Zweli Mkhize. Picture: RAYMOND PRESTON/SUNDAY TIMES
Zweli Mkhize. Picture: RAYMOND PRESTON/SUNDAY TIMES

The government will ensure that the National Health Insurance (NHI) bill is tabled in parliament soon, health minister Zweli Mkhize said on Tuesday.

The proposed legislation will have to be considered by both the National Assembly and the National Council of Provinces, and go through public consultation before it can be implemented.

It will have far-reaching health reforms aimed at achieving the government’s ambition of providing universal health coverage. Its main aim is to launch an NHI Fund that will purchase health services on behalf of patients from public and private sector providers, which will be free at the point of care.

A key aspect of the bill is the future role it envisages for medical schemes, which currently provide coverage to about 8.9-million people. 

Various stakeholders have warned that the roll-out of the NHI will not succeed if the poor management of public healthcare facilities persists, and the shortage of doctors and other health professionals is not addressed. SA has one of the lowest doctor-to-patient ratios in the world, and the country’s medical schools are producing just more than 1,000 doctors a year, which is not enough. “Earlier in 2019, the Hospital Association of SA (Hasa), which represents the private hospital sector, warned that NHI could lead to the loss of up to 132,000 jobs.”

During the debate on the state of the nation address on Tuesday, Mkhize emphasised  that the contested NHI programme will be implemented, despite the objections by various stakeholders. 

“We will be moving speedily to ensure the NHI Bill is tabled in parliament,” said Mkhize. “The NHI Fund requires strong governance mechanisms and improved accountability for the use of allocated funds. These provisions have been included within the structural design of the NHI Fund and they are reflected within the NHI.” 

Two-tiered system

Mkhize said that despite the government’s post-1994 democratic breakthrough and the multiple efforts aimed at improving access to healthcare services, especially for the vulnerable, the health system has stubbornly remained two-tiered, fragmented and inequitable, consisting of the public  and private health sectors.

SA spends almost 8.6% of GDP on healthcare, which is comparable to other middle-income countries, with 4.1% of the GDP spent on the uninsured population, who receive care in the overburdened public sector, Mkhize said. Private medical schemes cover approximately 16% of the population, with most of the principal members of these schemes working in the formal sector. 

“A smaller percentage of the population pay out of pocket to use the private health sector. In addition, ‘out of pocket’ services are rendered in both the public and private healthcare sectors [estimated at 0.6% of GDP or 8% of total health expenditure], which remain a burden to many poor households,” said Mkhize.

He added that the unresolved issues of unaffordable private healthcare and poor levels of service delivery in the public sector have impacted negatively on SA’s national healthcare system resulting in “our inability to ensure that all South Africans have access to quality healthcare based on need and not on their ability to pay.

“This government is determined to end these inequalities and bring quality healthcare to all, as demonstrated by the establishment of the war room in the presidency. The president has been a champion of universal health coverage through the NHI,” said Mkhize.

“The implementation of the NHI is aimed at moving SA closer towards universal health coverage, wherein all citizens, irrespective of their socio-economic status, will be covered to receive quality healthcare services based on their health needs,” said Mkhize.

DA MP and health spokesperson Siviwe Gwarube said NHI, as it stands, premises its entire existence on the need to level the field of access.

“It does not seek to improve the existing health facilities and level of care. NHI, in its current form will nationalise healthcare. We cannot allow a piece of legislation that has neither been costed nor effectively planned for destroy the little that we have,” said Gwarube. “The DA will oppose this bill until it places the patient at the centre of its conception.” 

With Tamar Khan

phakathib@businesslive.co.za