NHI has devastating consequences for South Africa 

The passage of the National Health Insurance (NHI) Bill, even before it becomes law, has already had devastating consequences for South Africa. 

This is feedback from Business for South Africa (B4SA) Steering Committee Chair Martin Kingston. 

Kingston’s comments come as Business Unity South Africa (BUSA) and B4SA are preparing to submit a petition to President Ramaphosa, requesting that the Bill be referred back to the National Assembly for amendment. 

If the Bill is signed into law, the organisations have threatened legal action against the government. 

Parliament’s National Council of Provinces approved the Bill in December and referred it to the president, who can either assent to it or ask lawmakers to amend it if deemed to be legally or technically flawed.

The business groups said the NHI, in its current form, is unworkable, unimplementable, unaffordable, and unconstitutional.

Kingston said BUSA and B4SA have highlighted the problems with the NHI consistently throughout the Parliamentary process. 

“Our concerns, recommendations, research, data, and inputs, as well as those made by a range of experts and affected stakeholders, have been summarily ignored,” he said. 

“No amendments were made at all, including those suggested by the Department of Health itself.”

In particular, Kingston is concerned about the devastating consequences of the NHI Bill being passed by Parliament. These effects are already being felt before it even becomes law. 

“The consequence of passing this Bill, unamended, is devastating,” he said. 

“It will materially delay access to universal health coverage, lead to disinvestment in the healthcare sector, further damage our already fragile economy, and create significant risks for the country in terms of the quality, management, and governance of healthcare.”

One sector of the economy that stands to lose out the most is health insurance, as medical aids will only be able to offer coverage for medical procedures that are not covered by the NHI. 

Martin Kingston
Martin Kingston

Netcare’s chairman, Mark Bower, warned that the NHI, in its current form, will lead to the collapse of this multi-billion rand sector that employs thousands of South Africans. 

“The NHI Bill in its current form poses serious challenges of practicality and affordability,” Bower said. 

It also lacks clarity on critical issues such as what will be covered by the NHI and what won’t, how it will be financed, and how much it will cost. 

“We are particularly concerned about specific provisions in the Bill that prevent medical aid schemes from funding services provided by the NHI,” Bower said. 

“In effect, these provisions take money out of the national health system and pose the real threat of collapsing the health insurance industry in SA.” 

Bower said that international experience has shown that single-payer healthcare systems, funded by taxation, do not expand access to quality healthcare. 

“A multi-payer model would ensure that after paying mandatory NHI tax, those with the means could still fund healthcare privately if they wish, relieving public money to be dedicated to the most vulnerable.”

He added that it is clear that a sustainable healthcare system that provides quality care to all needs strong public and private sector collaboration. 

To this end, Netcare has made comprehensive submissions to the National Council of Provinces and the National Assembly on proposed amendments to the NHI Bill. 

However, the Bill was passed by both chambers of Parliament without any consideration of the proposed amendments.