Dr Ryan Noach, CEO of Discovery Health

Discovery Health notes the approval of the NHI Bill by the National Assembly. Following this approval and the passing of the bill by the PPC on 24 May 2023, it still requires the approval from the National Council of Provinces (NCoP) for consideration, prior to formal parliamentary sign-off and presidential promulgation.

We are surprised that both the National Assembly and the PPC approved the largely unchanged amended Bill despite material concerns raised by almost all the opposition parties at the committee, and further to this, the significant constitutional concerns which were raised by the parliamentary legal advisor which seem to have been ignored.

It is disappointing to note that the meaningful contributions from multiple stakeholders to the draft bill were effectively disregarded, with the amended version of the bill showing little variation from the original draft. The Portfolio Committee elected not to take the opportunity to make amendments to the NHI Bill that would enhance both the feasibility and effectiveness of the NHI Fund, despite detailed and constructive inputs from multiple stakeholders, with the genuine intention of supporting expanded access to quality care for all South Africans. It is particularly concerning that the inputs of the healthcare professionals, who are core and essential to the delivery of care, are not being given the appropriate weight and attention in the amendments to the Bill.

As a result, it appears highly likely that this Bill will be challenged through various legal avenues, including probably being contested on various Constitutional grounds, based on multiple stakeholders’ stated intent during the PPC hearings premised on key issues which have been not amended.

The input from the National Treasury and the supporting “Money bill” have not been disclosed nor debated, and the funding of this bill therefore remains entirely unclear. This is particularly concerning given the Minister of Finance’s recent comments relating to the financing challenges and nascent stage of the Treasury’s work on NHI funding. It is absolutely critical to understand the affordability and economic strategy for supporting the Bill’s proposals, as well as the financial systems and controls required to ensure effective oversight of the monies in the fund. Sans substantial financial support, the necessary health system improvements and the sustainability of this approach will be impossible. It is in fact a clear and present risk that the resources to support this proposed structure do not exist within our fiscus.

As described by the National Department of Health’s representatives, the proposed model requires significant health system strengthening which means that full implementation will take many years and will require substantial investment in health system improvement. During this extended period, medical schemes and the private healthcare sector continue their vital role of meaningfully contributing to the health and productivity of the economically active population.

Discovery Health remains committed to supporting a National Health Insurance system, and universal healthcare coverage, that improves the equity and access to healthcare for all South Africans. However, we do not endorse the single funder model as proposed in the Bill and believe that sustainability can only be achieved through collaborative work between the private and public sector, built on the strength of the COVID-19 partnerships that served South Africa so well. Ultimately, the success of a revised health policy approach requires an integrated and responsive health system that encourages innovation and investment in the sector, for the benefit of all South Africans.

We recognise the need for simultaneous reform of both the public and private healthcare sectors to achieve this common goal.  Discovery Health is ready to contribute towards a blended, multi-party funding model underpinned by a robust NHI.

ENDS