The NHI is a government-led plan to make healthcare available to all South Africans. It is based on the idea that everyone should get the care they need, without having to pay at the time that they get it.

President Cyril Ramaphosa signed the NHI Act into law on 15 May 2024. The Act sets out how the NHI Fund will work. The NHI Fund will pay for a list of healthcare services for all South Africans. These services will be free at the point of care. This means you won't have to pay when you visit a doctor or clinic, as long as you follow the NHI rules, referral pathways and clinical guidelines.

Unfortunately, it will be very difficult to raise the taxes required to fund the NHI. Because of this, it is uncertain whether it is realistic to promise a comprehensive package of healthcare benefits to everyone or how long it will take to roll-out the NHI.

The NHI Act says that you'll need to follow a set process called a 'treatment and referral pathway' to use the NHI. For example:

• You'll first need to visit a general practitioner (GP) or a healthcare professional at a clinic.
• They will assess and treat you as per NHI clinical guidelines.
• If they think you need more specialised care, they'll refer you to a specialist or hospital. Specialist or hospital care will be provided if it falls within the list of healthcare services covered by the NHI.

This process will help the NHI to manage care and costs fairly across the system.

If you choose to go outside this pathway, for example if you go straight to a private doctor or hospital, the NHI will not pay for that care. You would need to pay for it yourself. Once the NHI has been implemented, your medical aid would only be allowed to cover you for services that are not part of the NHI benefit package.

For now, nothing changes. The Minister of Health says that the NHI will take many years to put in place. Until then, your medical aid membership stays important. You should not stop it! You still need your medical aid to cover your healthcare costs.

It is also unlikely that your taxes will increase in the near future to help pay for the NHI, as the government has said that there are other urgent priorities in the country and limited money available.

We don't know yet what services or medicine the NHI will pay for. The focus will likely be on basic (primary) healthcare, such as nurse and GP visits and screening tests.

We also don't know which doctors, clinics, pharmacies or hospitals (public or private) will be part of the NHI. They will need to meet certain standards and agree to work with the NHI Fund.

The Act says that once the NHI is fully in place, medical aids will not be allowed to cover services that the NHI already pays for. This means that medical aids will only be able to offer cover for services not included in the NHI.

The NHI is a big change and will take time. The NHI Act mentions 2028 as a target, but this is unlikely given how much still needs to be done. The Minister of Health has said it could take 10 to 15 years to roll out fully. One of the big challenges is that we need to train and employ enough doctors and nurses to provide healthcare services to everyone in South Africa.

The NHI Act says that the money for the NHI Fund must come from taxes and the centralisation of the public healthcare money that currently flows through the provinces. The government has not yet said how much the NHI will cost or exactly how it will be paid for.

The National Treasury said that because of the country's difficult economy and other urgent needs, taxes cannot be increased in the short or medium term.

Private doctors and hospitals can choose to work with the NHI or not. The NHI will probably initially focus on GP services to support the public healthcare system.