NHI Bill will turn healthcare into another government monopoly

The University of Johannesburg’s Dr Xolisile Ngumbela said National Health Insurance (NHI) should be implemented in South Africa, but the government cannot be trusted to do so alone.

Ngumbela told Newzroom Afrika that NHI would bring justice to South Africa’s healthcare system, which currently draws a clear line between the “haves” and “have-nots”.

However, he said the government shouldn’t drive away big businesses and the private sector. There should be a partnership between the private and public sectors to effectively implement NHI in South Africa.

In particular, there should be a clear approach to the management of the next system, as “it can’t be the next Eskom or SAA”. 

“What we need is a proper implementation with checks and balances and with a project manager so that it can be a seamless healthcare system for all,” he said.

According to Ngumbela, the government can also “not be trusted” with the massive sums of money required to fund NHI in the country. This is another reason the system requires both public and private partners.

“We can’t trust the government. Look at the state entities – they are all failing because the government can’t manage these finances and the large sums of money,” he said.

“Should we leave it to the government, it will lead us to a monopoly and to corruption.”

He said the government must first focus on fixing the current system – its infrastructure, management and governance issues – before it attempts to implement NHI.

“The current system is flawed – it can’t really guarantee Section 27 of the Constitution. Let’s level the playing field before we get into the NHI,” he said.

However, Ngumbela pointed out that the public sector is currently facing several challenges, including having their medical professionals “poached” by the private sector.

This is why both sectors need to work together, rather than having one take over the system completely.

“We can’t afford to fold our arms and say, ‘Let’s let the private sector take over.’ As we move along, we need to fix the current system.”

Private-public partnership

Business Leadership South Africa CEO Busi Mavuso has also warned that NHI, as envisaged in the Bill, would leave all South Africans worse off, and the system should rather consist of a private-public partnership.

Mavuso said the NHI Bill illustrates that the government did not learn from other successful public-private partnerships.

She used the Covid-19 pandemic as an example where a partnership between the government and private sector proved successful. Together, the two entities could source equipment and medicines, roll out vaccines and fund other interventions.

“It was a clear demonstration that national health outcomes are achieved faster and more efficiently when government and business work together, drawing on their respective strengths,” she said.

“With the right incentives, the private sector can complement government efforts, speed up the investment needed and reduce costs to the state and users.” 

Mavuso pointed to the Affordable Care Act (Obamacare) in the US as a viable alternative to NHI with a single-buyer model.

Under Obamacare, health insurers must provide minimum benefits, and the state subsidises those earning below a threshold.

However, insurers also compete in a marketplace to offer coverage, and consumers can choose their providers. 

“This approach focuses scarce public resources where it matters: supporting those who do not work or earn below a threshold while ensuring market incentives reduce costs and improve service quality,” said Mavuso.

“Together, we can build a mechanism that delivers the best possible universal healthcare to South Africans at the lowest cost while ensuring we do not destroy the parts of our health system that do work effectively.”

Additionally, forcing the private sector out of healthcare provision could discourage internationally mobile businesspeople from working in South Africa.