NHI can collapse South Africa’s healthcare sector

National Health Insurance (NHI), in its current envisaged form, will not give universal healthcare to all and can bring a collapse of South Africa’s healthcare sector.

This is according to DA Spokesperson on Health Michele Clarke, who said the DA has never and will never support the NHI.

Clarke’s comments come in light of a report from Momentum Health Solutions, which warned that it would cost more than R1.3 trillion per year for the NHI to provide each South African with the same quality of care as received under the private health system. 

Previous estimates suggested the country would need an additional R200 billion annually to fund the scheme. However, this is a big underestimation.

Momentum Health chief marketing officer Damian McHugh showed that the scheme would cost at least R900 billion per year.

He explained that the private sector spends an average of R1,750 a month, or R21,000 per year, on 9 million medical scheme beneficiaries.

The NHI plans to offer the same care to 63 million South Africans. This translates into R1.3 trillion annually.

McHugh said there would be savings, like doing away with medical aid tax credits and other economies of scale.

Taking cost savings and other revenue measures into account could bring this to a more conservative estimate of R900 billion.

Aside from its immense cost, the government’s NHI scheme has been severely criticised for several reasons.

For example, many have argued that South Africa already suffers from a shortage of healthcare workers, and the threat of working under the NHI could encourage many more healthcare professionals to leave.

In addition, the NHI Act faces a myriad of legal challenges, with many looking to take the legislation to court.

“Even if the Constitutional Court elects not to intervene at this stage, further objections may be brought in time as the NHI Act begins to be implemented in its various stages,” Cliffe Dekker Hofmeyr’s joint heads of the Healthcare and Pharmaceuticals sector, Susan Meyer and Roxanna Valayathum said.

“Controversially, the NHI Act also seeks to limit asylum seekers and illegal foreigners from accessing services other than emergency medical services and services for notifiable conditions of public health concern.”

For example, trade union Solidarity filed court papers seeking to overturn the NHI shortly after the Bill was signed. 

“Solidarity believes the NHI is unconstitutional as well as being unworkable and unaffordable,” the labour union said.

The union recently achieved a major breakthrough in its fight against NHI when a core pillar on which the state’s centralisation of health care rests was declared unconstitutional in the Supreme Court.

Prior to the May 2024 general election, the DA was also one of the opposing groups that vowed to take the government to court over NHI.

When the Bill was signed into law earlier this year, the DA vowed to “challenge the ANC’s NHI all the way to the Constitutional Court”.

“Our legal team was briefed months ago already and will file our legal challenge against this devasting legislation without delay.”

DA and NHI

Some uncertainty has surrounded the DA’s position on NHI following its inclusion in the Government of National Unity (GNU).

Many speculated whether the DA’s partnership with the ANC and other political parties in the GNU would shift its stance on NHI since it has always staunchly opposed the legislation.

However, DA leader and Agriculture Minister John Steenhuisen said in mid-July that, while the DA’s new role may have evolved, its “dedication to the people of South Africa has not wavered”. 

“The DA is still here, we have not changed, and we are primed to position ourselves within this new paradigm where we will offer our unique vision for the future of our country,” he said.

“This means that we will continue to fight against problematic national policies and legislation such as the National Health Insurance Act (NHI), the Basic Education Laws Amendment (BELA) Bill, and any proposal which is anti-constitutional or seeks to divide and regress South Africans.”

In a press statement released on 6 August, Clarke also clarified that “the DA has never and will never support the NHI”. 

She said the DA believes that universal access to quality health care can only be provided when the root causes of decline are addressed – corruption, maladministration, dangerous infrastructure, broken equipment, medical stockouts, and insufficient personnel.

“The DA has always been in support of universal healthcare especially for the poorest of the poor however NHI in its current form won’t solve this and can bring a collapse of the healthcare sector,” Clarke said.

“We once again ask President Cyril Ramaphosa and National Treasury to explain how the NHI will be funded.” 

“We also require detailed information on how the NHI Fund will be safeguarded against the institutionalised looting and corruption rife within the public health sector.”

She said the DA has never wavered in its efforts to improve public health care by holding the executive to account. 

“We have done multiple oversights in the provinces, requested investigations from the Human Rights Commission, the Special Investigating Unit, and the Public Protector, and pushed for intervention and consequence management,” she said. 

“Instead of addressing the systemic failures that erode the public health system, the Department opted for a centralisation of power and funds, that will make looting much easier while also crushing an overburdened public health system.”

“All the pleas of the DA, health experts, medical professionals, and civil society have fallen on deaf ears.”

She said the DA will continue to question and rally against the NHI. 

“We will not waver to hold the Minister to account. And we will be keeping a very close eye on how the NHI is funded and implemented,” she said.