NHI Bill will nationalise healthcare and create additional tax burden for South Africans

8 August 2019

The Democratic Alliance (DA) notes the National Health Insurance (NHI) Bill which was tabled in Parliament.

As anticipated, the Bill has not changed much since the first problematic version was tabled during the 5th Parliament.

The Bill, as it stands will not in anyway, be able to achieve universal health coverage.

The DA is convinced that instead of being a vehicle to provide quality healthcare for all, this Bill will nationalise healthcare, create another State Owned Enterprise and be an additional tax burden to already financially- stretched South Africans.

There are four main problematic elements of this Bill:

The establishment of the National Health Insurance Fundas a public entity or State-Owned Enterprise- the bill explicitly states that the Fund will operate as a public entity which will be constituted by the pooling of funds both from the public and private sector. The minister has sole discretionary powers over this fund. In addition, the board which is appointed by the minister, will be tasked with overseeing this Fund which means there are absolutely no checks and balances.

This fund will be nothing more than another SOE that will be completely vulnerable to grand corruption at the expense of the nation’s entire health system.

The nationalisation of healthcare and clear erosion of provincial powers – the Bill completely centralises the provision of healthcare by placing the management of all central hospitals under the national department. This is an undermining of the provincial powers as enshrined in the National Healthcare Act of 2003. This will mean the equitable share of funds to provincial departments is reduced to finance the Fund and will undeniably mean poorer health outcomes for ordinary South Africans.

The additional tax burden that will be imposed on South Africans - the financing model of this Bill will mean the removal of the tax credit benefit afforded to medical aid clients and in addition, impose tax on ordinary South Africans to fund an SOE which is likely open to public looting. As unemployment continues to reach crisis levels, more and more people are battling to sustain a living in South Africa. This additional burden is avoidable under a different financing model.

The complete removal of choice for South Africans – this Bill removes the autonomy of South Africans entirely. It mandates the national department of health as the sole provider of healthcare in the country while all private healthcare providers will be contracted by the state.This means that there is absolutely no choice for people on which services to purchase nor will there ever be competition to drive up the quality of healthcare. Medical aids will cease to be useful as the model makes the state the only provider of healthcare in the country.

The DA’s Sizani Universal Healthcare Plan:

In contrast to the NHI, the DA’s Sizani Universal Healthcare will truly achieve providing South Africans with quality health care, thus achieving Universal Healthcare in line with global trends.

The DA plan would ensure the following:

1. It will be funded through the current budget envelop which would include the tax benefit afforded to medical aid clients;

2. It would strengthen primary healthcare as the interface of health with many communities;

3. It would invest heavily in the provision of maternal and child health services and the training and provision of healthcare professionals;

4. It would reinforce the powers of the provinces by ensuring that they are funded and equipped to provide quality healthcare to all;

5. Through these interventions, all South Africans would have access to a quality health system that provides them with a standard package of care across all facilities;

6. Medical aid companies would be used as a top up measures for those South Africans who choose to use them and who can afford to do so;

7. Ultimately this system would increase competition, drive up quality and afford every South African the choice of which medical provider they wish to use.

The DA will fight these problematic elements of this legislation in Parliament. We will request an urgent meeting of the portfolio committee meeting as soon as parliament resumes so that the Minister and the department can do a line-by-line analysis if this Bill. We will lobby civil society and members of the public to take a stand against this Bill in its current form and we will use every avenue available to us to ensure that this disastrous bill does not destroy the health system and the South African economy.

Issued by Siviwe Gwarube, DA Shadow Minister of Health, 8 August 2019