South Africa

NHI Bill unconstitutional and illegal – Bonitas

Bonitas Medical Fund said it is illegal and unconstitutional for people to be prevented from purchasing healthcare should they have the means to. This is what the draft National Health Insurance (NHI) Bill in its current form would do.

Bonitas principal officer Lee Callakoppen said critics of the proposed NHI do not oppose the concept of Universal Health Care (UHC) but believe the Bill’s flaws could jeopardize citizens’ right to healthcare. 

“They object to a Bill that is so inherently flawed that it will jeopardise citizens’ rights to healthcare,” he said. “What is important to remember is that this means there is a responsibility and duty to provide quality healthcare.”

Callakoppen said he finds the lack of detail around implementing the national health blueprint worrying.

Currently,  Section 33 of the draft NHI Bill states that when the NHI is fully implemented, medical schemes will be limited to playing a “complementary role”. They will, therefore, not be allowed to provide services that the NHI already covers.

“However, at this stage, the Bill is still unclear on what will and will not be offered by NHI and the role – if any – private medical aids will play,” said Callakoppen.

“What is of concern is that the Bill suggests the scrapping of medical aids in its current form and only refers to complimentary services. What this means is unknown.”

He said there would be significant ramifications for curtailing the role of medical aids. These aids and their associated services make “an enormous contribution” to the annual fiscus.

In addition, the industry contributes significantly to employment and the economy. 

Callakoppen said taking away the rights of healthcare providers and recipients is unconstitutional, “and forcing this on the citizens is not an option”. 

He said using medical aid reserves to fund NHI is also unconstitutional. “These funds belong to the members of those schemes.”

Lee Callakoppen

Callakoppen believes NHI and private medical schemes can and should co-exist. 

“We wish to be clear that Bonitas supports the notion of UHC [Universal Healthcare] and sees the NHI Bill as a positive progression towards UHC for South Africa,” he said.

“But there needs to be a transitional path that ensures improved delivery of primary healthcare services.” 

“We suggest that the policy position outlined in Section 33 of the Bill be restructured to cover the same scope of services as offered by the NHI Fund.”

Callakoppen said this process would be consistent with the Health Market Inquiry (HMI) final recommendations on introducing a standardised base benefits package.

It would create an enabling environment for strategic purchasing, value-based contracting, performance-based reimbursement and contracting linked to quality health outcomes.

“We need to focus on public and private enterprise working together, strong leadership, accountability and dealing with social-economic issues as an integral part of the process,” he said.


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