20 December 2023

What is National Health Insurance?

National Health Insurance (NHI) is a government initiative intended to provide free universal healthcare from one central Medical Fund to all South African citizens.  The framework outlining the basic mechanism of NHI is recorded in the National Health Insurance Bill.

When will NHI be implemented?

Firstly, the Bill needs to signed into law by the State President now that it has been approved by the National Council of Provinces. Thereafter the NHI Act is likely to be challenged in the Courts which could further delay its implementation. There are also many practical issues that are not catered for in the Act, to name a few:

  • How will NHI be funded?
  • How will NHI contract with medical practitioners and hospitals?
  • What billing systems will NHI use?

Once these issues are resolved which could take quite a few years the Act can be implemented. By Government’s own admission this is a process which will start slowly, initially providing some primary health services and it will endure for a period of 10 to 15 years.

Will NHI remove the need for Medical Aid and Gap Cover?

There is a controversial section in the NHI Act which states that once NHI is “fully implemented” medical aids may only provide complimentary services not offered by NHI. This means that at the stage that NHI constitutes one giant Medical Fund providing all the benefits of medical aids to all the citizens of SA at no cost there will be no need for the existence of medical aids. If this is ever achieved it will certainly take in excess of 15 years to develop.

There is much debate around the role of Private Healthcare funding, and this may result in medical aids and gap cover working together with NHI which will alleviate the financial burden carried by NHI.

In conclusion, even in the face of NHI the need for medical aid and Gap Cover will remain for many years to come and this may continue in parallel with NHI even after NHI is fully implemented in the following decades.


The information contained in this communication, including attachments, is not to be construed as advice in terms of the Financial Advisory and Intermediary Services Act of 2002 (“FAIS”) as the writer is neither an appointed representative of Zestlife, nor a licensed financial services provider as contemplated in FAIS. Please consult your Financial Adviser or Zestlife should you require advice of a financial nature and/or intermediary services.