South Africa's National Health Insurance (NHI) Bill: Why it is controversial – BBC.com

South African President Cyril Ramaphosa has approved a controversial new law that will bring about the biggest changes to the health sector since the end of the racist apartheid system 30 years ago.

His promise of universal health care for all faces stiff resistance from the main opposition party, the Democratic Alliance (DA), which says the president has signed a “death warrant” for South Africa’s health care.

The group warns that the plan would be costly and could encourage corruption.

The National Health Insurance (NHI) scheme advocates the creation of a national fund to cover the healthcare costs of all South Africans, most of which are currently not covered.

Furthermore, it prohibits private health insurance from covering treatment costs paid by the fund, which is highly controversial.

“Once the national insurance fund covers benefits, the health system will no longer be able to cover the same benefits,” the government says.

This is unlike countries such as the UK, where there is a state-funded National Health Service (NHS) but where citizens are free to take out health insurance and receive any treatment they wish from private doctors and hospitals. Masu.

Once the NHI system is fully implemented, “the role of the health system will change as it will cover services that cannot be reimbursed by NHI funds,” the report said.

Post to X (formerly Twitter)The government says everyone “has access to the nearest National Health Insurance GP, clinic or hospital, whether in the public or private sector.”

“This means that when you feel unwell, you can go to your nearest family doctor or a clinic contracted with the National Health Insurance without having to worry about treatment costs,” he added.

The government has not specified the types of treatment that National Health Insurance-certified private hospitals and general practitioners must provide, but it says they include emergency services, mental health services, palliative care, and rehabilitation services.

Mr Ramaphosa said national health insurance was “an important tool to tackle poverty”.

“Rising healthcare costs are making households even poorer. In contrast, healthcare provided through the NHI frees up poor households’ resources for other essential needs. It will make healthcare more affordable,” he added. Comment posted on X after signing the bill.

The plan comes as opinion polls suggest the party could lose its outright majority for the first time in 30 years, with the ruling African National Congress (ANC) winning a May 29 election. This is seen as an attempt to increase the possibility of

During his election campaign, Ramaphosa made national health insurance one of his key promises to voters.

“We’re going to end the apartheid that remains in health care, where the rich get the best health care and the poor get inferior health care,” he told a rally last month.

Center-right MPs are strongly opposed to national health insurance in order to rally voters.

DA leader John Steenhuisen said in a statement on Tuesday that the plan would lead to “huge tax increases” with “money deposited in a central fund controlled by one all-powerful ANC executive”.

“It’s easy to imagine the looting that’s about to happen, but it’s too gruesome to think about, just as the ANC leadership was looted.” [power utility] Eskom has pushed the power supply to the point of collapse,” he said.

The council’s website lists three main sources of funding:

The government has not disclosed how much the public will need to contribute or how much will be needed to fund the NHI.

Nevertheless, an explainer on the parliament’s website says that “costs will be reduced for what is currently the world’s most expensive health care system.”

“When people visit health facilities, no fees are charged because the National Health Insurance Fund covers people’s medical expenses, similar to medical aid for its members,” the report said.

The DA took a different view, accusing the government of wanting to “tax South Africans to death”.

It said the plan would “cost well over R200 billion”. [$10bn; £8.6bn] per year – some estimates run as high as R1 trillion. ”

The DA has said it will take legal action to prevent the plan from being implemented.

It says it would mean universal healthcare, but the NHI would “destroy South Africa’s private healthcare system and thereby thwart any opportunity to repair our public healthcare system”.

“Just this week, nine medical associations representing 25,000 medical professionals declared the NHI unfeasible,” Steenhuisen said in an article published on the News24 website.

The Daily Maverick reported that the government is likely to face an “avalanche” of lawsuits from the South African Medical Association and others.

One of the main arguments against this bill is that it would limit people’s right to buy private health insurance to cover their medical costs.

Critics say this is unconstitutional, but argue that the government is actually fulfilling its constitutional obligation to provide equal health care to all, rich and poor. rejecting the view.

Opponents will take the case to South Africa’s Supreme Court, which will have the final say on whether the law can be enforced.

Even if the Constitutional Court gives the green light, the system is likely to be phased in over many years. Especially since the government needs to come up with the funds first.

This is a difficult challenge as South Africa is in a deep financial crisis and the government is struggling to provide existing public services such as electricity and water to businesses, households and even some state hospitals. It will be.

The government says around 14% of the population receives private healthcare, but costs are rising without “significant improvements in health outcomes”.

The remaining 86% of the population cannot afford medical aid and rely on state clinics and hospitals, which the government admits are “overburdened.”

As a result, schemes have been introduced that allow both rich and poor people to receive medical care without having to first ask for payment from a GP or private hospital. This is currently done even when the patient has a life-threatening condition and requires emergency treatment.

Private hospitals are concerned that the government plan will overwhelm them with patients and that they have no guarantee that they will receive payments from poorly managed national insurance funds.