The consequences of rushing through the National Health Insurance (NHI) Bill without important amendments will be profound and undermine SA's ability to deliver quality healthcare to the very patients the draft legislation seeks to protect.
That’s the view of about 25,000 doctors and health professionals across the country, the SA Health Professionals Collaboration (SAHPC), that have labelled the hasty adoption of the bill by the National Council of Provinces (NCOP) select committee on health and social services as “deeply concerning” due to unintended consequences it could have on patients and the economy.
The newly formed group that includes GPs, specialist doctors, dentists and allied healthcare workers, has urged the NCOP, set to consider the bill in a plenary session on Wednesday, to send it back to the committee on procedural grounds.
“The SAHPC does not believe that this version of the bill is in the best interest of patients, who are at the heart of any healthcare system. The bill will also have severe repercussions for the economy and the country’s long-term economic sustainability.”
In a joint statement this week the body — which includes the South African Medical Association (Sama), Federation of South African Surgeons (FoSAS), South African Dental Association (Sada) and South African Society of Obstetricians and Gynaecologists (Sasog) — accused the committee of disregarding submissions by “numerous clinician bodies, whose primary objective is to safeguard the future of health care in the country”.
Spokesperson Simon Strachan said while the reforms to the public and private healthcare sectors that are proposed by the NHI Bill are urgently needed, “there is too much at stake for the country’s healthcare system to get NHI wrong”.
“We are concerned that the bill’s hasty progression through the legislative process, without taking into account the diverse perspectives and expert insights delivered through numerous prior expert submissions, is a lost opportunity to put the country on a pathway to quality healthcare for all.”
This week business bodies, Business Unity South Africa (Busa) and Business for South Africa (B4SA), also called for the NCOP to disregard the bill, accusing the committee of not following proper processes and failing to consider amendments made by stakeholders.
The unhappiness follows the committee’s final vote on the NHI Bill a week ago in which eight out of nine provinces voted in favour of the bill. The adoption of the bill brings the legislative process of NHI one step closer.
If the NCOP votes in favour of it on Wednesday, the bill will be submitted to President Cyril Ramaphosa, who is likely to sign it into law, which will start the process of establishing the single NHI fund proposed by the bill.
The draft legislation proposes a single state-run medical fund that will purchase health services on behalf of all patients from public and private sector service providers. Some critics of the NHI argue this will not only reduce the role of medical schemes, but having a government-run fund opens it up to widespread corruption that’s been seen in state-owned businesses such as Eskom, Transnet and South African Airways.
On Monday Busa and B4SA said they had submitted letters to the presiding officers of the NCOP and deputy president Paul Mashatile — in his capacity as leader of government business in parliament — to have the bill sent back to the committee for proper engagement.
They allege that no consideration was given by the select committee “to the many constitutional issues, procedural and substantive, which were raised by four provinces and a wide range of stakeholders”.
“This amounts to a serious and significant procedural lapse and a violation and disregard of parliament’s own public participation model, fundamentally undermining the principles of participatory democracy on which our constitution is based.”
BUSA CEO Cas Coovadia said it would be unconstitutional for both houses of parliament, the National Assembly and the NCOP to disregard proposed amendments “that will have a beneficial and tangible impact on citizens”.
“It makes a mockery of due process and portrays the NCOP as nothing more than a rubber stamp. Our belief is that the bill in its current form is utterly unimplementable and will have severe consequences for South Africa, the economy and every citizen, for generations to come.
“The self-evident truth is that there is no money to fund this NHI Bill, and there is no clarity over its benefits, contracting terms, capacity, systems, management, governance or even a plan that begins to outline a viable approach to these fundamental considerations. We have also repeatedly cautioned against a single fund for the NHI that will require taxes to be raised to unsustainable levels. This is unaffordable, unsustainable and presents a material risk to the economy,” said Coovadia.
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