COMMENT - AS MINISTER I welcome the current debate on the introduction of the National Health Insurance (NHI). We will be noting all the views and comments made by all citizens as a healthy contribution in reshaping the system that is being introduced to serve all South Africans and ensure universal health coverage for all.
Naturally the NHI will be welcomed by many as a way to resolve unequal access to health care while there will be those who will be sceptical for various reasons.
We reiterate that the NHI will benefit all, ensure equitable access to health services, by promoting pooling of resources and ensure social solidarity in which there is cross subsidisation of the sick by the healthy, the poorer by the richer and the older by the younger. This is in line with global trends in both developed and underdeveloped economies.
We have taken note of the criticism of the bill by the DA leader, Mmusi Maimane. However, as minister I reject his claims as unfounded and an effort to preserve the inequitable access to health services.
No government should allow the perpetuation of the levels of inequality that currently exist in the country, especially in terms of access to health care.
For the longest time in memory, the DA was opposed to any changes in health care that introduced reforms in private health care and medical aid schemes, including opposition to reviewing medical tax credits, which the DA now supports.
The DA has realised their preservation of privileges at the expense of the majority is unsustainable, they now concede that such changes are inevitable.
Despite the rejection by the DA, many South Africans welcome the NHI. Many citizens are concerned about the poor state of health care in the country, which is quite justifiable.
I am acutely aware and sensitive to the issue of corruption and inefficiency - I wish to assure the citizens that I share their concerns and remain committed to uprooting corruption and inefficiency before it happens, or through swift consequence management as it happens.
The DA is welcome to take the bill to the Constitutional Court as they threaten.
I need to assure the public that this bill has been subjected to scrutiny by various constitutional experts and the state law adviser has issued certification to confirm the constitutionality of the bill. I have certifications dated October and January 2018 and another dated March 2019.
The opinion the DA seeks has already been sought. Parliament is at liberty to seek their own legal advice if needed.
The bill makes no effort to take away the concurrent powers of the provinces which are protected by the Constitution. Provinces will continue to have concurrent powers in management of health services under NHI.
These powers and roles will be the subject of discussions between national and provincial government in line with the health reforms.
After all, the current powers of provinces were developed through consultations between national and provincial leaders that led to the promulgation of the National Health Act.
The same process will be followed. Changing legislation is not unconstitutional. Changing circumstances will always ensure that the laws evolve to suit the needs of the country at each stage. Section 146 of the Constitution guides us where there is no proper alignment between national and provincial legislation.
The NHI will be introduced in phases that will allow all role players to adapt to the changes both in public and private sector, in line with the social compact signed with President Cyril Ramaphosa recently with various stakeholders.
The current cost implications are carried in the existing allocations which have been made public. Due to many variables some future costs will be made public when they become available. However, the NHI will be implemented in a responsible manner that the country will afford.
The NHI as a schedule 3 state entity has less powers, more limited than the other entities such as Eskom. Thus strong oversight will ensure good governance and transparency will ensure continuous public scrutiny over its financial activities as such an entity receives funds from the fiscus and is not permitted to take risks and participate in speculative and unsecured borrowing and lending.
Maimane has further made wild and unfounded claims that the NHI will lead to nationalisation of health care which will be fragmented, removing the choice of health care providers for citizens and adding tax burden to South Africans.
Clearly he has not studied the bill properly to understand the fallacy of his claims.
Patients will still be able to register their preferred health care provider under the NHI. Private practices, pharmacies and hospitals will not be nationalised. Those who wish to serve as providers for the NHI will apply for accreditation and the NHI will reserve the right to procure services from private providers as well as the public sector facilities. In the current phase, discussions are advanced to enlist private family practitioners to support the NHI. Their positive response is overwhelming.
While the NHI will depend on the revenue derived from the fiscus, National Treasury’s progressive taxation policies are decided on carefully after analysing the tax burden and ensure the best interest for South Africans.
NHI will ensure one health system for one country with national and provincial departments co-operating in a co-ordinated manner.
Developed economies have demonstrated that NHI contributes to a healthy population that is able to realise its potential. This human capital development leads to economic growth.