THE NHI PROCESS

Understanding the NHI Legislative Process

The National Health Insurance (NHI) Bill in South Africa is going through a process to become a law. It has been discussed for almost four years, but there are many more steps to go through before it will be enacted.

It’s important to stay updated on healthcare developments in South Africa. There will be opportunities to share your views at NHI meetings in each province. Keep an eye out for news, government announcements, and information from your medical aid provider to understand any changes or improvements in the healthcare system that may affect you and your family.

NATIONAL ASSEMBLY

  • As of 13 June 2023, the National Health Insurance (NHI) Bill has been passed by the National Assembly of South Africa.
  • On June 28, 2023, the NHI Bill was sent to the National Council of Provinces (NCOP) for deliberation and consultation
  • The NCOP is the upper house of the Parliament of South Africa, which represents the interests of the provinces and local government in the legislative process and ensures that they have a direct voice in Parliament when laws are made.

NATIONAL COUNCIL OF PROVINCES

  • The NCOP Select Committee on Social Services is briefed by the National Department of Health (NDOH)
  • Any member of the public or an organisation can write to the committee to be heard.
  • Following this briefing, NCOP members will take the Bill back to their respective provincial legislatures.

PROVINCIAL LEGISLATURES

  • The NCOP members will then take the bill to their respective provinces, where the Provincial Portfolio Committee on Health will decide if public hearings should be held.
  • If public hearing takes place anyone can participate in these meetings and also write to the committee.
  • After the hearings, each province will create a plan for the NCOP member to bring back to the Select Committee.
  • The Select Committee, together with legal advisors, will discuss the bill considering the provinces’ plans and can change, approve, or reject the bill.

THE FINAL STAGES

  • If changes are made, the Bill goes back to the National Assembly Portfolio Committee for agreement.
  • If the two houses do not agree, they go into arbitration and have 30 days to come to a resolution.
  • If after 30 days there is no consensus, the Bill is rejected.
  • If both houses agree, the Bill is sent back to the Speaker of the National Assembly whereby it’s noted that both Houses concur.
  • Thereafter it is sent to the President for signature.

ENACTMENT OF THE BILL

  • The President signs the Bill, transforming it into law.
  • Before proclamation, the President evaluates the system’s preparedness, capacity, and financing for successful implementation.
  • The President signs an order to proclaim the law’s operational commencement.
  • The proclamation specifies when the Act, either in full or part, will become effective and operational.

WHAT NEXT?

  • It is important to recognise that the NHI Bill does not = UHC.
  • The NHI bill is only one part of many reforms proposed in the White Paper.
  • From a health system perspective there are other elements that we need to focus on
  • There are many reforms that can be implemented to advance UHC that do not require the NHI Bill.
  • For example, reforms to different Health Professionals Acts, including scopes of practice, ethic rules on employment and revenue sharing, are all necessary for alternative reimbursement models to be implemented. And this does not require an NHI Bill.