The signing of the National Health Insurance (NHI) Bill on Wednesday will just be a ceremonial event by President Cyril Ramaphosa, as not much is expected to change due to the unrealistic costs of funding the project, experts say.
Ramaphosa will finally sign the controversial NHI Bill despite criticism of and strong opposition to the multibillion-rand health insurance fund.
The fund is intended to offer good quality healthcare to those with or without medical aid, with the NHI covering the costs for medical treatment, even at private healthcare facilities.
However, the signing of the bill will make no immediate difference to the country’s healthcare system as it requires R200bn per year, which is unrealistic to obtain, said experts.
A report by FTI Consulting earlier this year found that raising the funds would require increasing VAT, personal income tax, corporate income tax and payroll tax.
According to the Wits School of Governance’s Alex van den Heever, increasing tax was not really possible.
“The fact of the matter is, tax increases are not really possible. Whether it is VAT, corporate income tax or personal income tax, people will evade and avoid them. Then they will reach a ceiling, and high tax rates are a reduction in tax recovery. There is no fiscal scenario for this.”
“During the BHF [Board of Healthcare Funders] conference, the National Treasury’s [chief director for health] Mark Blecher said there are no funds for health. There is never going to be any money above the normal increment adjustments. The government’s debt-to-GDP ratio is already extended,” he said.
Finance minister Enoch Godongwana had previously indicated that the NHI may not be the best solution, but what is more feasible would be investing in upgrading the public healthcare system and infrastructure.
The NHI is not set up for those with medical aid as the country’s healthcare system does not have the capacity for the 9-million people who are covered by medical schemes, Van den Heever said.
We all agree that the country’s healthcare system requires reform, but the NHI Bill, in its current form, is not going to be able to give us that reform because it is not economically viable.
— SAMA's Dr Angelique Coetzee
“The public health system cannot accommodate the medical health systems. It was never for medical scheme members. There is no money for those with medical schemes. If one wants to get into the system, they have to be provided somehow in a private facility and the department of health has to be contracted with them. There is no immediate framework to contract with anyone.
“This is just a ceremonial thing to create a narrative,” he said.
The South African Medical Association’s Dr Angelique Coetzee said the bill’s signing would just be the establishment of a “bank” for the required funds. However, it would take years before we see the NHI in full swing.
“If you look at government’s plans, it could take many years for them to implement it as there is limited scope to fund it with higher taxes. It is important to understand that the term ‘NHI’ only refers to the funds required. We all agree that the country’s healthcare system requires reform, but the NHI Bill, in its current form, is not going to be able to give us that reform because it is not economically viable.”
“They will have to employ people and have an electronic health system with details of every patient in the whole country. The health budget cuts this year were substantial. Already the department doesn’t have funds to appoint doctors. How are they going to implement this?” Coetzee said.
The number of doctors and specialists in South Africa has decreased in the past 10 years, said Profmed CEO Craig Comrie. There are now 0.8 doctors for every 100,000 people in the country, which is less than one whole human being, he said.
He said the current NHI Bill did not set out a strategy to keep doctors and specialists in the country.
“Most developing countries have more than double the number of doctors that we have. The developed world sits with more than five times the number of doctors. These same countries still have shortages of doctors since the pandemic, and they are aggressively recruiting our doctors and specialists to solve their shortfalls,” Comrie said.
“One of the biggest gaps in the NHI Bill is a retention strategy to keep doctors and specialists in South Africa. We also need to produce more doctors and specialists here and retain them before we can provide broader-based access to healthcare in South Africa.”
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