Newly-appointed Health Minister Aaron Motsoaledi is determined to forge ahead with National Health Insurance (NHI), despite legal challenges and opposition from some quarters, saying that the current system was wrong and that medical schemes and private healthcare providers were profiting at patients’ expense.
But the 11 political parties in the government of national unity (GNU) have not yet found common ground on how to proceed with the NHI, DA leader John Steenhuisen has said, according to a News24 report.
Although upbeat about the GNU, the opposition party leader, who is now also the Agriculture Minister, said: "The NHI Bill is a sticking point, and it has been a sticking point on the issues around the negotiation of the statement of intent. It also has been a subject matter that has come up for discussion.
"I would say this, there's no single party that is part of the GNU that does not fundamentally believe we have to have universal access to basic health care and that we have to do something to improve the quality of care for every South African citizen, but particularly to ensure that nobody is deprived of good medical assistance based on their income," Steenhuisen said.
"I think where there are differences is on the funding model. I think around the issue of choice and where are we going to be making a very strong pitch that instead of us tying up the NHI with decades of constitutional challenges and the like, are there ways that we could look at that particular bill to achieve the outcomes that I believe we all want – universal access to basic health care in a way that doesn't deprive people simply because they can't afford it."
Steenhuisen said he believed the NHI Act could be tweaked and there should be discussions to start implementations that can move towards improving the public healthcare sector and partnering with the private health care sector.
"It's my view that the NHI in its current form will frustrate universal access to basic health care for at least a generation.
"I think that there are some areas where the Bill can be amended or changed or the approach and regulations can be changed to reintroduce choice to treat the private sector as a partner in fixing the public healthcare sector," he added.
Steenhuisen pledged in May to challenge the legislation in the Constitutional Court but since being in government, he has adopted a more pragmatic approach.
"I think that we can find each other as the parties in the GNU. I think we all want the same thing; we just have slightly different ideas about how we're going to get there. So that will be an ongoing discussion within the GNU as we proceed," Steenhuisen said.
But Motsoaledi, an energetic support of NHI in his previous role as Health Minister from 2009 to 2019, said: “When I was taught medicine, the first thing in an emergency (was) to check the ABCs – airways, breathing, circulation. Now the first thing an ambulance will check is your pocket.”
The legislation is already facing two legal challenges, one from trade union Solidarity and the other from the Board of Healthcare Funders, while several more are in the offing.
Business Day says in his budget speech to Parliament last week, the Minister said that NHI was a health financing system that would level the playing field between rich and poor.
“If you want to see what inequality means, come to the health sector in SA. If there is something we can do, about it, we must do it here and now, and not in some distant ill-defined future.”
Motsoaledi said that he was open to talking to stakeholders about their differences on NHI, but dismissed any possibilities of a relaxing of section 33 – under which medical schemes will be allowed only to cover services not provided under NHI.
“Medical schemes as they are now won’t solve the problems of inequitable access to health in SA,” he said.
As for low-cost benefit options for medical schemes, it “would be wrong to provide poor people with less cover than rich people who could afford more generous options”.
“It’s like sticking a plaster on a crack,” he said. “I don’t favour them. It’s wrong. It’s not dealing with health, it’s money.”
Proponents of low-cost benefit options (LCBOs) say these options could extend private healthcare to millions more people and help reduce the load on the overburdened state sector.
The Council for Medical Schemes spent several years working on a regulatory framework for LCBOs and submitted its report and recommendations to for Health Minister Joe Phaahla in November 2023.
News24 – 'NHI frustrates universal healthcare': GNU partners still struggling with controversial health act
Business Day PressReader article – Motsoaledi doubles down on NHI (Open access)
See more from MedicalBrief archives:
Why Motsoaledi trumped Phaahla to the top heath job
NHI can now be referred to as ‘Ramaphosa-care’ — Motsoaledi
After protests, CMS agrees to stakeholder engagement on low cost benefit options