NHI needs private sector to succeed 

South Africa’s National Health Insurance (NHI) Bill is unworkable, unimplementable, and unaffordable in its current form. For it to work, it needs private sector buy-in. 

This is feedback from Business Unity South Africa (BUSA) CEO Cas Coovadia. 

Coovadia’s comments come as BUSA and Business for South Africa (B4SA) prepare to submit a petition to President Cyril Ramaphosa. 

The petition will request that the Bill be referred back to the National Assembly for amendment as it is unconstitutional and technically flawed. 

If the Bill is signed into law, the organisations will threaten legal action against the government. 

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.

Coovadia said the organisations have not entirely rejected the NHI, just the current form in which it will be implemented. 

“We have not rejected the Bill in its entirety and have consistently supported its policy direction towards universal health coverage,” he said. 

“Our inputs have been intended to remedy the constitutional, funding, and practical deficiencies in the Bill.”

He said if the private sector had been consulted sufficiently in the legislative process and its concerns taken on board by the Portfolio Committee on Health, these problems could have been solved.

“The private sector’s participation in the NHI is critical to its success, not only in terms of funding but also in the expansion and delivery of quality healthcare services,” he said.  

“As a country, we have consistently seen that when the public and private sectors work together, pooling our substantial resources, expertise, skills, and technical know-how, we are able to achieve far more than when we work in isolation of each other.”

“We must work together to ensure that the healthcare system we land with is practical, affordable, and implementable.”

Coovadia’s concerns echo those of Discovery CEO Adrian Gore, who said the NHI scheme will not be workable unless the public and private sectors work together.

He said Discovery supports the implementation of universal health coverage in South Africa, and “we have to make it work”.

However, he said the NHI is not workable without private-sector collaboration. 

“When you look at the numbers, the funding, the complexity – it requires private sector collaboration, and if that can be achieved, then the Bill can be made workable,” he said.

Currently, the Bill says that once the NHI is fully implemented, private medical schemes cannot provide coverage for things the NHI covers. 

Gore said the NHI Bill in its current form would require significant additional funding, estimated to be around R200 billion.

The only way for the government to raise this additional funding consistently is to raise taxes. Gore estimated it would require a 30% increase in personal income tax or a 22% value-added tax.

This, he said, would destroy South Africa’s economy and only achieve a marginal benefit for public sector healthcare.

The NHI will also need more doctors and hospitals, many of which could only come from the private sector.

Gore, therefore, thinks a blended and multi-funder model would be a better way to implement universal health coverage in South Africa.