12 reasons why you should be worried about government’s national healthcare plans

 ·13 Aug 2018

Solidarity Research Institute has highlighted 12 of the biggest lingering concerns around the planned National Health Insurance (NHI) scheme, pointing out some seemingly insurmountable challenges that are yet to be addressed in any capacity by the government.

In June, health minister Aaron Motsoaledi presented both the National Health Insurance and the Medical Schemes Amendment Bills.

The new legislation will pave the way for more access to medical healthcare through National Health Insurance (NHI), and represents a massive shake-up to both the governmental and the private healthcare systems.

However, while the bills outline the general plan for the NHI, they both lacked any details – particularly on how the scheme will be funded, and how government plans to cover the many pitfalls inherent to its plans.

According to Solidarity researchers, Nicolien Welthagen and Morné Malan, the NHI faces a host of problems – not only the pertinent question of funding.

These are outlined in the 12 points below:


Solidarity has previously noted that the costs associated with the NHI in the white paper has been understated – and Motsoaledi himself has admitted that the estimates were just guesses. The group anticipates that R369 billion in extra tax would need to be collected by 2025 to cover the NHI – after which, R156 billion will be needed every year.

This means an additional tax of 5% of GDP will be required, with an automatic tax addition of 1%-2% being considered, or even an automatic deduction by employers of 1.5%-4%, or premium being charged.

Financial management

The NHI as it is envisioned will become the largest state institution in the history of South Africa, Solidarity said. Given the state’s track record of mismanagement and corruption at state-owned companies, this is a massive point of concern.

State control

Healthcare providers will be forced to work in the public sector, with rates determined by the NHI, Solidarity said. While this will bring equal pay, it will remove incentives for providers to perform, and competition will effectively disappear. This would also present Constitutional hurdles, as people will be forced onto the NHI and to pay for it.


South Africa’s 33,000 private healthcare bodies will have to be accredited by 2025. There is no indication of how or through whom this process will take place.


The bureaucracy and red tape introduced by the scheme will hamper effectiveness. Orders, repairs, shortages – everything – will be delayed because it will all have to be channelled through one central body.

Managing assets

The state will be the sole purchaser, but there is no indication how the purchasing and managing of assets, medication and equipment will be handled. A central fund has to be managed perfectly to be effective, Solidarity said. If there are any errors, the potential for drastic consequences is greater.


The question of who will maintain infrastructure and equipment is unanswered. There is also little to no incentive for hospitals and private practitioners to maintain equipment that is not funded by themselves, or linked to some tangible reward, Solidarity said.

Current service levels

Current studies have shown that South Africa’s public hospitals are already in a terrible state – linked to poor management, lack of skills, and non-compliance with health policies. Most South African hospitals are non-compliant with health standards, and less than half have sufficient staff.

Increase in patients

The NHI making private hospitals open its doors to the greater public means an increase in patients. An increase in patients will require an increase in medical staff. There are already shortages of qualified medical staff in South Africa, Solidarity said.

Disease load

South Africa has an “extraordinary” disease load due to the HIV and TB epidemics. An increase in patients at private hospitals will cause treatment to deteriorate.


The health department plans to remove teaching hospitals from provinces so they can be handled nationally. No further information around this has been revealed. Emergency services will also change. However, where training will take place, or how, or how many new medical professionals will be processed remains a mystery.

Major shortage of human resources

It’s estimated that 25% of medical professionals who finish their training in South Africa leave the country, Solidarity said. At present, South Africa trains 1,200 doctors a year at 8 medical facilities. The country has a shortage of 83,000 healthcare workers. Solidarity said that filling all empty posts would come at a cost of R40 billion.

The full report can be read in Solidarity’s magazine.

Read: VAT would effectively have to be doubled to pay for NHI: Solidarity

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