Signing the NHI into law is premature and unconstitutional, says Profmed CEO
16 May, 2024

Craig Comrie, Chief Executive Officer at Profmed




President Cyril Ramaphosa has officially signed the National Health Insurance (NHI) Bill into law, a move that has sparked a wave of criticism from the private sector.



Among the critics is Craig Comrie, CEO of Profmed, who stresses the critical need meaningful reform to the healthcare system which preserves South Africa’s healthcare assets, with a particular emphasis on protecting our doctors and nurses.


“The Bill is premature and unconstitutional and outside a fluid political landscape, the Bill may have been sent back to Parliament or the Constitutional Court for a more thorough review and amendment. As it is the Bill restricts freedoms related to healthcare access and fails to provide assurances to medical schemes and healthcare professionals about their future roles in the healthcare system,” argues Comrie.


He points out several impractical and unclear provisions that are likely to lead to failure in the promise of better healthcare in effectively serving South Africans from the outset. Despite the signing of the NHI Bill into law, Comrie believes it will not bring meaningful change to the healthcare landscape in the medium term.


“While the announcement has caused some alarm, it was highly anticipated. In fact, given the political cycle we find ourselves in, it is unsurprising that the President chose this moment to sign,” says Comrie.


Although he agrees the healthcare system needs evolve to better cater to the entire population, the NHI Bill, as it stands, is too flawed and will directly work against this goal. Instead of promoting equitable healthcare, he says it may inhibit the objectives of universal healthcare and infringe on the right to quality healthcare.


Acknowledging that this is a policy that will require thorough testing of its constitutionality and practical implementation steps in the courts, Comrie says it is crucial to ensure that South Africa’s healthcare assets in both the public and private sectors are not jeopardised.


“It is vital to centre our discussion on the preservation of healthcare assets like doctors and nurses who’s main source of income will be government controlled NHI, are currently experiencing significant uncertainty. The Bill’s lack of clarity and assurance for medical professionals jeopardises their future roles and value in the healthcare system.”


“The government has committed to achieving universal healthcare through this Bill, which will forever change the healthcare landscape in South Africa. However, the Bill threatens to nationalise medical scheme premiums through significant tax increases, one of the primary funding mechanisms contained in the Bill, a concern that has largely gone unheard despite numerous engagements with the private sector since the Bill was first proposed in 2009.



Here are a few of the concerns Profmed submitted on multiple occasions:



Limitations on Benefits Medical Schemes Can Provide: Nearly nine million lives are covered by medical schemes, alleviating a significant funding burden. If this coverage is limited, the already failing public health system cannot effectively manage these additional lives, which would be detrimental to overall quality of care in both the public and private sectors.


Nationalising Medical Scheme Premiums by Increasing Taxes: While consolidating medical scheme premiums and public funds into a single NHI Fund could provide some benefits, there is still no clarity on what benefits will be included in the NHI and at what cost. How can we agree to pay for something we don’t fully understand?


Flight of Skills: Many professionals rely exclusively on private sector funding whether this is out of pocket or medical scheme funding they are reticent to become an extension of the government service. The Profmed medical scheme covers almost 50% of healthcare providers and in the past five years people leaving the Scheme have cited emigration as the main reason for resigning their membership. Various healthcare providers have also noted this concern yet the Bill lacks a resource plan or incentives to retain critical healthcare professionals in the country, as it will ultimately nationalise their services and require them to earn over 80% of their income from the NHI depending on the final benefits actually afforded within the NHI system.



“At the end of the day, we have to believe that healthcare is a fundamental human right enshrined in our constitution. That’s why we’re actively collaborating with industry bodies to advocate for a reassessment of the current NHI position,” says Comrie.


Regardless of the Bill being signed into law by the President himself, Comrie says Profmed will continue to pursue what is right to create a realistic and sustainable healthcare system that not only ensures access to care but also fuels the growth of South Africa’s economy.








@Craig Comrie
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