As President Cyril Ramaphosa is expected to sign the National Health Insurance (NHI) Bill into law on Wednesday in a move set to profoundly change the country’s health landscape, he must be confident that his decision is the right one for South Africa.
This pivotal moment will also shape his legacy indefinitely, according to Unisa lecturer in the Department of Political Sciences, Sanet Solomon.
“The timing of the signing is most fascinating as some believe that it could be the ruling ANC’s last attempt at securing the elections. Whether this is the case or not, the president needs to ensure that this decision would benefit the country most as his legacy will be attached to this decision indefinitely.
“South Africa's healthcare sector has been plagued with numerous challenges and has been facing near collapse at several points in time.
“While some welcome the forthcoming signing of the National Health Insurance Bill, many caution against this decision given the current shortcomings of the bill. They reckon that the bill could throw the healthcare system in absolute disarray and result in the mass exodus of several health experts.
Contrary to this, those with no access to medical care are excited as this could result in improved care for them,” Solomon said.
Ramaphosa is expected to sign into law the bill, which aims to achieve universal access to quality healthcare services for all South Africans, whether in public or private health facilities.
The act establishes a National Health Insurance Fund funded through mandatory prepayments.
Its goal is to provide sustainable and affordable access to quality healthcare for everyone in the country by acting as the sole purchaser and payer of healthcare services, in efforts to ensure the equitable and fair distribution and use of healthcare services, sustainable funding, and promoting equity and efficiency in funding through pooling of funds and strategic purchasing from accredited providers.
The NHI Bill, passed by the National Assembly (NA) and the National Council of Provinces (NCOP) last year, currently only requires Ramaphosa’s signature for enactment.
National Health Department spokesperson Foster Mohale said: “As the department we are happy that finally the president has found a pen to move the country closer to universal health coverage to ensure equal access to quality and affordable healthcare by all South Africans regardless of their socio-economic status.”
The South African Medical Association Trade Union (Samatu) on Tuesday said they welcomed the landmark occasion.
“This development indicates that the government is cognisant of the inequalities that exist in South Africa’s healthcare system, and is committed to reforming the system, aiming to alleviate the burden on our public health facilities while also improving the quality of healthcare services across the board. This signifies a move towards a more equitable and just health system, where the right to health is not just a privilege for those who can afford it, but a fundamental human right accessible to all.
“As a union representing doctors, (Samatu) has long advocated for healthcare reforms that not only benefit our members, but also significantly improve patient care and access to health services.
We believe that the implementation of the NHI is a critical step in addressing the disparities in our current healthcare system and ensuring a healthier future for all South Africans.
Samatu is committed to working alongside the government, healthcare providers, and the community to ascertain that the NHI fulfils its promise of a more inclusive and efficient healthcare system,” the union said.
However, the Health Funders Association (HFA) was disappointed by the decision, but it would not yet impact medical scheme members.
“Throughout the NHI Bill’s development process, the association submitted recommendations centred on collaboration and maximising the sustainability of healthcare provision through the use of a multi-funding model to build the South African healthcare system,” HFA chairperson Craig Comrie said.
Even with the president signing the NHI Bill into law on Wednesday, there will be no immediate impact on medical scheme benefits and contributions, nor any tax changes.
The HFA is well prepared to defend the rights of medical scheme members and all South Africans to choose privately funded healthcare, where necessary.”
Medical scheme, Medihelp said health was a fundamental human right as entrenched in the UN 2023 agenda as part of the Sustainable Development Goals (Goal 3).
“And thus, in its purest form, the conviction of universal health coverage or national health insurance, which is widely recognised as a means to facilitate health for all, is noble and one worth striving for.”
Medihelp’s principal officer, Varsha Vala, said: “Many developed and developing countries around the world have successfully implemented national health insurance or have healthcare policies in place. In our view, the implementation of the NHI will rest heavily on the readiness of the existing healthcare infrastructure and the healthcare workforce, public education and engagement, the political landscape, and the financial resources of which we are cognisant is a mammoth task requiring many hands and minds to address.”
The Hospital Association of South Africa (Hasa) added that while they supported universal access to healthcare, they felt this version of the bill would not promote it.
Stellenbosch University School of Public Leadership director Professor Zwelinzima Ndevu said: “The introduction of NHI is significantly a step in the right direction, as this brings hope regarding the much-talked-about universal healthcare system..”
Cape Times