NHI: We can’t afford to get this wrong

We’re talking to experts and we’d like public input, to find solutions for universal health coverage.

22/08/2019 08:31:44

NHI: We can’t afford to get this wrong

South Africa, get involved in discussing the National Health Insurance Bill. It’s vital to your future.

The goal of universal health coverage is essential and not negotiable. However, we believe that unless the NHI Bill is changed substantially it is unlikely to get us to this goal.

Access to healthcare affects every single person in the country so we need a national debate about the Bill, which was introduced to Parliament in July.

Over the next few weeks, OUTA will discuss the NHI Bill with experts from a range of fields and will hear from the public, with a view to looking for solutions for a universal health coverage system. OUTA intends to make a submission during the public participation process on the Bill.

“Access to healthcare is a basic human right, which is enshrined in Section 27 of the Constitution, and we want to see universal health coverage with the widest range of health services available to as many people as possible, particularly to those who are marginalised and vulnerable,” says Dr Heinrich Volmink, OUTA’s Executive Director for the National Division.

“Nobody should face catastrophic financial risk due to illness or injury.

“So achieving universal health coverage is vital.”

Widespread concerns have been raised about the Bill, the fund it proposes establishing and the implications for access to healthcare.

“We understand the deep concerns from the public who will have to use the system, the healthcare workers who will have to run it and those who are worried about possible job losses in the medical aid industry and the health sector more broadly,” says Volmink.

“We’d like to see all of these concerns directed into constructive suggestions that will take this debate forward.”

Considerable risks

We believe that there are serious risks with the NHI Bill, in its current form, which need to be addressed.

1. There is a massive risk in trying to impose a new system on top of a broken health system without fixing that system first.

2. There are risks to the fund itself, as currently proposed. We have seen an endless list of examples of public funds and entities which have been targeted for looting. We need to see a cast-iron system for guarding big funds before risking such an enormous new venture.

3. The source of the funds for the NHI is another risk. Realistically, where will this money come from? Taxpayers are already struggling. Much of the public concern over this Bill arises from fear that people will be left with higher bills and taxes, but substantially less healthcare. Healthcare workers and experts are concerned about having to use compromised and underfunded state facilities that don’t have enough staff or equipment. Our country is lurching deeper and deeper into debt, with no possibility of extra funds for the NHI.

4. There have been significant failures in the NHI pilot projects. Why are we going ahead with the NHI instead of learning from the pilots and reassessing what might work?

More concerns

We have additional concerns about the Bill.

There’s no guarantee that the NHI will indeed improve the access of the poor. We’re concerned that the centralisation of the system in the NHI – if not managed properly – may in fact leave them even more marginalised.

We are concerned that the Board which will oversee the fund is appointed solely by the Minister of Health. This concentrates too much control in the Executive. We’d prefer to see a Board of experts nominated by a range of players, such as the President, civil society, professional bodies and academia. Alternatively, we’d like this Board to be appointed through a parliamentary process.

We’re concerned about some of the committees in the bill (such as Stakeholder Advisory Committee), as there isn’t enough detail about their roles and powers.

We’re concerned that consumers may have limited choice in their healthcare providers.

We’re concerned about the role of medical aid schemes, which will be allowed to offer only cover which is not offered by the NHI. How will this affect their viability and their affordability? Will this leave too many people without high-cost care?


Fix the system

South Africa already spends 12% of the total annual budget on health.

This is the third biggest slice of spending, after education and social welfare.

Our debt costs are nearly as much as our health spending.

We are not getting public value for money for this spending. The solution should not be to throw more money – that we can’t afford – at the problem.

What OUTA is doing

“OUTA wants to see a solution that benefits as many people as possible, that does not limit patient choice, that protects jobs in the health industry, and that does not exclude the poor. We should be looking for solutions that deal with the risks we face, so that we can fix the system and make universal health coverage a reality,” says Volmink.

“South Africa doesn’t have the resources to make mistakes. We have one shot at fixing this system. We cannot get it wrong.”

Over the next few weeks, we will consult with a range of experts and knowledge leaders to identify concerns and solutions. We’d also like to hear from the public: please give us your suggestions.

OUTA’s NHI page on our website is here. You can use this for submitting comment to us.

The NHI Bill [B 11 – 2019] is here.

A video with comment by Dr Heinrich Volmink is here (3 min 29 sec).

OUTA is a proudly South African civil action organisation, that is purely crowd funded. Our work is supported by ordinary citizens who are passionate about holding government accountable and ensuring our taxes are used to the benefit of all South Africans.