South Africa

NHI Bill unworkable, unaffordable, unconstitutional – Netcare

In its current form, the NHI Bill is not only unworkable and unaffordable but also unconstitutional on substantive and procedural grounds. 

This is feedback from Netcare chairman Mark Bower, who said in his board chair’s review that the NHI Bill is not the best way to ensure universal access to quality healthcare. 

“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 there are far better alternatives that involve private and public sector collaboration. 

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

“Disappointingly, however, the NCOP passed the Bill on 6 December 2023 without considering any such amendments,” Bower said. 

Through Business Unity South Africa and Business for South Africa, Netcare submitted a formal petition to President Ramaphosa asking him to send the Bill back to Parliament for revision. 

“The petition expresses our collective belief that the Bill in its current form is not only unworkable and unaffordable, but also unconstitutional on substantive and procedural grounds,” Bower said. 

Wits professor Alex van den Heever

Bower’s concerns echo those of health professionals and social systems expert Professor Alex van den Heever. 

Van den Heever said the NHI Bill is incoherent, unconstitutional, and will limit people’s access to healthcare.

He said the plan to create one system to serve everyone in the country has not been done anywhere and is unfeasible in a developing economy.

He added that the NHI Bill is unconstitutional as it undermines people’s right to choose healthcare.

“There is nothing wrong with somebody purchasing their own healthcare at the level at which they want to, as long as it does not affect another person’s healthcare,” he said.

“We do it in education and housing. We implemented no framework in South Africa that prohibits you from using private services when public services are available.”

For example, people can not be stopped from using private security when there is a public police force to protect them.

Van den Heever said it makes no sense to implement a law to prohibit you from paying for private healthcare should you desire.

The South African Healthcare Professionals Collaboration (SAHPC) said how the NHI Bill was railroaded through Parliament was an embarrassment to the country’s constitution. 

Dr Caroline Corbett explained that healthcare professionals have the most skin in the game and will be the people expected to implement such a Bill. 

Healthcare professionals have a responsibility to ensure that the sector itself is sustainable and can provide access to quality healthcare. 

“The NHI Bill, as it stands, is not the solution to that,” Corbett said. “It is not implementable. It is not affordable. There are multiple problems with this.”

The SAHPC’s biggest concern is that the NHI does not include any reform of the public healthcare system, which fails to provide adequate healthcare to South Africans. 

“There are huge concerns around corruption. There are huge concerns around maladministration and misappropriation of funds. The current healthcare budget is effectively wasted,” she said. 

Another concern is the Bill’s unconstitutional proposals and the undemocratic way it was forced through Parliament. 

“There are constitutional infringements that are extremely concerning and have not been addressed. The process of railroading this Bill through Parliament and the National Council of Provinces is an embarrassment,” Corbett said.