Warning that NHI would leave South Africans worse off

Published Jun 14, 2023


DURBAN - Opposition to Parliament’s Health Portfolio Committee on Health's approval of the National Health Insurance (NHI) Bill continues to grow, with Business Leadership South Africa (BLSA) fearing that the bill, as envisioned, would leave people ‘worse off’.

Parliament’s Portfolio Committee on Health has recently voted to approve the NHI Bill, with President Cyril Ramaphosa expected to soon sign it into law despite objections from several institutions, including the official opposition, the Democratic Alliance (DA).

Expressing BLSA’s fears over the NHI Bill this week, CEO Busisiwe Mavuso said that in a system in which state provision becomes impossible and private health provision is effectively closed down, it would leave the country’s citizens worse off.

“The system would impose a single-payer model in which the government is the only buyer of healthcare services for its citizens. It would relegate the private health insurance market to only complementary healthcare that is not covered by the state scheme,” Mavuso said.

She said that the Covid-19 crisis had seen a rapid partnership formed between business and government to globally source the equipment and medicines needed to fight the pandemic, roll out vaccines as rapidly as possible, and fund many other interventions.

Mavuso said it was a clear demonstration that national health outcomes were achieved faster and more efficiently when government and business work together, drawing on their respective strengths.

“There has also been good cooperation in providing infrastructure such as the Albert Luthuli Hospital in KwaZulu-Natal and that being developed for the Tygerberg Hospital in the Western Cape through public-private partnerships.

“Against these examples of effective delivery through cooperation, we must consider the state of the public sector, which outgoing Health Ombud Professor Malegapuru Makgoba recently said was not ready for a national health insurance system and in which care quality has been deteriorating in most provinces,” Mavuso said.

She called for the principles of blending private and public cover, which have also been applied in developing countries such as Thailand, where 99.5% of citizens have coverage from a mix of public and private schemes, and Brazil, where a robust public healthcare system works alongside private service providers.

“The NHI format proposed would be hugely expensive, drawing resources out of the rest of the government and the services it provides while increasing the tax burden on all of us.

“But, most importantly, we have no reason to believe the quality of care it provides would be an improvement on the status quo. By forcing the private sector out of the provision of all but a limited set of complementary services, private provision would effectively cease,” Mavuso added.

On Friday, DA MP and spokesperson on health Michelle Clarke wrote an open letter to Ramaphosa, urging him not to sign the NHI Bill into law.

“Should the NHI come to pass, health services would collapse. To this day, the Department (of Health) has never made it clear which health services would be available under the NHI and which would be out-of-pocket expenses for patients,” Clarke said.

She said that the NHI would bankrupt South Africa beyond measure, while thousands would die, and any skilled medical practitioner worth their salt would leave the country for better conditions.

“Mr President, my request is simple: do not allow cheap political gain to cloud your judgment. You took an oath to protect this country.

“When the NHI Bill inevitably comes across your desk, please, for all South Africans, do not sign it. For once, put your country above your comrades – your actions will either save lives or destroy thousands,” Clarke said.

Last week, the Hospital Association of South Africa (Hasa) said that approving the Bill without substantive consideration of the many valid and significant recommendations and contributions made by many participants during the parliamentary hearing is deeply regrettable and a missed opportunity by the Committee.

“We urge the National Assembly and the National Council of Provinces in their deliberations on the Bill to insist on a multi-payer model to mitigate against the concentration of risk, an iterative rollout based on milestones rather than dates and to pay heed to the nation’s concerns that the proposed National Health Insurance Fund is susceptible to theft and corruption by proposing and approving alternate and appropriate governance structures.

“The healthcare reform decisions taken now will impact the sustainability of South Africa’s health system and will be deeply felt for generations to come,” according to a statement by Hasa.