Implementation of the National Health Insurance (NHI) Bill will be a long way off and faces numerous legal challenges due to constitutional challenges, experts said yesterday after it was announced that President Cyril Ramaphosa will sign the Bill into law today.
Old Mutual Group chief economist Johan Els said the fact that the NHI Bill was going to be signed into law was a moot point at this stage.
“Firstly, it’s the fact that any implementation will take very long because of spending pressures. Secondly, this might be taken to the courts and eventually to the Constitutional Court by private sector health operators,“ he said.
He said South Africa was a long way off from the NHI Bill affecting the economy as it would be implemented over a long-period of time.
“I say that because National Treasury has not allocated any money over the Medium-Term Expenditure Framework for the NHI. Treasury has said numerous times that there is no money for this. The Treasury has given us an indication that it is going to take a long time to implement this very gradually,” Els said.
The main aim of the Treasury currently was to consolidate the fiscal situation so that the country could stabilise and reduce its debt ratio.
“That means that there is no room in the Budget for extra-spending measures. In fact, other spending will probably have to be cut over the next few years. The Treasury has also indicated that we as consumers are overtaxed and there is no real room for additional taxes or higher tax rates to finance the NHI,” he said.
Damian McHugh, the chief medical officer of Momentum Metropolitan Health, said the intent to enable access to attain more health for more South Africans was positive.
“Healthcare is a fundamental right for all. For us to create and implement a national health system to enable this, we must be mindful of the current constraints and ensure that we move forward in an informed and sustainable manner,” McHugh said.
But, he said, the implementation of the NHI Bill in its current format was not sustainable, and the country could expect the already documented challenges made by numerous stakeholders to become more vocal, particularly around the constitutionality of the bill.
“Another key consideration is that the South African economy does not have the required funds to support the implementation thereof,” he said.
Momentum Metropolitan Health said based on this, their belief remained that the current private and public system should collaborate to better use the experience and infrastructure of the private industry to augment the public offering and ensure they did not lose critical experienced resources from health economy.
“Critically, even though President Ramaphosa has signed the bill, the current status quo remains in effect, as the implementation of the bill will take some time. So, our message to our members and the wider South African community is to continue with your current healthcare arrangements.”
Meanwhile, the Health Funders Association (HFA) said the news of the NHI Bill news was disappointing, although not unexpected.
Craig Comrie, HFA’s chairperson, said the HFA had been preparing for this day, despite their strong belief that a more collaborative approach between the public and private sectors was essential for achieving Universal Health Coverage (UHC) in a timely and effective manner.
“We are deeply disappointed that the opportunity to review certain flawed sections of the NHI Bill has been missed, as the HFA sees enormous potential for leveraging the strengths of both public and private healthcare to expand access to quality care for all South Africans,” Comrie said.
“Throughout the NHI Bill’s development process, the association submitted recommendations centred on collaboration and maximising the sustainability of healthcare provision through the use of a multi-funding model to build the South African healthcare system,” he said.
HFA said there would be no immediate impact on medical scheme benefits and contributions, nor any tax changes.
The HFA said it was well prepared to defend the rights of medical scheme members and all South Africans to choose privately funded healthcare, where necessary.
“Our focus, as always, is on protecting and expanding access to quality healthcare for all South Africans. As we await the finer details of the president’s signing, we wish to assure all South Africans that we are ready for this next step,” Comrie said.
The HFA said it would continue monitoring developments closely and share updates as necessary.
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