Most organisations litigating against the National Health Insurance (NHI) Act have poured cold water over finance minister Enoch Godongwana’s suggestion that they reach a settlement with the government.
Many expressed scepticism about the state’s willingness to consider their standpoint, as few changes were made when the policy underpinning the act was drafted or when parliament considered the NHI bill.
NHI, the ANC’s controversial plan for achieving universal health coverage, seeks to provide healthcare services that are free at the point of delivery to all eligible patients, regardless of their socioeconomic status.
It paves the way for a single, government-controlled fund that will pay for all health services and envisages a sharply reduced role for provincial health departments and medical schemes.
The finance minister’s call for consultation to reach a settlement was exactly what parliament’s lawmaking process should have facilitated, said Mireille Wenger, the Western Cape’s minister for health and wellness.
“However, when the NCOP [National Council of Provinces] considered the NHI Bill, it failed to facilitate proper public participation, especially regarding the act’s major impact on provincial healthcare,” she said.
“We therefore continue to believe that the public process was flawed and that the NHI Act should be declared invalid and unconstitutional.”
The Western Cape provincial government is one of eight parties that have challenged the NHI Act in court.
The others include trade union Solidarity; the Board of Healthcare Funders (BHF) and the Health Funders Association (HFA), representing medical schemes; the South African Private Practitioners’ Forum (SAPPF) and the South African Medical Association (Sama), representing doctors; the Hospital Association of SA (Hasa), representing private hospitals; and business lobby group Sakeliga.
In a debate in parliament last week, Godongwana said that since the health department and the litigating parties had all expressed support for universal health coverage, they should “meet and craft a settlement”.
Hasa said it would not have embarked on litigation had the government been willing to engage in constructive discussion.
It remains open to working with the government to improve access to healthcare, but that would require the government “fundamentally revisiting” its approach to NHI legislation, said Hasa CEO Dumisani Bomela.
The BHF said the government had blocked all of its previous proposals for expanding coverage, improving affordability and integrating public and private healthcare services.
“It is in this context, and to protect patients and the sustainability of the health system, that the BHF had no alternative but to seek clarity from the courts,” said its head of research, Charlton Murove.
The NHI Act risks dismantling a system that delivered care to millions of people covered by medical schemes, undermining instead of accelerating progress to universal health coverage, he said.
‘Open dialogue’
SAPPF CEO Simon Strachan said the organisation is willing to participate in “true and open dialogue” about achieving universal health coverage but questioned why the government has yet to respond to the various alternatives to the NHI Act that have already been put to it.
These include separate proposals from the Universal Healthcare Access Coalition and Business Unity SA (Busa), both of which were submitted to the president more than a year ago. UHAC is a coalition of healthcare organisations, including the SAPPF.
“You don’t need the NHI Act to achieve health reform … or universal health coverage,” said Strachan.
The NHI Act would need to be “taken off the table” for litigation to be dropped, he said.
You don’t need the NHI Act to achieve health reform … or universal health coverage.
— Simon Strachan, SAPPF CEO
HFA CEO Thoneshan Naidoo said the organisation has always sought to work with the government to improve access to healthcare.
The HFA intends to press ahead with its legal challenge to the NHI in parallel with any possible future discussions arising from Busa’s proposal, he said.
Sakeliga executive director Russell Lamberti said the NHI is an “unacceptably extreme proposal” that should not be the anchor for an industry settlement.
“The [finance] minister is wrong that all litigants support universal health coverage. Under this policy, a private healthcare sector is tolerated or even co-operated with when it can be subjected to high state regulation and legally channelled into the pursuit of state healthcare objectives. Sakeliga does not accept such a policy,” he said.
Solidarity researcher Theuns du Buisson said the organisation has been open to negotiating since the very beginning, but on strict terms.
“We won’t settle on anything that contains any form of NHI,” he said.
Sama had not responded to Business Day’s request for comment at the time of publication.
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