South Africa

NHI faces legal threat


Business Unity South Africa (BUSA) and Business for South Africa (B4SA) have threatened legal action against the government over the National Health Insurance (NHI) Bill should it become law. 

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.

BUSA and B4SA are preparing to submit a petition to Ramaphosa, requesting that the Bill be referred back to the National Assembly for amendment. 

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

“Our concerns, recommendations, research, data, and inputs, as well as those made by a wide range of experts and affected stakeholders, have been ignored by the Parliamentary Portfolio Committee on Health and the NCOP,” Martin Kingston, B4SA Steering Committee Chair, said. 

Those entities are legally mandated to ensure that the NHI Bill passes constitutional muster and is properly configured to give healthcare the best possible chance of success.

“No amendments were made at all, including those suggested by the Department of Health itself, which is deeply concerning for our country and democracy,” Kingston said. 

He added that the effects of passing this Bill are devastating. 

“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.”

BUSA and B4SA were clear that they are not against the creation of NHI but are against the implementation of it in its current form. 

The concerns raised by BUSA and B4SA echo those of one of the country’s largest private hospital groups, Netcare

Netcare chairman Mark Bower said in his board chair’s review at the end of last year 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.