • Machinery: Establishes an NHI Fund, Benefits Advisory Committee, and Benefits Pricing Committee to set covered services and pricing.

  • Medical schemes: May not duplicate NHI-covered services (once defined).

  • Providers: Must register and contract with the Fund; selection criteria remain unclear.

  • B-BBEE link: Expect emphasis on jobs, skills development, and health SED—align your BEE strategy now to de-risk participation.

What is the Aim of the NHI?

The NHI Act aims to centralize healthcare services in South Africa and ensure equitable access to healthcare. Currently, private healthcare is considered to be significantly better than public healthcare, but only 20% of South Africans have access to private healthcare. The NHI seeks to bridge this gap by ensuring that all South Africans receive high-quality healthcare, regardless of race or economic status.

Key Components of the NHI Act

Establishment of the NHI Fund: 

  • The NHI Act authorizes the creation of an NHI Fund, a Benefits Advisory Committee, and a Healthcare Benefits Pricing Committee. These bodies will determine the services the NHI will offer and fund, as well as the relevant pricing. Medical schemes cannot offer the same services that NHI covers.

Registration and Contracting:

  •  Healthcare companies wishing to offer services will need to register and contract with the NHI Fund. However, the criteria for how suppliers will be selected remains unclear.

BBBEE Impact:

  • While there is no clear indicator that Broad-Based Black Economic Empowerment (BBBEE) will be a factor in partnering with the NHI, historical context suggests that partners will be expected to create jobs, develop healthcare professionals through skills development, and contribute to healthcare-related socio-economic issues.
  • These outcomes are directly related to BBBEE and transformation, indicating that BBBEE is likely to remain a requirement for partner companies, even if it may be given a different name.

Despite there being no set implementation date for the NHI, aligning your existing BBBEE efforts with NHI objectives is a prudent business planning and risk aversion strategy. This proactive approach will enhance your company's readiness for when the implementation date is eventually set.

Contact our team if you would like to set up a quick meeting to

  1. Inquire about the NHI and its potential impact on BBBEE strategies
  2. Learn how to build or optimize your BBBEE plan to include healthcare business objectives and outcomes
  3. Discover how to align all transformation strategies, including BBBEE, Diversity & Inclusion (D&I), and Environmental, Social, and Governance (ESG) for a sustainable and impactful plan
  4. Leverage low-cost, high-impact transformation strategies in your BBBEE plan

 

FAQs

How can healthcare companies build an NHI-readiness roadmap before the start date is announced?

Create an internal NHI PMO, run a gap analysis (quality, outcomes, digital, billing), prepare a mock registration pack (licenses, clinical results, pricing rationale), model volume & tariff scenarios, and map B-BBEE projects (skills, ESD, SED) to health outcomes.

Which B-BBEE elements best align with likely NHI partner expectations?

  • Skills Development: train nurses, clinicians, coders, health IT.
  • Enterprise & Supplier Development: support Black-owned local device/pharma/primary-care SMEs.
  • Socio-Economic Development: fund community health and preventative programmes.
  • Ownership/Management Control: strengthen HDP participation in governance.

What documentation should suppliers assemble now for faster NHI contracting?

Up-to-date accreditations and licenses, clinical outcomes & quality dashboards, pricing and cost transparency, data privacy & cybersecurity policies, B-BBEE certificate plus skills/ESD/SED plans, and ESG & D&I frameworks tied to health access.

How should medical schemes rethink products when NHI benefits are set?

Conduct a benefit redesign to avoid coverage duplication, pivot to complementary/top-up services permitted by regulation (e.g., expanded wellness, disease management), and rework provider networks and admin stacks to integrate with NHI claims flows.

How do we integrate ESG and D&I with B-BBEE for NHI readiness—without duplicating spend?

Build one impact portfolio where projects are tagged across ESG, D&I, and B-BBEE; prioritise initiatives that improve access, quality, and workforce inclusion; set shared KPIs (retention of scarce skills, patient access, local procurement) and report once for all frameworks.

 
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