SOUTH AFRICA— During its plenary sitting, the National Assembly of the Republic of South Africa, has passed the National Health Insurance bill which aims to provide free universal health care though critics fear may not be sustainable.
In a statement by the Parliament’ Spokesperson, Mr. Moloto Mothapo the adoption of the NHI Bill seeks to guarantee provision for universal access to health care services in the country.
Moreover, this is in accordance with the National Health Insurance White Paper and the Constitution of South Africa.
Furthermore, the Bill envisages the establishment of a National Health Insurance Fund and sets out its powers, functions, and governance structures.
The NHI Fund will be funded from general taxes and monthly contributions by employees to the fund.
Employers will assist the NHI Fund by ensuring that their workers’ contributions are collected and submitted, in a similar manner to UIF contributions.
The Bill will also create mechanisms for the equitable, effective, and efficient utilization of the resources of the fund to meet the health needs of users.
The bill seeks to realize universal health coverage for all, which means that every South African will have a right to access comprehensive healthcare services, free of charge, at accredited health facilities, such as clinics, hospitals, and private health practitioners.
Health Minister Joe Phaahla addressed the National Assembly, “The reality, honorable members, is that this situation is not sustainable.”
Dr. Phaahla added that the number of people in formal jobs is not rising in line with the investment in private healthcare and the cost of administering medical aids, the cost of subscription is rising above inflation every year, while benefits are reducing and getting exhausted before the end of every calendar year.
According to Dr. Phaahla, it was unjust that almost all healthcare professionals are trained at the expense of taxpayers and once they become specialists and super specialists, they become available to only the top payer.
“The National Health Insurance (NHI) Bill is one of the most revolutionary pieces of legislation presented to the National Assembly (NA) since the dawn of democracy,” Dr. Phaahla added.
South Africa’s NHI Fund bill journey
After a heated debate, the bill was adopted by 205 members of Parliament and rejected by 125 NA members.
The NHI Bill was initially tabled in Parliament and introduced to the Portfolio Committee on Health on the 8th of August 2019 for processing.
The Committee received its first briefing on the Bill from the Department of Health on 29 August 2019 and was subsequently briefed on the NHI pilot districts on 4 March 2020.
In facilitating effective public participation on the NHI Bill, the Committee conducted nationwide public hearings in all nine provinces, from 26 October 2019 to 24 February 2020.
The public hearings were attended by 11564 members of the public and various stakeholders across 33 district municipalities.
A total of 961 oral submissions were heard by the Committee during these hearings.
The Committee also conducted virtual public hearings from 18 May 2021 to 23 February 2022.
The virtual public hearings afforded an opportunity to stakeholders who had expressed interest to make oral presentations of their written submissions.
In total, 114 stakeholders participated in the virtual public hearings including, among others, the professional associations, civil society organizations, medical aid schemes, faith-based organizations, academics, public health entities, hospital groups, labor unions, political organizations, and other interested stakeholders.
In addition to the provincial and virtual public hearings, the Committee received approximately 338,891 written submissions from the public.
The Committee further consulted and sought extensive legal advice from Parliament’s Legal Unit and the State Law Advisors on the Bill.
The bill is now on President Cyril Ramaphosa’s table, awaiting his review of it and assentation into law.
On the flip side, the NHI Bills’ opponents
The Democratic Alliance party’s Michele Clarke said the ANC kept touting the NHI as being in the best interests of South African citizens.
Hon Clarke said, “Let’s take an honest look at what the implementation of the NHI Bill will mean for ordinary South Africans.”
She went on to expound on the Bill saying that about nine million people were on medical aid and once the NHI was implemented, these nine million people would have to be accommodated in an already overburdened public health system.
The Economic Freedom Fighters through Hon. Naledi Chirwa said the NHI could be counted as one of the biggest scams.
Hon Chirwa said, “They agree to manipulate people to tell us that the NHI will bring us equality. It’s not the eradication of a two-tier system. The only way to do this is to nationalize healthcare. This NHI is to sell healthcare to the private sector.”
The African Christian Democratic Party rejected the bill and Hon. Marie Sukers said that the ACDP believed the architecture of change requires critical elements to be present.
Hon. Sukers questioned whether the lofty aims of universal healthcare for all could be achieved under the African National Coalition’s (ANC) administration and whether the legislation before the NA when implemented, would move South Africa closer to this aim.
The Freedom Frontiers Plus’ Philip van Staden said healthcare in South Africa would crumble under the complete control of the ANC.
Threats of legal action have predictably followed the passing of the NHI Bill due to a string of concerns raised by various stakeholders, and conflicting legal opinions were still unresolved.
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