The National Health Insurance 20 of 2023 (NHI) Act, was signed just a few days ago. Private medical schemes have expressed strong support for structural changes that enhance the healthcare system for all South Africans. However, these organisations raise significant concerns about the practical implementation of the NHI, emphasising the critical role of private healthcare and medical schemes in achieving universal health coverage.


Key Issues and Concerns

Private medical schemes point out that the NHI Act stipulates the elimination of medical schemes for services covered by the NHI once fully implemented. They argue that this restriction is counterproductive, given the limited resources to meet the healthcare needs of all South Africans. By preventing citizens from purchasing additional medical coverage, the policy could overburden the public healthcare system and diminish the quality of care.


The organisations highlight several risks associated with limiting medical schemes:

Financial Viability and Implementation Challenges

Private medical schemes question the financial feasibility of the NHI, citing the absence of a clear cost framework in the Act. The anticipated funding of R200 billion would require substantial tax policy changes, which the current economic climate cannot support. The proposed funding options—such as significant increases in VAT, personal income tax, or payroll taxes—are deemed unrealistic.

Private Sector’s Role 

The NHI Act envisions voluntary contracts with private hospitals and healthcare professionals to supplement public sector services. Private medical schemes support this collaboration but stress that most NHI services will likely continue to be delivered by public facilities, with private entities funded by medical schemes for the foreseeable future.

Legislative Process and Future Outlook

The NHI Act, approved by the Portfolio Committee on Health in May 2023 and passed by Parliament in June 2023, was signed into law by President Cyril Ramaphosa on 15 May 2024. Despite this progress, private medical schemes foresee significant delays in full implementation due to financial and operational challenges, potentially spanning decades.

They anticipate legal challenges to the Act, which could further delay its rollout.

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