LETTER: Tempting fate with NHI fund powers

The National Health Insurance (NHI) Act provides for the following (among others): “The [NHI] Fund must determine payment rates annually for healthcare service providers, health establishments and suppliers in the prescribed manner and in accordance with the provisions of this act,” and, “account to the minister on the performance of its functions and the exercise of its powers.”

The board that will administer this fund, “consists of not more than 11 persons,” and these individuals, “are appointed by the minister, one of whom represents the minister on the board”.

Thus, the NHI significantly increases the powers of the given minister of health and the NHI board members, along with the ability to decide what happens with a substantial amount of money and other resources.

This is not to presume that the current government, current health minister, or those individuals of whom the NHI board will be composed, will automatically undertake wasteful or corrupt actions or decisions. But it would be deeply irresponsible to ignore or dismiss the deep damage caused during the state capture years, from corruption that took place during a global pandemic, to medical negligence and malpractice.

How much will the NHI fund encompass? R200m? R1-trillion? Regardless of the final number, no matter which future government, minister, or board is in place in the future, control over such resources can tempt those with even the best of intentions.

The policies, systems, and incentives — from cadre deployment to patronage — remain in place. The burden of proof on the government has not been shifted. To assume that the increased powers and access granted to individuals by the NHI will not result in similar consequences makes light of challenges facing millions of SA citizens as they struggle to access quality healthcare services.

Regarding the NHI and potential corruption, President Cyril Ramaphosa recently said: “Incidents of corruption are something that you curb as you learn. You learn on the job… and then close the loopholes because people who want to steal will always find loopholes and that is when as they happen you close those loopholes.”

The benefits of the NHI (presuming it will work as intended) have been repeated loudly and regularly. Has due consideration been afforded to the abuses and damage that the scheme might allow?

Chris Hattingh
Centre for Risk Analysis

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