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Call to post identifies many potential problems

27 January 2016 Jonathan Faurie

One of the cornerstones of our constitution is that services of the best quality need to be made available to the greatest number of the population possible. This applies to many services in the country, but healthcare has been put in the spotlight of late.

To live up to this ideal, government has been on an extensive campaign to establish a National Health Insurance (NHI) system. This would ensure that high quality healthcare would be made available to every person in the population, no matter what your income level is.

Having mixed feelings

While there has been some support for the NHI, there are others who have seen the failure of international public healthcare system and are therefore less than convinced that the NHI will be a success.

Government recently released a white paper to further extrapolate its standpoint on the NHI, and this is where the area of concern comes in. FAnews spoke with Neil Kirby, Director Health Care & Life Sciences Law at Werksmans Attorneys, to discuss some of the finer points of concern.

The first issue we discussed with Kirby is whether government has designed a system that will inspire confidence or a system that will cause anger.

“In my view, government is endeavouring to address matters concerning the delivery of healthcare throughout the country pursuant to its obligations in the Bill of Rights. The contents of the white paper may encourage and anger various constituencies throughout the country,” says Kirby.

He adds that one area of encouragement is the potential for deficient public healthcare services to be improved. The potential for inciting anger may be the possibility of medical scheme premiums to increase dramatically. This may, in turn, cause good quality healthcare to be placed beyond the financial reach of those currently enjoying it.

Freedom of association

While the white paper is a major step forward in what can only be described as a long process, there are some particular watch points which may cause trouble down the line.

The first is the fact that government wants to make it compulsory for every citizen to belong to the NHI. While we can understand this because of the cross subsidisation principles that medical schemes follow, some people may not want to be forced into a corner.

Kirby points out that our constitution protects the right to freedom of association. This means that you are free to associate with a club/organisation, in this case a medical scheme, if you do so willingly. But you are also free to disassociate yourself from this scheme if you do not wish to be associated with them.

“As far as I am concerned, forcing an individual to join a National Health Insurance Scheme and requiring him/her to pay for the privilege is problematic and unreasonably infringes on an individual's right to freedom of association.  The ultimate ramifications of such an argument would need to be thrashed out in a courtroom in order to understand whether or not current proposals for a National Health Insurance Scheme in South Africa are constitutionally tenable,” says Kirby.

Don’t open the cheque books

There is a legal issue here. If we look beyond the problem of challenging freedom of association, government will basically be forcing you to join their scheme and then expecting you to pay for it as well.

“The payment issue is a thorny issue at best. The white paper is incredibly vague about the most appropriate payment method for a National Health Insurance Scheme. We also need to bear in mind that this funding issue is described as potentially costing hundreds of billions of Rands. With current levels of corruption and public distrust in the public service, further taxation in respect of the premium payable to join the National Health Insurance Scheme may be a bridge too far for the South African Public,” says Kirby.

Avoiding the can of worms  

While the ideal of equitable healthcare for all is a noble ambition in principle, to implement it in practice may become difficult.

The NHI will impose major changes on medical schemes. But this is no different to the legislative guidelines they currently face. Kirby points out that in terms of current medical schemes legislation, a great deal of direction is provided to medical schemes as to how to run their businesses. 

“The white paper promises amendments to current medical schemes legislation, which, once available, will provide an indication as to the ultimate role that medical schemes will play under a National Health Insurance Scheme. Presumably, all of the difficulties that arise from the current proposals in the white paper will be ventilated during the public comment period, which expires three months from the publication of the white paper, which occurred on 11 December 2015,” concludes Kirby.

Editor’s Thoughts:
Will the NHI face too many problems that need to be ironed out before we can be happy with the system? Comments can be sent to the Director General at We would also like to hear your thoughts. Please comment below, interact with us on Twitter at @fanews_online or email me your thoughts


Added by Ian McDonald, 28 Jan 2016
Really Mr Kirby? Are you also suggesting that we should all have freedom of association, or otherwise, with SARS, and our local council, etc., as well as the NHI scheme. I would suggest, only if you go and live on another planet. And, another thing, don't believe all you read and hear on the telly about the failures of the UK NHS. It provides an excellent service for the vast majority of citizens of that country, and anything that gets close to it will be a major social welfare reform for this country. Don't knock it till you've tried it.
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Added by Paul, 27 Jan 2016
One only has to look at the failing NHS in the UK (A first world country) to realise that this idea is untenable.
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Added by Izak, 27 Jan 2016
My opinion is that the ANC Government is basically doing this to buy votes. Looking at the local Governments and there waste of Public Funds. Will this not be the situation with the NHI?.
I can continue with matters like this.
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Added by lee, 27 Jan 2016
Another Socialist idea which cannot be funded.
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