Medical professionals, business groups and trade union Solidarity have responded with varying degrees of outrage at the passing of the National Health Insurance Bill by the National Council of Provinces (NCOP).
Eight of the country’s nine provinces voted in favour of the bill during a sitting on the NCOP on Wednesday (6 December). The vote was delayed by a week after business groups BUSA and B4SA petitioned the House to reconsider the bill.
All the provinces in favour of the bill were ANC-led – with the party describing its plans for universal healthcare as an “unstoppable train” while deriding opponents of the bill as racist. The only province to reject the bill was the DA-led Western Cape, which described the bill as unaffordable, unworkable and a vote-farming exercise ahead of the 2024 elections.
Following proceedings, DA MP Michele Clarke said that ANC had ignored a vast number of submissions and concerns raised by the healthcare industry, legal experts and taxpayers at large, all while leaving gaping and critical questions on the bill – particularly around logistics and funding – unanswered.
“The truth is that the NHI Bill is nothing more than cheap electioneering ahead of next year’s election,” she said.
Various stakeholders in the healthcare sector – including medical professionals, hospitals, private businesses and unions representing workers – have reacted to the passing of the bill in the NCOP, and a common thread is that they all feel ignored.
All the groups have been explicitly in favour of universal healthcare in principle but have rejected the NHI Bill as the pathway to this ideal for a variety of reasons.
Having raised their concerns every step of the way, their efforts have been for nought, with the bill being pushed through with no changes.
The bill will now be sent to President Cyril Ramaphosa, who will have the option of signing the bill into law or sending it back to parliament for more work.
The South African Health Professionals Collaboration (SAHPC), a national group of nine medical, dental and allied healthcare practitioners’ associations representing more than 25,000 medical professionals, said the bill becoming law in its current form would devastate healthcare in the country.
The group said it would petition President Cyril Ramaphosa to send the bill back to the National Assembly to reconsider its terms.
The SAHPC’s main concerns relate to the way the bill was “rushed through” without substantive engagement with the healthcare sector. It also flagged a host of other problems with the bill, including:
- Quality of Healthcare: The Bill does not guarantee quality of healthcare, and may inadvertently lead to a reduction in standards.
- Limitation of access to healthcare: Accreditation, choice, and the certificate of need for healthcare providers will limit access to healthcare.
- Treatment protocols: There is concern that treatment protocols under the NHI will favour cheap and basic care.
- Governance of the fund: Granting excessive authority to the Minister of Health may compromise the effective governance of the NHI Fund.
- Corruption risks: The Bill does not adequately address the risk of corruption, a factor that could undermine the entire healthcare system.
- Professional mobility: The NHI Bill forces healthcare providers to accept government terms of fees and employment, which will lead to the loss of these highly mobile and vital professional skills and resources.
- Training and retention: The training and retention of healthcare professionals is placed at risk under the NHI.
- Medicolegal litigation and risk: The service delivery pressure on healthcare professionals under the NHI will increase the risk of medicolegal litigation. Currently, the state accepts liability for all public sector facilities and the private sector bears the cost burden for insuring themselves. It is unclear how this will work under the NHI, or if the state will accept liability for services performed by private sector practitioners.
- Provincial impact: Section 58 of the Bill transfers the bulk of the provincial healthcare functions and budget to the NHI, effectively centralising healthcare. This is contrary to global best practice, which is to move healthcare delivery closer to communities.
The Hospital Association of South Africa also said it was disappointed by the passing of the bill, echoing many of the same sentiments.
“We have consistently noted the need for more clarity regarding the future role of medical schemes and the need to incorporate a multi-payer approach instead of the proposed single-payer regime,” it said.
BUSA and B4SA – which are said to be the main force behind the vote on the bill being delayed by a week – said they are now preparing to submit a formal petition to Ramaphosa, requesting that he refer the NHI Bill back to the National Assembly for amendment.
The business groups believe that the Bill, in its current format, is unworkable, unimplementable, unaffordable, and unconstitutional, both on substantive and procedural grounds.
“BUSA and B4SA have, throughout the entire NHI Bill legislative process, highlighted the deficiencies in the Bill, including those unconstitutional provisions that required clarification and amendment,” the groups said.
“Our concerns, recommendations, research, data and inputs, as well as those made by a wide range of experts and affected stakeholders, have been summarily ignored by the Parliamentary Portfolio Committee on Health and the NCOP, which are legally mandated to ensure that the NHI Bill passes constitutional muster and is properly configured to give healthcare the best possible chance of success.
“No amendments were made at all, including those suggested by the Department of Health itself, which is deeply concerning for our country and democracy.”
Union ready for war
Trade union Solidarity, which has been opposing the bill and threatening legal action against its adoption from the start, said it would launch a “full-on assault” against the NHI, which will be triggered by Ramaphosa signing the bill into law.
“Should one last appeal to President Cyril Ramaphosa to halt the NHI fall on deaf ears too, we will be heading to court about the NHI where Solidarity will go all out to stop it,” it said.
“All the pleas have been made, and all the warnings have been issued as to why the NHI will have disastrous consequences for all South Africans,” Theuns du Buisson, economic researcher at the Solidarity Research Institute (SRI) said.
“We have shown how the cost of the so-called ‘free health care’ will be recovered from South Africans as additional taxes – something that will no doubt ruin households financially. We have shown how it will affect the prospects of health care workers and medical staff to such an extent that they may be left with no choice but to consider career moves or even emigration.
The union said that it is unconscionable to leave the healthcare system entirely in the hands of the same politicians that “wrecked Eskom, Transnet and SAA”, adding that it will “not only be the death knell of our economy, but will literally also cost human lives”.