Government’s NHI fix won’t work
The recent adjustments to the National Health Insurance (NHI) framework have been described as a “compromise,” but according to the Universal Healthcare Access Coalition (UHAC), they do little to address the fundamental issues making the NHI unworkable. Nor will the introduction of a ministerial advisory council resolve the deep structural challenges facing South Africa’s healthcare system.
This was the key message at a virtual media briefing hosted by UHAC, where leading healthcare professionals and policy experts discussed the shortcomings of the NHI and presented an alternative framework for reform.
A healthcare system in crisis
Since the inception of the NHI policy discussions in 2007, South Africa has seen little meaningful health reform. The public healthcare system is under immense strain, with infrastructure failures, staffing shortages, and inadequate funding crippling service delivery. Simultaneously, reforms in the private healthcare sector have been stalled, exacerbating inequality in access to quality medical care.
UHAC, representing over 30 professional healthcare organisations, acknowledges the realities, which is why they developed their proposal. However, they don’t argue/agree that the latest amendments to the NHI Act (which have been reported, but not yet confirmed) acknowledge the realities.
An evidence-based, pragmatic alternative
During the briefing, UHAC presented a comprehensive, evidence-based reform plan designed to address systemic failures in both the public and private sectors. This framework prioritises financial sustainability, practical implementation, and alignment with constitutional commitments to universal healthcare access.
UHAC Steering Committee Member, Prof. Alex van den Heever, presenting the proposal, explained that the UHAC model draws on “the research, extensive engagements, and recommendations of numerous formal committees of inquiry and government-appointed task teams and expert panels on healthcare reform over the past 30 years. The outcomes and recommendations remain highly relevant, and much of this work has been collated into the UHAC proposal and updated to account for the absence of healthcare reform over the past two decades.”
Key highlights of the UHAC proposal include:
- System-wide cross subsidies: a universal unconditional subsidy for all, with a risk-equalisation and social reinsurance for the medical schemes system, ensuring that all citizens have access to a basic healthcare package regardless of their income level.
- Integrated public and private systems: a funding and service delivery model that enables both public and private healthcare providers to operate efficiently under a regulated framework.
- Mandatory contributions for high-income earners: a structured contributory system ensuring financial viability without jeopardising access for lower-income populations.
Urgent need for action
The government’s piecemeal approach to NHI implementation has delayed critical reforms, leaving both patients and healthcare professionals in limbo. UHAC’s proposal, developed through broad professional consensus, offers a more immediately implementable and financially viable pathway to universal healthcare in South Africa.
Prof. van den Heever also addressed the funding model’s sustainability, stating that the public health system requires “strategic governance reforms rather than a fundamental change in its architecture. Many of these governance reforms affect the management of costs, the productivity of expenditure, and the quality of care.” He emphasised the importance of strategic reforms, including “proper human resource planning – taking account of the absorption capabilities of the health system, the decentralisation of operational decision-making through the establishment of autonomous public hospitals and district health authorities, and the implementation of strong localised supervision through the establishment of independent supervisory (not advisory) boards for hospitals and district health authorities.”
He further pointed out that these independent boards should have “no conflicts of interest with the supervised entities. Such conflicts are unavoidable if political appointments are permitted into both the boards and health services. Members of the executive of government should no longer be permitted to make such appointments, with an independent appointments authority responsible for vetting and supervising all appointments.” This, he explained, would help “eliminate institutionalised corruption – which will significantly enhance performance in the public sector.”
For the private sector, Prof. van den Heever referred to the Health Market Inquiry, which identified systemic interventions aimed at stabilising cost increases, improving value-for-money, and expanding coverage. “The framework requires the implementation of risk equalisation and social reinsurance structures that will fundamentally alter the nature of competition in the private sector – permanently altering the coverage capabilities of the system,” he said. He also emphasised the importance of transparency in health outcomes, suggesting the creation of an “information regulator – which should operate across both the public and private systems.”
Moving forward
The briefing concluded with an open engagement session where industry experts and stakeholders discussed the implications of the NHI budget allocations for 2025 and the next steps for healthcare reform advocacy.
With healthcare professionals across the country backing UHAC’s vision, the question remains: Will the government finally take the necessary steps to implement meaningful, workable healthcare reform? The time for action is now.
Writer’s Thoughts
As the healthcare system continues to deteriorate, it’s clear that mere adjustments to the NHI will not resolve the deep-rooted challenges South Africa faces. The government must embrace a bold, evidence-based reform model to ensure that the nation’s healthcare system is both equitable and sustainable, before the crisis worsens beyond repair. Do you agree? Please comment below, interact with us on Twitter at @fanews_online or email me your thoughts myra@fanews.co.za
