National Health Insurance Bill – The house is divided

The National Health Insurance (NHI) Bill has been a subject of controversy since inception. Whilst the government forges ahead with the introduction of NHI, many experts believe the system will fail. A wide range of commentaries was made in the wake of its introduction to Parliament on 8 August 2019 and subsequent countrywide public hearings.

As part of the stipulated parliamentary processes, the Portfolio Committee on Health, chaired by Dr Sibongiseni Dhlomo, commenced with public hearings in all provinces in October 2019, before the Bill will be put before the National Assembly for a vote.

Aim of NHI Bill

The aim of the NHI Bill is to achieve universal access to quality healthcare services in South Africa, in accordance with section 27 of the Constitution. It further aims to:

establish a National Health Insurance Fund and to set out its powers, functions and governance structures to provide a framework for the strategic purchasing of healthcare services by the fund on behalf of its users,
to create mechanisms for the equitable, effective and efficient utilisation of the resources of the fund to meet the health needs of the population, and
to preclude or limit undesirable, unethical and unlawful practices in relation to the fund and its users.

Conclusion of public hearings

The Portfolio Committee on Health earlier this week concluded its public hearings on the Bill. According to a government media release there was wide support for the Bill in all provinces. “The majority of residents who participated in the hearings supported the Bill as they hoped that it will address the question of quality healthcare especially to those in deep rural areas,” was reported.

Dr Dhlomo refuted claims, by political parties who participated, that the hearings were flawed and that the public misled about the objectives of the Bill. “There was a wide spectrum of views. People from various backgrounds came to have a say on the Bill. If the claims were true, surely we would not have heard the concerns which the people raised that include structural and infrastructure challenges in the public healthcare system that needs to be addressed. It would have been all positive,” said Dr Dhlomo.

Diverse Viewpoints

In the lead up to the deadline of 29 November 2019 for public comment, several stakeholders made themselves heard:

The Institute of Race Relations (IRR), South Africa’s leading think tank, is seriously concerned that the National Health Insurance (NHI) plan will have a disastrous impact on healthcare and healthcare funding in SA. Under the NHI, people who pay for the private healthcare of their choice will have to pay increased taxes to help fund the NHI, which, according to former health minister Dr Aaron Motsoaledi, will be “like a giant state-run medical aid”.
Concerns have also been raised that the government’s plan to set up an NHI scheme will result in another state-run monopoly that will be susceptible to greater levels of corruption and mismanagement. These fears have especially been voiced by Alex van den Heever, an adjunct professor at the University of the Witwatersrand (Wits) School of Governance, who was one of the speakers during a panel discussion on the NHI at the SA Vision 2030 Summit in Ekurhuleni recently.
The public interest law centre, Section 27, has highlighted three major concerns with the NHI Bill, namely governance, transparency and the fact that the NHI Bill introduces a range of new structures and administrations that are untested.
According to Nicolien Welthagen, a research psychologist at the Solidarity Research Institute, the general feedback shows that healthcare practitioners have huge concerns about the proposed NHI. “The findings indicate that there is distrust towards the government regarding the way they want to implement and manage the NHI. 80% of respondents are negative or sceptical about the NHI,” said Welthagen.
An opposition party has concluded a thorough analysis of the Bill and found 25 reasons why the Bill in its current form is deeply flawed and will not achieve quality healthcare for all. These reasons have been included in their submission to Parliament. Some of these reasons include poor governance structures, too many vague elements of the Bill which indicate poor planning as well as questions about the funding of the Bill. They also believe that Parliament’s past week’s public participation have been flawed.

The right to health care services is provided for in the South African Constitution. The question, therefore, is if the implementation of the NHI is the only solution. In a National Council of Provinces meeting this week, Finance Minister Tito Mboweni said he did not believe NHI should be considered the only panacea to the challenges dogging the public healthcare system. “We don’t have to wait for NHI to be implemented to fix our public healthcare system. There are things that are within our power that can be fixed now,” Mboweni said.

According to a recent article in Die Burger Dr Zweli Mkhize health minister, assured the National Assembly that government will ensure that corruption is weeded out by the time the NHI is implemented. Given the current state of affairs in state-owned enterprises, this assurance is anything but reassuring. Perhaps more energy should be spent on fixing now what is broken, rather than reinventing the wheel and waiting to see if the new plan works?

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