The National Health Insurance Bill (NHI) is one step closer to implementation. On Tuesday the bill passed through the National Assembly with more than 205 members of parliament voting in favour of its implementation. 125 MPs voted against the bill. 

Last month the Portfolio Committee on Health adopted the bill in its current form, making only slight changes. The NHI bill was first introduced to the National Assembly in August 2019. The next step is for it to go before the National Council of Provinces.

Health Minister, Dr Joe Phaahla says that the bill is the necessary foundation needed to build on for the progressive improvement of access to health with quality and equity.

Phased approach to NHI

The legislation will be implemented in phases from 2026. During his address to the house, the minister conceded the public health system required fixing.

“We must address the genuine fears of those who have access to private services where there are no queues, no waiting times, and no shortage of commodities except in a disaster like Covid-19 where even private hospitals ran out of beds and oxygen at some stage,” says Phaahla.

He says fears of corruption and mismanagement must be addressed. “Not all public hospitals have been run like Tembisa Hospital, you have your Steve Biko, Charlotte Maxeke, and Groote Schuur. Even Mamelodi District Hospital was turned around in just two years to become the darling of the Mamelodi people,” says Phaahla.

Since its inception opposition parties and several civil society organisations have raised concerns on how universal health coverage would be achieved without current faults within the public health system being resolved. Capacity issues, insufficient funding and government corruption were other concerns. At Tuesday’s vote opposition parties argued against its implementation. 

Official opposition against NHI

Democratic Alliance MP Michele Clarke says the already burdened public health services in South Africa will be unable to carry out the required mandate of the NHI. Especially since it will have to accommodate the over 9 million people who currently belong to medical aid schemes.

“Instead of going directly to the private paid doctors and hospitals, they will now be competing for treatment in the public health system with its severe staff and resource constraints. The last indicator of the national surgeries backlog was more than 168 000 cases,” says Clarke.

Clarke points out that without feasibility studies on the NHI, it was impossible to ascertain how many facilities would survive the government-free structures.

“These potential closures will further dismantle the health sectors. Staff shortages are a massive problem and have been for years. And there will surely be a mass exodus of medical professionals if NHI is forced,” says Clarke.

Well-equipped health facilities and safety at hospitals and clinics were other concerns she raised. “Have they ensured that the facilities have working equipment, beds, medicines, and food? The DA can attest that many of the hospitals, and clinics are in inhumane conditions. To this day we do not know which health services the NHI will cover”.

The Economic Freedom Fighters(EFF)

Economic Freedom Fighters MP Naledi Chirwa says the NHI is not what it’s being sold as. “The bill is not the eradication of the two-tier entire system. The fact that the only way to eradicate the two-tier system is through nationalisation and not tenderising health care,” says Chirwa.

Chirwa echoes concerns that the Health Department has not revealed the true cost of the NHI to parliament. 

“The NHI is not easing the access to healthcare for the poor as those who are living in rural areas will still be subjected to the use of dilapidated health facilities. There is no development in most of those areas. In fact, public hospitals will only become more dilapidated and corruption will also be rife under the NHI. We reject this bill and we will not be a part of it,” says Chirwa.

Inkatha Freedom Party(IFP)

IFP MP Magdalene Hlengwa also raised concerns about the cost of implementation.

“In our opinion the bill will deny access to healthcare services rather than promote it, because of the enormous amount of funding it will require,” says Hlengwa. 

Hlengwa says that the IFP is extremely concerned that the NHI could further limit access to healthcare services.

“Through its proposed implementation of the referral and accreditation, which could exclude specific clinics and that the current form of the bill provides the minister of health with power beyond the political office, to which he has been appointed,” explains Hlengwa.

The National Health Insurance(NHI) is a health financing system that is designed to pool funds to provide access to quality affordable personal health services for all South Africans based on their health needs, irrespective of their social-economic status.-Health-e News.