Calls intensify for the government to address several shortcomings of NHI

The current public healthcare system in South Africa is under-resourced and strained. Photo:

The current public healthcare system in South Africa is under-resourced and strained. Photo:

Published Oct 13, 2023


The Bill seeks to create one government fund that will be able to pay for both private and public health facilities. But will it work?

Some members of the healthcare sector have called for the government to address the flaws in the National Health Insurance (NHI) Bill, passed by the National Assembly in June and with the National Council for Provinces.

The Bill seeks to create one government fund that will be able to pay for both private and public health facilities.

The Bill, among other things, covers: who will be able to access healthcare services; how these services will be funded; the establishment of a board and advisory committees, general provisions applicable to how the fund will operate, complaints about and appeals to decisions made by the fund; and the source of income of the fund and transitional arrangements.

It states that once the NHI is fully implemented, medical schemes can only offer complementary coverage for services not reimbursed by the NHI.

Medical schemes and insurers, in particular, had expressed concern about the effect the Bill would have on their current businesses.

Bonitas Medical Fund principal officer Lee Callakoppen said Parliament without taking into account the numerous objections by several role players in South Africa, passed the Bill.

“Critics of SA’s proposed NHI do not object to the concept of Universal Health Care (UHC), accepting that access to healthcare should be a constitutional right rather than a privilege.

“They object to a Bill that is so inherently flawed that it will jeopardise citizens’ rights to health care. What is important to remember is that this means there is a responsibility and duty to provide quality healthcare,” he said.

Callakoppen said the NHI Bill in its current form is a funding mechanism, not UHC which would: improve access to quality healthcare; enhance the quality of life of all South Africans; contribute to addressing the social-economic imbalances, injustices, and inequities of the past.

“The devil is in the detail. Pragmatically, the path to UHC through the phased implementation of NHI must start with cover for the vulnerable groups, before it is expanded to cover better-off sections of the population.

“This implies that there will be an inevitable period of co-existence between medical schemes (as they currently exist) and the NHI Fund. In this scenario, the NHI Fund should start by offering comprehensive primary healthcare services before adding higher-cost items, such as hospitalisation,” said Callakoppen.

He said this would allow time for developing the necessary purchasing capability within the NHI Fund.

“However, at this stage, the Bill is still not clear on what will and will not be offered by NHI and the role - if any – private medical aids will play. What is of concern is that the Bill suggests the scrapping of medical aids in its current form and only refers to complimentary services.

"What this means is unknown. However, we believe that the only way for the healthcare system to evolve is through inter-dependent relationships, with public and private healthcare co-existing,“ Callakoppen said.

Medshield Medican Scheme principal officer Kevin Aron said while implementing the NHI was commendable, the execution in South Africa will likely encounter significant challenges.

He said corruption and mismanagement of funds would be one of the challenges.

“Implementing robust measures to prevent corruption and ensure accountability is crucial. It may include strengthening the regulatory framework, enhancing transparency and accountability, and providing training and support to healthcare workers. Effective oversight of the NHI is essential to prevent misuse of funds,” he said.

Aron said limited resources and capacity would also be another challenge.

“The current public healthcare system in South Africa is under-resourced and strained. The government should invest in recruiting and training more healthcare workers, constructing new healthcare facilities, and upgrading existing ones. It will ensure fair compensation for healthcare professionals to prevent a brain drain to the private sector.”

Aron said, nonetheless, Medshield Medical Scheme approaches the approval of the NHI Bill by the National Assembly with caution.

“Regrettably, the revised version of the bill did not incorporate many valuable contributions from multiple stakeholders. Despite this, we remain committed to supporting the implementation of the NHI to increase access to quality healthcare for all South Africans. Strong partnerships, collaborative efforts, public healthcare reforms, and private healthcare involvement can lead to a viable and effective NHI,” he said.

Legal firm Webber Wentzel, through its attorneys, partner Lenee Green, associate Mateen Memon, and trainee attorney Mariam Ismail, said the NHI Bill in a press release, does not contain any clarity on how South Africa’s large and complex medical schemes and insurance industry will be affected.

“The Bill has been closely scrutinised by various stakeholders in the healthcare sector. Concerns have been raised by medical schemes and insurers about the effect the Bill will have on their current businesses,” they said.

Meanwhile, Trade Union Solidarity said it would request a cost order process against the Bill should it be implemented.

The union said although it has also emphasised in the past that the country is in desperate need of cheaper healthcare, reports from the Solidarity Research Institute (SRI) make it clear that the NHI is certainly not the best solution.