What everyone’s saying about the signing of the NHI Bill

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What everyone’s saying about the signing of the NHI Bill

In what can only be described as a desperate electioneering move, President Cyril Ramaphosa finally found his pen and signed the NHI Bill into law this week. It’s created waves throughout the industry, and amongst consumers, who are all battling to understand the basics of the Bill, not least how exactly it will be funded. MoneyMarketing collated the key information about what’s happened this week – and who’s saying what.

What the President has to say

At a signing ceremony at the Union Buildings, President Ramaphosa said: “The NHI is a commitment to eradicating the stark inequalities that have long determined who receives adequate health care and who suffers from neglect.” He explained further: “This transformational healthcare initiative in many ways gives further impetus and effect to our constitutional commitment to progressively realise access to healthcare services for all citizens. By putting in place a system that ensures equal access to health care regardless of a person’s social and economic circumstances, the NHI takes a bold stride towards a society where no individual must bear an untenable financial burden while seeking medical attention.” In terms of how it will be funded, the president was deliberately vague. “The financial hurdles facing the NHI can be navigated with careful planning, strategic resource allocation and a steadfast commitment to achieving equity.”

What the health minister has to say

Health minister Joe Phaahla was quick to point out that the new system would not fall into place immediately, despite some rumours that have been doing the rounds that anyone could use any health facility from 1 June. He explained it will take at least four years to get the NHI up and running, and the signing this week is just the first phase, which will run from 2023 to 2026. He emphasise that those with medical aids should continue with them. “We have implemented various quality improvement programmes in all provinces,” he says. “In terms of the various improvements which are being rolled out from primary health levels right up to specialised services. We do acknowledge that even though the second phase will be focusing on actual implementation of the programmes, the purchasing of services will be built up even in the first phase.”Phaahla says the signing of the Bill does give the department power to go to National Treasury to say it must allocate funds for the programme.

What the medical aids have to say

With Discovery shares falling significantly in light of the announcement of the signing, Discovery group CEO Adrian Gore was one of the first medical aid leaders to speak out about the Bill, describing it as flawed. “We see no scenario in which there is sufficient funding for a workable and comprehensive NHI in its current form – hence our conviction that private sector collaboration is vital, and that full implementation of the bill remains a long way off – likely decades,” Gore said. “Significant flaws in the bill and the legislative processes followed in promulgating the bill, will also likely result in the bill being challenged on numerous fronts, leading to further likely delays. The NHI is an inordinately large and complex initiative requiring considerable planning and preparation before it can be implemented.”

Gore also sent out a letter to all Discovery medical aid members clarifying what the signing of the National Health Insurance (NHI) into law means. He said that medical aid members need not panic, noting that medical scheme cover and benefits will not be affected by the new laws “for a long time to come.”

Medihelp released a statement saying: “We agree that health is a fundamental human right as entrenched in the United Nations (UN) 2023 agenda as part of the Sustainable Development Goals (Goal 3). In its purest form, the conviction of universal health coverage or national health insurance, which is widely recognised as a means to facilitate health for all, is noble and one worth striving for.” Varsha Vala, Medihelp’s Principal Officer says: “South Africa’s national health insurance will be structured as a fund, as established in terms of the National Health Insurance (NHI) Bill. The legislation provides that different sections of the Act will come into force over time, as and when certain milestones are achieved. So even though the Act will be signed tomorrow, the provisions of the Act are not operative. The first sections of the Act, which will most likely become operative, are those relating the creation of benefit committees and the like. These committees must then sit and determine the benefits. This process itself will most likely take a significant period of time as evidenced in other countries,” says Vala.

What the unions are saying

The South African Medical Association Trade Union (which represents most public sector doctors) has strongly supported the Bill, describing it as “a monumental shift towards achieving universal health coverage and ensuring that every South African has access to quality healthcare irrespective of their socio-economic status.” But other labour groups have different opinions. Trade union Solidarity said” “We will start with a legal process within an hour of Ramaphosa signing this bill which we believe to be populist, irrational and unaffordable.”

The South African Health Professionals Collaboration (SAHPC), representing 25 000 healthcare workers across both public and private sectors, announced it is considering a legal challenge because they believe the Bill will “reverse, rather than advance, equitable, quality healthcare in South Africa.” Similarly, the business lobby BUSA stated it is evaluating its options, including potential lawsuits, against a measure it described as “unworkable, unaffordable, and unconstitutional.”

What private doctors are saying

In a snap survey by News24, South African private doctors said they vehemently oppose the National Health Insurance (NHI) Bill, with many threatening to leave the country or the medical profession altogether.

What the opposition has to say

There has been strenuous opposition to the legislation by healthcare practitioners, funders, business, civil society groupings, some trade unions, as well as opposition political parties. Court challenges have already been declared, with the DA describing is a “ploy for votes”. “We will challenge the law all the way to the Constitutional Court,” said DA leader John Steenhuisen. “Our legal team was briefed months ago already and will file our legal challenge against this devastating legislation without delay.”

He went on to say the DA has “built up reams of correspondence, including with Ramaphosa himself, that we will enter into evidence to show that the process which led to the adoption of this bill by Parliament disregarded public input, and that the bill itself is flagrantly unconstitutional”.

Sources: Sowetanlive.co.za; news24.com; medihelp.co.za; businesstech.co.za.

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