Will healthcare brokers continue to have a role under the National Health Insurance (NHI) system? While the current bill still lacks specifics on its implementation, healthcare brokers and Representatives could potentially continue to play a significant role in helping customers navigate the complexities of the healthcare system.
A recap of the NHI
The NHI, as described on the South African Government’s website, is a health financing system designed to pool resources for affordable, quality personal health services for all South Africans, regardless of their socio-economic status. This is to help prevent financial hardship resulting from healthcare expenses for individuals and their families.
While many believe that the local healthcare system should undergo improvements to better serve all South Africans, critics have raised concerns about the bill’s potential success in transforming the country’s under-resourced and poorly managed public health sector.
In addition, the bill has also been opposed by many in the healthcare sector and by business leaders, with many questioning how the scheme will be funded.
What is the current status of the NHI?
Introduced to Parliament in August 2019, the NHI Bill was passed by the National Assembly on 13 June 2023.
Thereafter, it was reviewed by the National Council of Provinces’ Select Committee on Health and Social Service. On 23 June 2023, the committee posed several questions regarding the bill to the Department of Health. The department assured the committee that there are plans in place to address the challenges identified in the bill.
On 6 December of last year, the bill was passed by the National Council of Provinces and sent to President Cyril Ramaphosa for assent.
In February 2024, during the State of the Nation Address, President Ramaphosa joked that he was looking for a pen to sign the NHI Bill into law.
After the bill is signed into law, government plans to roll out the NHI in phases with incremental implementation.
The role of healthcare brokers under NHI
One pressing question is whether healthcare brokers will have a place in the restructured system. In 2018, the then Minister of Health, Aaron Motsoaledi, said that medical scheme brokers are an unnecessary expense, suggesting that the medical scheme regulator, the Council for Medical Schemes (CMS), could step in to perform the duties of brokers. However, the argument can be made that healthcare brokers will continue to serve a crucial function even after the NHI becomes a reality.
While the Council for Medical Schemes (CMS) could offer advice to consumers, their capacity to serve all South Africans is uncertain. Therefore, consumers will still need guidance from brokers regarding their healthcare choices and their rights to receiving healthcare services through the private or state-run NHI services. Moreover, brokers can help their clients compare services and find the best solutions to their healthcare needs.
Furthermore, brokers will play a significant role in educating consumers about changing benefit structures and their consequences, including advice on how various products or services can be structured to achieve the best possible result. They can ensure that consumers do not encounter obstacles when lodging complaints or submitting medico-legal claims if necessary.
The argument can also be made that given the challenges such as corruption, lack of external audits and risk management in the public health sector, brokers will be essential in upholding the principles of Treating Customers Fairly (TCF) on behalf of consumers.
Another approach that has been floated is that the government should consider including brokers as NHI employees, though this is a complex topic with many unanswered questions.
Meaningful healthcare advice will always remain relevant
Despite the uncertainties surrounding the NHI framework and when it will come into law, the demand for healthcare brokers and intermediary services could persist within the new system. As the healthcare landscape becomes increasingly complex, the need for brokers to educate and assist customers is more meaningful than ever.