The National Health Insurance (NHI) Act was “dangerously flawed” and if implemented will collapse SA’s healthcare system, the SA Medical Association (Sama) said on Tuesday.
Sama chair Mvuyisi Mzukwa said the organisation was challenging multiple provisions that would severely prejudice doctors and patients. The provisions raised “fundamental concerns about access to care, administrative barriers, financial feasibility, the impact on the public health sector and the long-term sustainability of the NHI”.
Sama, which represents about 12,000 medical doctors, is poised to join a list of organisations that have initiated legal challenges against the act at the high court in Pretoria.
The government aims to achieve universal health coverage for all South Africans through NHI.
Mzukwa said at a media briefing on Tuesday the NHI had troubling fine print that violated the constitutional rights of doctors and patients.
“SA’s healthcare workforce is already under immense strain. Sama’s expert analysis shows that a private sector surgeon currently works at 158% of normal capacity,” he said.
“Under the NHI, that same surgeon would be expected to work at 368% capacity for a significantly reduced income, a scenario that is unrealistic and unsustainable.
“The act makes no provision for insuring private doctors against medico-legal claims, even though they will be required to operate within NHI protocols.”
Mzukwa said it would take years for NHI to sort out the administration of registering millions of South Africans and this “could do more harm than good”.
“Every South African will be required to register as an NHI ‘user’ receiving treatment. The process raises concern about access, as unregistered individuals may face challenges even in emergencies,” he said.
He said there was a lack of clarity about what services would be covered under NHI. “SA is embarking on a radical overhaul of its healthcare system without even knowing what it will offer patients.”
Procurement of medical supplies under the NHI remained unclear, he added.
The government could not use the act as a scapegoat to avoid its constitutional responsibility to fix the public healthcare system, Mzukwa said, adding that this would be the heart of Sama’s arguments, which will be filed this week.
“The act is like a big medical aid that will cover all South Africans. Medical aids do not employ healthcare workers, they do not build hospitals or buy medicines. If you have rural areas without clinics and hospitals they will remain so, even under NHI,” Mzukwa said.
“There won’t be universal access; it will be urban healthcare access, because the rural areas will still be out of reach in terms of those services.”
Despite the challenge to act, he said Sama was not against the goal of universal healthcare coverage.
Sama’s challenge comes almost a year after Ramaphosa signed NHI into law.
The association’s legal head, William Oosthuizen, said the organisation delayed the application as they needed to consult experts and file a comprehensive constitutional challenge to the act.
He said their legal challenge differed from the ongoing legal challenge in court launched by the SA Private Practitioners’ Forum and the Board of Healthcare Funders.
“The act is irrational and it is incapable of achieving what it seeks to achieve because it is unaffordable. So, many of its sections are vague and cannot be implemented,” he said.
Oosthuizen said the act infringed on patients’ various constitutional rights to access care, as well as medical practitioners’ rights to freedom of association.
“The act is a wish list and unfortunately unworkable, and to stick to it is blind ideology or arrogance. We need to fix the fundamentals of healthcare. We need to look at past the NHI as a solution to universal health.”
Sama vice-chair Ames Dhai said the state of public health governance did not inspire hope that NHI would be a miracle fix for South Africans.
“A strong pillar for health is ethical governance. We look at the corruption that we are steeped in; is anyone comfortable the increased taxes they plan for NHI won’t be proffered away as well?
“Is universal healthcare feasible at this moment? No, we have to fix our house [government] first before we go ahead with [NHI],” Dhai said.
As NHI debates continue, health minister Aaron Motsoaledi contends that the act is the answer to saving SA’s healthcare system.
“Health is a fundamental human right and attaining the highest standard of healthcare is the world’s most important social goal,” Motsoaledi said.
Update: April 1 2025
This story has been updated with new information throughout.
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