Ramaphosa wants proposals from business on NHI
President Cyril Ramaphosa has urged Business Unity South Africa (BUSA) “to put forward specific proposals on the remaining issues of concern” relating to the National Health Insurance (NHI) Act.
On Tuesday, 17 September, Ramaphosa, Minister of Health Aaron Motsoaledi, his Deputy Joe Phaahla and senior health officials met with the leadership of BUSA to discuss the contentions relating to the NHI.
BUSA was one of the key business stakeholders who decided to skip the signing of the President’s Health Compact, which ultimately sought to solidify support for the rollout of the NHI.
However, BUSA CEO Cas Coovadia said “our concern is that this is at the expense of immediate opportunities to expand and improve healthcare access.”
“While everybody supports universal health coverage, there are ways to achieve it other than implementing an unaffordable, unworkable and unconstitutional NHI, which is essentially a funding model that is impractical, inequitable, and not feasible in the South African context,” he added.
Ramaphosa signed the NHI into law before the May election, but it has not been promulgated, thus it is not in force.
However, Motsoaledi has initiated the process to set up the NHI board and has been on a roadshow to promote the NHI around the country.
These talks come amid senior government officials baulking at NHI critics, to the disdain of some groupings.
Recently, Motsoaledi has been lashing out at critics of the NHI, labelling opposition as “hooliganism” and “propaganda”, accusing the media in particular of using apartheid-era tactics to sow discord.
He repeated that the NHI will not cost R1.3 trillion, as some in the medical schemes industry have claimed.
However, it must be noted that neither Motsoaledi nor anyone in his department or the government as a whole has provided any figures to counter this claim.
There is still no official costing of the scheme outside of very broad estimates in whitepapers published a decade ago, using outdated figures.
Ramaphosa recently told Parliament he had a “fairly lengthy discussion” with Motsoaledi after his recent comments on the NHI and responses in Parliament about the matter.
“I want to assure you that he is one of those ministers who is open to engagement, to listening, and to talking,” said Ramaphosa.
“We both agreed and underscored the need for exchanging views with those who may well have concerns… they are South Africans whose views we must hear,” he added.
According to a statement published by the Presidency, the engagement between the senior government officials and BUSA on 17 September was “constructive and forward-looking.”
Ramaphosa said that he wanted solutions and proposals, not just criticism.
“The President has requested BUSA to put forward specific proposals on the remaining issues of concern as a basis for further engagement.”
The Hospital Association of South Africa (HASA) outlined a proposal on 2 September, which broadly boils down to mandatory healthcare insurance for all formally employed workers in South Africa.
By making this mandatory, medical scheme coverage would eventually reach 27.5 million people, allowing the government to increase its spending on the remaining population without having to adjust the health budget.
The proposal was put forward by Netcare Chief Executive Officer Dr Richard Friedland, who said that there is widespread concern that the NHI Fund is unaffordable and will take too long to implement, necessitating the exploration of alternatives.
It was reported that the proposal had received a warm reception from some senior officials close to Ramaphosa—however, Motsoaledi said he had not heard anything about it.
“It was not put to us,” he said, adding that he could not track down anyone in his department or the presidency to express a view—hot or cold—on the concept.
Regardless, following the engagements with BUSA, the Presidency said that “government remains committed to engaging with all stakeholders in good faith on the process of healthcare reform, and to finding workable solutions that will advance quality and affordable healthcare for all.”
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