Nod for NHI Bill, flaws and all

Health coverage for everybody a revolutionary milestone: minister

The National Assembly has approved the National Health Insurance (NHI) Bill, taking the ANC-led government one step closer to its plans for achieving universal health coverage.

While the bill still needs to be considered by the National Council of Provinces, SA’s second house of parliament, is not expected to make material changes to the bill before submitting it to the president in the final round of assent.

The bill is the first piece of enabling legislation for NHI and proposes sweeping reforms to realise the ANC’s ambitions of providing all eligible patients with healthcare services that are free at the point of delivery.

It envisages a central NHI fund that will pool resources to purchase healthcare services on behalf of the population from accredited public and private healthcare providers, and a sharply reduced role for medical schemes.

It has faced a barrage of criticism from the private sector in the three weeks since it was approved by parliament’s portfolio committee on health. Warnings were sounded by Business Leadership SA; the Board of Healthcare Funders and the Health Funders Association, which both represent medical schemes; the two biggest professional organisations for doctors and medical specialists; and SA’s biggest medical scheme administrator Discovery Health.

During MPs’ consultation on the bill, concerns were also raised by civil society organisations, patient advocacy groups, and parliament’s legal advisers, who warned that it may be unconstitutional.

Health minister Joe Phaahla said the government is determined to implement NHI and it would defend the reforms all the way to the Constitutional Court.

“We live in a constitutional democracy. It won’t be the first bill to be taken to court,” he told journalists after it was debated in the National Assembly.

One of the bill’s most contentious aspects is its provisions on medical schemes, which when NHI is fully implemented will only be permitted to provide “complementary ” cover for services not covered by the fund. These measures have been opposed by a wide range of private sector players that say it will destabilise the private healthcare sector.

Critics have warned these measures would be at odds with the constitution because they would reduce members’ access to healthcare services. The bill has also been panned for what critics say are its weak governance provisions, which they say leave the NHI fund open to corruption.

“We want to assure South Africans that we are ... paying deep attention to makes sure managerial and leadership risks are addressed.

“That is why we have said the NHI implementation is not going to be an event, but a process. We have said over and over again it

will be in stages,” he said.

The debate in the National Assembly on Tuesday largely mirrored discussions in parliament ’ s portfolio committee on health, with SA’s biggest opposition parties — the DA, EFF, IFP and FF+ — roundly rejecting it, while smaller parties such as GOOD, Al Jama-ah and the NFP supported the ANC majority.

Phaahla said the bill is one of the most revolutionary pieces of legislation since the advent of democracy and will reform SA’s deeply inequitable healthcare system. The rich and employed belong to medical schemes and enjoy access to private services, while the poor and unemployed rely on the public sector.

“As inequality has been growing in our country even cutting across race, access to quality health services has been a casualty with those who have private medical insurance [medical schemes] consuming 51% of the national spending [on health] while constituting only 16% of the population,” he said.

The DA’s health spokesperson, Michele Clark, said forcing nearly 9-million people out of medical schemes would raise the load on an overburdened, corrupt and mismanaged public system, to nobody’s benefit.

NHI is not the miracle the ANC claims it to be, she said, but “smoke and mirrors meant to make voters believe that the grotesque looters standing in front of them have returned to their revolutionary roots that once liberated a nation”.

EFF MP Naledi Chirwa said NHI will not end SA’s two-tier health system, but simply outsource the provision of healthcare to the private sector. “Stop depending on the private sector to solve your problems.”

FF+ MP Philip van Staden said the bill, if enacted in its present form, would make things worse and trigger a mass exodus of healthcare professionals.

ACDP MP Marie Sukers said that trust in the government is at a low in the wake of the extensive corruption during the coronavirus pandemic.