South Africa’s NHI has hit a wall

The National Treasury does not expect South Africa’s National Health Insurance to be a significant cost pressure in the medium term, with the scheme’s planned implementation progressing a glacial pace despite being mooted more than a decade ago.

In its Medium Term Budget Policy Statement published on Thursday (MTBPS), Treasury said that a limited costing of the national health insurance policy proposal has previously shown that it would require about R40 billion per year in additional funding in the first five years, and perhaps considerably more over time.

“At present, however, there is insufficient capacity in the health sector to work substantively on national health insurance. The national health insurance indirect grant has been underspent, the National Health Insurance Fund has not yet been established, and the National Health Insurance Bill still needs to be passed by Parliament.

“It is therefore unlikely that national health insurance will be a significant cost pressure in the medium term,” it said.

While the Department of Health has repeatedly said that it remains committed to the NHI system, several studies show that the system is unpopular among healthcare professionals.

In August 2021, trade union Solidarity published a report showing that a significant number of healthcare workers plan to leave the country due to concerns around the new system.

The survey drew a response from 1,410 healthcare workers in three separate studies conducted in 2018, 2019 and 2021.

Across the studies, the overarching response from healthcare professionals is one of uncertainty and mistrust around the NHI, with general sentiment towards the system being overwhelmingly negative.

“Almost all the respondents have serious concerns regarding the state’s ability to manage and administer the NHI,” Solidarity said. “The total administration and management of funds and decision-making will be in the hands of the state.

“Most are seriously concerned about the fact that the state can determine and enforce tariffs, place of work, type of diagnostic tests and type of medication and treatment.”

Solidarity said that respondents’ opinions are likely shaped by the observed mismanagement and maladministration at institutions such as Eskom, the SAA and the SABC. The NHI will be significantly larger and more complex, must serve a population of more than 55 million people, and will have to manage and execute many contracts, it said.

Read: Medical aids are going through drastic changes in South Africa – and the NHI is speeding things up

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South Africa’s NHI has hit a wall