Workers of the NHI Centralised Chronic Medicines Dispensing and Distribution programme were protesting outside Department of Health offices demanding permanent jobs in 2018. BONGANI SHILUBANE Independent Newspapers.
Nicola Mawson
WHILE there are no clear timelines for when the new National Health Insurance (NHI) Act will be implemented or how it will be funded, what is clear is that the medical fraternity is prepared to take legal action where necessary.
However, a legal resolution could take at least three years.
The health industry is more than prepared to sit down with government to find an outcome to implementing NHI without killing the private sector, which would have the unintended consequence of adversely affecting public facilities.
Yet, delegates at the Healthcare Funders Association (HFA) NHI Scenario Planning Symposium heard yesterday that several umbrella bodies were gearing up for legal action.
Elsabe Klinck, managing director of Klinck & Samuels, said at least two challenges had been filed, including one by the Board of Healthcare Funders and another by union Solidarity.
Klinck noted that as more cases were lodged, it was likely that they will be consolidated and there will be one judgment.
However, she said should the parties wish to declare it unconstitutional, any judgment will have to come from the Constitutional Court, which could take as at least three years.
Issues raised with the act include that it is vague, there are no indications of how it will be funded, and there are deficiencies in the consultation process, said Klinck.
Dr Paula Armstrong, from FTI Consulting, said that in 2011, the government anticipated that the worst case in terms of funding would be 2% of gross domestic product.
That, she said, was “hugely optimistic” given “a problematic view of the future state of the South African economy”.
As of 2011, South Africa’s economy was valued at $458.2 billion, implying that the cost of implementing the NHI would be $9.16bn, or R165bn.
The DA, South Africa’s second largest political party, reckons that the NHI implementation currently will cost more than R200bn, with some estimates as high as R1 trillion.
According to the latest national Budget, the health function was allocated R260.7bn in the 2024/25 financial year.
Yet, speakers at the event agreed on the need for universal healthcare.
Armstrong pointed to the fact that, even among the top 20% quintile of earners in South Africa, not all had access to private healthcare, yet South Africans were generally sicker relative to their peers while the country also faces the challenge of chronic poverty.
She said there was an inadequate framework to deal with need for universal healthcare.
Charlotte Mbewu, chair of the HFA NHI Steering Committee, said that one of the unintended consequences of the law was that it would increase the lack of medical professionals in the private sector as medical aids would be unable to provide further funding.
This, she said, would have a knock-on effect on funding for public institutions.
Moreover, Mbewu said the lack of progress in implementing the low-cost benefit package that would allow more South Africans access to private care at a lesser premium meant that there will continue to be a burden on the public healthcare sector.
Despite the challenges and many being nervous over the new law, Mbewu was hopeful that the right outcome will be reached “that is to the benefit of South Africa as a whole”.
Dr Ntuthuko Bhengu, a member of the panel of the Health Market Inquiry, said there were issues that industry players needed to sit around the table and discuss, adding that the more stakeholders represented, the more likely it was to succeed.
“It’s not perfect, there’s work to be done, but the private sector really needs to be part of the solution going forward,” Bhengu said.
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