South African health plan will prompt more controversy

Subject

National Health Insurance (NHI).

Significance

The long-awaited National Health Insurance (NHI) Bill has been released and is poised to begin its passage through parliament. The Bill contains the biggest health reforms in post-apartheid South Africa and is the first piece of enabling legislation for realising the government’s ambitions for achieving universal health coverage, called NHI. The Bill signals a sharply diminished role for medical schemes, which 8.9 million people use to pre-fund access to private healthcare services.

Impacts

• Given the apartheid-era legacy of inequitable access to health services, opposition to NHI will be cast as being anti-black and anti-poor.
• With little scope to raise revenue with further tax hikes without undermining compliance, NHI funding will be a perennial problem.
• Anxiety about the rates government will be willing to offer private healthcare providers could trigger an exodus of doctors and nurses.
• The NHI Bill rolls back current health rights for migrants, raising the prospects of a future legal challenge.