OPINION

Fixing the NHI Bill

Khulekani Mathe |

29 April 2024

Khulekani Mathe provides BUSA’s perspective on how to correct the legislation

BUSA: Building a sustainable healthcare future requires thoughtful reform, care and collaboration

29 April 2024

As the election draws closer, the future of our nation is at the forefront of our thoughts. We are fully aware that South Africa’s success depends on our ability to generate employment, boost the economy, tackle crime and corruption, provide education for our youth, secure reliable power and water supplies, and deliver high-quality healthcare to all. In order to achieve a fair and sustainable healthcare system, it is crucial that we establish a system that will benefit present as well as future generations.

While there are undoubtedly areas in need of reform in both the public and private healthcare sectors, it is important to recognise that there are also areas of world-class excellence, notably the many outstanding healthcare professionals and hospitals operating in both domains.   It is vital that healthcare reform secures and improves rather than damages these areas of excellence, while also sustainably bolstering health system resources.  The private sector has made immense contributions to job creation, innovation, service delivery and infrastructure investment.  

Most importantly, any healthcare system we adopt for our country must be affordable, feasible, sustainable, and resistant to corruption. Furthermore, it is essential for the healthcare system to be in accordance with our Constitution.  This is a long-term investment for our country that needs to be prioritised over short-term political ambitions.  

The current NHI Bill, which is on the President’s desk for consideration, is unfortunately not consistent with building long-term sustainability and access.   It is deeply troubling that a vast number of concerned stakeholders have repeatedly raised these concerns throughout the legislative process. 

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It is regrettable, not only for this Bill, but for the country itself, that their cautions and proposals were disregarded without proper consideration. As my colleague, Busi Mavuso, CEO of BLSA so rightly said in her weekly newsletter, proper public participation is a vital step in the development of sound policy. Ignoring this step, she said, is a missed opportunity to improve laws and regulations to maximise the public benefit. 

Business is not the only segment of society that is deeply concerned.  The South African Health Professionals Collaboration, a group of some 25 000 public and private healthcare doctors, dentists, specialists and allied healthcare workers also believes its members’ concerns and recommendations throughout the parliamentary process were dismissed, raising serious questions about the fairness and effectiveness of the democratic process.  

Most recently, the Public Servants Association (PSA) raised its own concerns, cautioning that significant issues need to be addressed to ensure the NHI’s success, and to mitigate negative consequences.  It was particularly concerned that the transition to the NHI may result in public servants losing out on the medical-aid subsidy they currently receive through the Government Employees Medical Scheme (GEMS). This, it said, could place an undue financial burden on public servants and their families, particularly if they are required to contribute to the NHI fund whilst receiving reduced remuneration benefits. 

This not only affects public sector employees, but every citizen that has a medical aid subsidy as part of their employment benefit package, as well as those benefiting from medical scheme tax credits that reduce their personal income tax burden.  The intention of the Government to eliminate this benefit in order to finance the National Health Insurance (NHI) should be a cause for concern for all employers and employees who access these benefits.