Healthcare Consulting – NHI Bill

Jillian Larkan
Head – Healthcare Consulting

_______________________________________________________________________________________________________

Will South Africans really have the free healthcare the NHI brochure promises?

The National Health Insurance (NHI) Bill was passed by the National Assembly on 12 June 2023 and is now headed to the National Council of Provinces, where it will undergo further scrutiny.

When a Bill is passed, it has usually undergone rigorous scrutiny, verified proof-of-concept, and is ready for practical implementation. In GTC’s estimation, South Africa is, unfortunately, light-years away from meeting our healthcare objectives, notwithstanding the passing of the NHI Bill last month.

Governments’ ‘What is NHI?’ brochure reveals what the South African population has been told about this national scheme.  Let’s unpack why the vision portrayed by the brochure is ideal for all South African citizens, and where we think it will not work.

The brochure confirms that no initial taxes will be imposed to fund the Bill and that any problems with decrepit infrastructure, staff training, and non-functioning supply systems will be upgraded before implementation. 

The brochure further commits that maladministration and corruption will be rooted out, and there will be no difference between the care provided in the public or the private healthcare system.  The brochure notes that there will be no upfront tax to fund the NHI, with any required funding being pooled funds ‘that already exist in the public sector’ to cover the initial costs.  Treasury may introduce ‘a small tax’ to augment this initial pool at a later stage.  Of course, this statement is disingenuous.  If existing funding was sufficient to cover the costs of the NHI in the first instance, there would be no talk about the combination of public funds and private medical aid contributions to create a funding pool big enough to initiate the launch of NHI. 

The brochure advises South Africans that before the NHI becomes law, the government will have the systems to administer the fund to provide services, refurbish clinics and hospitals, training and employing sufficient qualified staff and employing suitable systems to improve care and medicine supply, and rooting out maladministration and corruption.

Through the administration of private medical aids, millions of members’ claims and contributions are managed each month, as too are the ‘fraud and corruption’ issues that sadly accompany so much of what we do every day. 

How Government is going to accomplish this same task within a scheme that caters for more than 60 million members, without losing control, will need to be proven, particularly in the context of so much of the rest of government expenditure being mismanaged and misappropriated. 

While the brochure states that Government will ‘upgrade all facilities to ensure that there is no difference between a public and private facility’, if this were at all possible, we’re sure that this would already have been done.

Finally, Government confirms that the NHI will buy services for all South Africans from providers in the public and private sectors, and combine public and private funds, integrated into one system.  All providers will form part of this system and get paid from the central fund. 

NHI-registered doctors will not be able to charge private practice rates and will see more patients, work longer hours, and earn less income than they do in private practice.

Healthcare professionals are valued and sought-after around the world.  The chances of our service providers remaining in South Africa – working under these proposed restrictive conditions – is remote and a catastrophic ‘brain-drain’ within the healthcare system should be planned for, concurrent with the actual roll-out of the NHI. 

The brochure envisages an equitable healthcare system, competently and professionally managed. 

The delivery of the NHI depends upon an electorate choosing a government who has committed to delivering this.  It also requires that this same government can deliver it. 

Given the many ‘unknowns’ of the Bill in its existing format, from the level and extent of benefit provisions to the confirmation as to whom the service providers will be within the NHI, the biggest threat to the South African public remains the unknown funding requirement for the Bill.  Government insists that it will not reassess the funding requirement for the Bill; that it will be implemented in phases; and that it will launch the NHI beginning with the entry point into healthcare, namely primary care. 

Government’s vision of healthcare for all must surely be enthusiastically shared by every South African.  Equally, most South Africans will know that without the restraints and obstacles of practical application and real-life cognisance of prevailing conditions, any brochure’s content can be painted as an El Dorado or a Shangri-La – a beautiful, though mythical place.  Is the recent passing of the NHI Bill indeed good business or a last-minute populist election ploy? 

Your answer may well depend on the current state of your healthcare provisions…

Read the press releases here.