No rational reason for NHI in South Africa

There is no rationale for South Africa to implement the National Health Insurance (NHI) Bill in its current form, as it poses a threat to both the public and private healthcare systems. 

This is feedback from Wits School of Governance Professor Alex van den Heever, who told Newzroom Afrika that the NHI will disrupt healthcare provision in South Africa with potentially devastating consequences. 

Van den Heever’s comments come on the back of President Cyril Ramaphosa saying that despite the threat of legal challenges, the NHI Bill will be signed into law soon.

Ramaphosa joked during his State of the Nation Address that he was looking around for a pen to sign the Bill. 

Parliament’s National Council of Provinces approved the Bill in December. It was referred to the President, who can either assent to it or ask lawmakers to amend it if deemed legally or technically flawed.

“It is extremely controversial and potentially very prejudicial to the healthcare system as a whole, both the public sector and private sector,” Van den Heever said.

Van den Heever explained that the Bill seeks to collapse the provincial healthcare system and centralise it in a national institution that does not exist yet while also collapsing private funding for healthcare. 

“You are disturbing the entire current healthcare system and attempting to create a new, third system which you claim will be better. There is no rationale for that kind of move. There is no real reason for this,” he said.

“The concern is that the real reason for this is to consolidate power in one entity that will result, in its ultimate form, in R600 billion being under the control of the Health Minister. That is just wrong.” 

“It is the design that has collapsed pretty much everything that we have in the state at the moment.”

He clarified that he is not against the concept of NHI and enabling everyone to have access to quality healthcare but is against the current form of the NHI. 

Van den Heever’s concerns echo those of the University of Johannesburg’s Dr Xolisile Ngumbela, who said the NHI should be implemented in South Africa. However, the government cannot be trusted to do so alone.

He said the government shouldn’t drive away big businesses and the private sector. Instead, there should be a partnership between the private and public sectors to implement NHI in South Africa effectively.

In particular, there should be a clear approach to the management of the next system, as “it can’t be the next Eskom or SAA”. 

“What we need is a proper implementation with checks and balances and with a project manager so that it can be a seamless healthcare system for all,” he said.

According to Ngumbela, the government also “cannot be trusted” with the massive sums of money required to fund NHI in the country. This is another reason the system requires both public and private partners.

“We can’t trust the government. Look at the state entities – they are all failing because the government can’t manage these finances and the large sums of money,” he said.

“Should we leave it to the government, it will lead us to a monopoly and corruption.”

He said the government must first focus on fixing the current system – its infrastructure, management and governance issues – before it attempts to implement NHI.

“The current system is flawed – it can’t really guarantee Section 27 of the Constitution. Let’s level the playing field before we get into the NHI,” he said.

However, Ngumbela pointed out that the public sector faces several challenges, including having their medical professionals “poached” by the private sector.

This is why both sectors need to work together rather than having one take over the system completely.

“We can’t afford to fold our arms and say, ‘Let’s let the private sector take over.’ As we move along, we need to fix the current system.”