South Africa

NHI will be dysfunctional 

National Health Insurance (NHI), if implemented as outlined in the NHI Bill, will be dysfunctional and take 1,000 years to implement due to the government’s incompetency. 

This is feedback from Wits Professor Alex van den Heever, who told Newzroom Afrika that the NHI Bill is magical thinking and unworkable. 

“As it is currently, the Bill is, in many respects, magical thinking. It is not going to give better access to private or public healthcare because none of the core problems preventing access are addressed by it,” Van den Heever said. 

He explained that, in essence, the NHI would be a big purchaser intending to buy healthcare services using methods no one has ever used. 

“It is a completely untested regime, and no promises can be made on what is very likely to be a dysfunctional institution.”

The governance structures proposed in the Bill mimic those of every public entity that has failed spectacularly in the last decade. 

Ultimately, the NHI will only disrupt the public and private healthcare systems without rectifying the things that are not working now. 

Nothing will be solved by forcing the private and public sectors into one centralised entity. 

“It does not actually address any of the resource-related issues in our healthcare system. It makes no material difference to our services,” Van den Heever said. 

There has been no analysis of the issues the NHI claims to address, never mind the proposals themselves. 

“There is a reason why they have not been assessed because if they did the assessment, it would not make a case for the NHI.”

Van den Heever said there are various other problems with the NHI, such as the constitutional issues with how it has been pushed through Parliament and the lack of funding for it. 

Wits professor Alex van den Heever

However, Van den Heever does not think the NHI will even be implemented as the government is too incompetent to do so. 

He previously said the NHI Bill would take 1,000 years to implement as it is “far too complex for this government ever to achieve”. 

He said the proposals contained in the Bill are financially and institutionally impractical. 

The government aims to consolidate the public and private healthcare systems into a single system that does not yet exist. 

This consolidation is to be done by a department and government that cannot run state institutions effectively, according to Van den Heever. 

He said it is “far too complex for this government to achieve”, and Parliament only passed the Bill to give the impression that the government is doing something. 

In reality, the Bill is “merely window-dressing health reform and is not substantive”, Van den Heever said. The can will just be kicked down the road, and “nothing of substance will happen”. 

NHI in South Africa has become a political tool for the ruling party to score political points and is “not a true, public interest-oriented health reform”. 


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