The Portfolio Committee on Health has decided to go ahead with the National Health Insurance Bill (NHI) despite pushback and growing concern over some of its provisions.
According to Parliament, the committee considered and adopted the NHI bill on Thursday (25 May) after the Parliamentary Legal Advisor presented both the A-List and B-Bill to the committee.
“The A-List essentially listed all the amendments as agreed to by the committee. The B-Bill reflected all the proposed amendments and comments forming part of the new NHI Bill,” Parliament said.
On Friday (26 May), the committee will consider and adopt the NHI Bill committee report.
In broad terms, the NHI Bill aims to provide universal access to healthcare in South Africa – as enshrined in the Constitution as a fundamental right. It seeks to achieve this by ensuring that:
- No one is deprived of the right to healthcare because of their socioeconomic status;
- One public health fund is created with adequate resources to plan for and effectively meet the health needs of the entire population, not just for a selected few.
- The ultimate goal is to achieve Universal Health Coverage (UHC)
Funded through general taxes and contributions from people earning above a set amount, the NHI fund will pool money for both private and public healthcare providers – ultimately making it no longer a requirement for South Africans to contribute directly to a medical health scheme.
The NHI bill was originally introduced to Parliament in August 2019 and has undergone years of public participation and consultation in an attempt to calm the nerves of private sector stakeholders, including medical aid schemes, hospital groups, political organisations and labour unions.
Despite consultation, private healthcare providers and medical aid schemes alike feel as if they are getting the short end of the stick, believing that if the bill becomes law, they will no longer be a viable option for people.
Under clause 33 of the NHI Bill, private insurance and medical aid are pushed to the wayside. It states that:
“Once National Health Insurance has been fully implemented as determined by the Minister through regulation in the Gazette, medical schemes may only offer complementary cover to services not reimbursed by the fund.”
The announcement that the bill was approved instantly brought threats of legal action.
Trade union Solidarity said it would continue to take the government and the department to court over the bill.
Peirru Marx, Network Coordinator of the medical industry at Solidarity, said that the government is “misleading South Africans by saying that the NHI will promote healthcare in South Africa while concealing the fact that healthcare is readily available, but that the officials managing these essential services do not have the political will to do what is necessary to improve the quality of health services that must be delivered.”
“Implementing the NHI will undoubtedly result in a disaster in the medical industry. The government is simply not to be trusted. Their history of abuse of power, mismanagement and corruption will undoubtedly compromise the quality of medical care.”
“We are also worried about the number of healthcare practitioners who have indicated that they will not work in these circumstances. There is also prevailing concern about the complete collapse of the free market in this sector as a result of the NHI,” Marx said.
Discovery Health, one of the country’s largest medical scheme providers, said that the new legislation would be open to constitutional challenge.
As reported by Business Day, Ryan Noach, the CEO of Discovery Health, said he was disappointed that the newly amended version of the bill had hardly any substantial changes.
“The portfolio committee elected not to take the opportunity to make amendments to the bill that would enhance both the feasibility and effectiveness of the NHI Fund, despite detailed and constructive inputs from multiple stakeholders.
“As a result, it is highly likely that this bill will be challenged through various legal avenues, including probably being contested on constitutional grounds,” the CEO said.
Private institutions are not the only ones raising concerns over the bill. The Parliamentary Legal Services has noted that there are a host of potential constitutional traps in the current composition of the bill – including a lack of clarity and the attribution of incorrect power to certain ministers.
According to the PLS, the NHI will significantly change the function of medical schemes.
It said that certain arguments in the bill’s submissions claim that the NHI’s requirement of determining where individuals can receive medical care and what treatments they can receive infringes upon people’s right to access healthcare and their freedom to associate.
The bill has had the full backing of President Cyril Ramaphosa, who, on 6 May, called for strong governance and leadership by the Department of Health.
Ramaphosa said the NHI aims to provide the quality healthcare South Africans require, and despite efforts to integrate health departments, quality healthcare is largely influenced by where ou live – adding to the need for a universal approach.
He added that the bill is expected to be debated and passed into consideration in the National Council of Provinces after June.
See a full copy of the NHI bill below:
Read: Short-term pain, but long-term gain for South Africa