Parliament, Thursday, 29 August 2019  The Portfolio Committee on Health was today briefed by the Department of Health on the National Health Insurance (NHI) Bill.

The purpose of the Bill is to establish and maintain an NHI Fund funded through mandatory prepayment that aims to achieve sustainable and affordable universal access to quality health care services. The fund will operate on the basis of single purchaser and single payer of health care services, by pooling funds and strategic purchasing of healthcare services and goods from accredited and contracted health care service providers. The NHI envisages a standardised healthcare system, wherein everyone, rich and poor, rural and urban, can receive the same level of quality healthcare.

Briefing the committee, the Office of the State Law Advisor, Ms Ayesha Johaar, said the Bill is constitutionally sound. “We are therefore satisfied that Parliament, in passing the proposed legislation, would not be acting capriciously and arbitrarily, in violation of the rule of law, thereby rendering such legislation inconsistent with the Constitution,” said Ms Johaar.

Some members of the committee expressed concerns about the appointment of the Board. In addition, committee members are committed to rolling out universal healthcare, as there are deep inequalities, but what is of concern is the establishment of a public entity that pulls money into a single fund.

Addressing the question of the Board appointments, Minister of Health Dr Zweli Mkhize said things that are procedurally correct and which have been benchmarked internationally make South Africans nervous, because of various issues in the public domain.

Members also asked questions about how the NHI will be financed to get it running by 2026 and whether the country can afford it. In response to this, the Chairperson of the committee, Dr Sibongiseni Dhlomo, said: “Can we afford not to have NHI?” The committee heard that NHI will be sustainable because it will be funded through taxation.

The committee requested the NHI pilot project evaluation report. Dr Mkhize said the pilot project report would be made available to the committee, but indicated that any weaknesses in the pilot projects do not mean that the NHI should be abandoned. “That was not the approach of NHI. The pilot sites were to find weaknesses and to correct them,” he said.

The committee recognised the importance of legal aspects of the Bill, but also emphasised the importance of considering how the NHI will benefit the people.

While briefing the committee, the Department of Health said once the NHI is fully implemented, the Minister will introduce regulations limiting medical scheme benefits to services that are not reimbursable by the fund.

The committee also enquired about how NHI will impact the 12 pieces of health-related legislation already in effect. This process of considering whether these Acts will require repeal or amendment will be done concurrently with the NHI Bill. Responding to the questions, special advisor to the President, Dr Olive Shisana, said her understanding is that once the NHI Bill has been passed, these Acts will be amended.

Some committee members emphasised concerns that the NHI Bill will see national government taking over all aspects of health care and that provinces will no longer have a role to play. However, the Bill envisages that all spheres will deliver proper healthcare services.

On the issue of the provision of health care to asylum seekers or illegal migrants, the Bill states that emergency services, health care for notifiable conditions and basic health services for children will be provided. The department noted that the constitution is unequivocal that no one may be refused emergency medical healthcare.

Deputy Minister of Health, Dr Joe Phaahla, emphasised social solidarity, social cohesion where the healthy will look after the sick, the young will look after old and the rich will look after the poor.


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