South Africa president Cyril Ramaphosa is expected to sign the National Health Insurance bill (NHI) into law tomorrow (15 May 2024).
But the bill has proven controversial, with private sector organisation Business Unity South Africa (BUSA) maintaining it has many constitutional flaws.
BUSA said it was deeply concerned by the announcement that president Ramaphosa will sign the NHI Bill into law tomorrow, “given its many substantive and procedural constitutional flaws”.
BUSA said it “believes that the legislation, in its current form, is unimplementable and damaging to the country’s healthcare sector, to the economy more broadly and to investor confidence.”
The NHI Bill, passed by the National Assembly (NA) and the National Council of Provinces (NCOP) last year, aims to provide free healthcare at the point of care for all South Africans, whether in public or private health facilities.
The Bill currently only requires the president’s signature for enactment.
The enactment of the bill comes two weeks ahead of national and provincial elections on 29 May 2024.
Universal coverage
According to the presidency, the move will “transform South Africa’s healthcare system and ensure universal coverage for health services, with an aim to overcome critical socio-economic imbalances and inequities of the past.”
Speaking during the State of the Nation Address in February, president Ramaphosa said the State was working tirelessly to improve healthcare quality and access equality, despite the country’s health system significantly impacting people’s lives.
But Cas Coovadia, CEO of BUSA, said today: “We fully support the objective of universal health coverage, however, the NHI Bill in its current form is unworkable, unaffordable, and not in line with the constitution.
“What is especially troubling is that the president is proceeding with the bill despite extensive constructive inputs made by a wide range of stakeholders, including doctors and healthcare professionals, civil society, public sector unions, academics and business.
“The unfortunate consequence is that this version will hamper, rather than promote, access to quality healthcare for all citizens in our country.
“Consequently, we will pay close attention to the president’s announcement on Wednesday, based on which we will consider our options.
“Our subsequent actions will be guided by our belief that it is essential that we get the NHI right through all means still at our disposal, including appropriate legal interventions, so that the legislation that is finally implemented is in the best interest of our country, and all her people, for generations to come,” Coovadia concluded.
Discovery Health
Discovery Health, South Africa’s largest health insurance provider and which operates as Vitality in the UK, previously also expressed concerns about the NHI and the effect it would have on insurance schemes.
Health & Protection reported in February that Discovery had said: “Our strong view is that substantially limiting the role of medical schemes would be counterproductive to the NHI because there are simply insufficient resources to meet the needs of all South Africans.
“Limiting people from purchasing the medical scheme coverage they seek will seriously curtail the healthcare they expect and demand.”
Discovery added: “We also believe that limiting the rights of citizens to purchase additional health insurance, after they have contributed to the NHI, would be globally unprecedented and inappropriate.
“In virtually every other country with some form of NHI, citizens are free to purchase additional private health insurance cover, including cover that overlaps with services covered by the national system.
“A restriction on choice of medical scheme cover is not dissimilar to limiting the rights of citizens to purchase private education for their children or private security, on the basis that the public system already provides state schooling and security services.”
Two phases
South African health minister, Dr Joe Phaahla, announced in February that the NHI would be implemented in two remaining phases from 2024 to 2026, while between 2026 and 2028 government will focus on establishing the Board and CEO and several key committees of the NHI Fund.
“We are confident that the innovative funding of infrastructure as stated by the president will also contribute to health facilities,” he told Parliament at the time.
In the meantime, the minister said his department was strengthening key delivery areas.
These include the healthcare benefits design, digital health systems, and risk identification and fraud prevention.
The signing ceremony will take place at the Union Buildings (pictured) in the administrative capital of Pretoria.