What is the NHI bill and how will it affect South Africans

The DA has done a comprehensive analysis of the NHI Bill and highlighted the aspects of the Bill which are catastrophic, not just for the health system but for the economy at large.

Should this Bill be passed in its current form, all South Africans will be the main causalities of this system. There are deep inequalities in the system. 84% of South Africans are dependent on an ailing health system with only 16% of our people who can afford private medical care.

The broader inequalities of insiders and outsiders in this country play themselves out painfully within the health system. In line with global trends, South Africa must move towards Universal Healthcare – however not in the form of NHI.

The greatest tragedy of this Bill is that it will not in any way achieve universal healthcare for South Africa. Instead, it is bound to destroy the health system as we know it by fragmenting it, eroding provincial powers, centralizing and nationalizing healthcare, and establishing a multi-billion rand SOE that will be in the hands of the politically connected few.

The DA is opposed to the following aspects of the draft Bill:

  1. The establishment of The National Health Insurance Fund as a public entity or State-Owned- Enterprise – the Bill explicitly states that the fund will operate as a public entity which will be constituted by the pooling of funds both from the public and private sector. The Minister has sole discretionary powers over this fund. In addition, the board which is appointed by the Minister, will be tasked with overseeing this fund, leaving very little room for adequate checks and balances. In addition, the Bill makes provision for investigative powers in cases of corruption and maladministration within the National NHI Fund Office , and not through any independent body. This fund will serve as just another SOE vulnerable to grand corruption at the expense of the nation’s entire health system.
  2. The nationalization of healthcare and clear erosion of provincial powers – the Bill completely centralizes the provision of healthcare by placing the management of all central hospitals under the national department. This is, in our view, is the undermining of provincial powers as enshrined in the National Healthcare Act of 2003. In practice, the equitable share of funds to provincial departments will directly finance the fund, meaning poorer health outcomes for ordinary South Africans. Provincial departments are already stretched in terms of the healthcare services they are required to rollout, and a reduction in their equitable share will be disastrous for the actual delivery of healthcare. Provinces are at the coalface of the delivery of health services and must be given more funds to improve public health care, not less.
  3. Fragmentation of the health system – Currently, the health system is premised on an all-encompassing referral system, from community health workers who form part of the primary health system right through to tertiary hospitals. The Bill seeks to change this by having tertiary hospitals under the management of the national department. This will lead to a complete breakdown in the system, and ordinary South Africans will not be able to hold provincial departments to account for poor outcomes. In addition, the referral system that is prescribed by the Bill, will slow down the provision of emergency care. According to the legislation patients would need to follow a cumbersome and bureaucratic referral path before being seen by a specialist. This will curtail the powers of all medical healthcare professionals who can easily identify emergency cases that need urgent attention. Fragmenting the health system will bring normal functioning systems to a grinding halt, and take power and decision making further away from people, not closer to them.
  4. The additional tax burden that will be imposed on South Africans – The financing model of this Bill will mean the removal of the tax credit benefit afforded to medical aid clients while imposing a new tax on ordinary South Africans to fund this new SOE. Ordinary South Africans have been squeezed dry by government and cannot be subjected to yet another tax.
  5. The complete removal of choice for South Africans – this Bill removes the autonomy of South Africans to choose their own healthcare. It mandates the national department of health as the sole provider of healthcare in the country while all private healthcare providers will be contracted by the state. This means that there is absolutely no choice for people on which services to purchase, nor will there ever be competition to drive up the quality of healthcare. Medical aids will cease to be useful as the model makes the state the only provider of healthcare in the country. Considering that the ANC government will be the sole medical service provider in the country, medical aid companies will also have to contend with payment from the state. Currently, the ANC government is battling with upholding the 30-day rule of paying service providers and this problem will only be compounded. This was clearly demonstrated at each and every NHI Pilot Project where payments were never made on time and private GPs simply pulled out of the system. This will, no doubt, lead to massive brain drain and erosion of talent in our health system. Doctors and health professionals will seek opportunity beyond our borders.

The DA’s Sizani Universal Healthcare Plan

In contrast to the NHI, the DA’s Sizani Universal Healthcare Plan will ensure all South Africans are provided with quality healthcare, without crippling the economy.

The DA plan would ensure the following:

  1. It will be funded through the current budget envelop which includes the tax benefit currently afforded to medical aid clients;
  2. It would strengthen the role of primary healthcare in many communities;
  3. It would invest heavily in the provision of maternal and child health services, and the training and provision of healthcare professionals;
  4. It would reinforce the powers of provinces by ensuring they are adequately funded and equipped to provide quality healthcare to all;
  5. Through these interventions, all South Africans would have access to a quality health system that provides them with a standard package of care across all facilities;
  6. Medical aid companies would be used as a top up measure for those South Africans who choose to use them and who can afford to do so;
  7. Ultimately this system would increase competition, drive up quality, and afford every South African the choice of which medical provider they wish to use.

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One Response to “What is the NHI bill and how will it affect South Africans”

  1. Lynne Lawson Says:

    It is important that this Bill does not see the light of day

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