Momentum Health Solutions’ estimate that National Health Insurance (NHI) will cost more than R1.3 trillion a year was “mathematical hooliganism” designed to scare South Africans into rejecting the new system, says Health Minister Dr Aaron Motsoaledi (pictured).
Motsoaledi also said – not for the first time – that he and the Department of Health will engage in dialogue with people who are in favour of universal health coverage but have objections to the NHI Act.
Motsoaledi, along with other members of the ANC’s national executive committee, addressed the media on Tuesday following the party’s three-day policy lekgotla.
“We are going to implement section 57 [of the NHI Act] immediately to make sure that we get going with transitional mechanisms. But simultaneously we are intending to run massive roadshows, workshops, and meet all the roleplayers and relevant stakeholders to understand their concerns,” the minister said.
He said that in “the war that is raging about NHI” no one says they are against universal health coverage. “They will all say they support universal health coverage and then put a big ‘but’. And after that ‘but’ they will say, in the form in which it is in NHI […]
“So, our job is going to find out exactly in what form do you want it. What is that which you think if put on the table then you’ll go along with it and for what reason. We need to start dialoguing. South Africa is known for dialogue.”
Motsoaledi contrasted this envisaged dialogue with Momentum Health Solutions’ dissemination of its estimate that it will cost more than R1.3 trillion a year to provide every South African with healthcare of the same quality as is provided by the private healthcare system. The estimate was made public during a webinar on 30 July.
“I found this extremely unfortunate and in very bad taste. It is quite disturbing. It doesn’t build a nation, because all it does is to create fear and uncertainty, for people to live in fear. It’s a scarecrow, to scare them off […] this system that the government wants to establish. It needs R1.3 trillion, which we do not have, of course. It is bigger than South Africa’s budget,” he said.
According to a News24 report, Momentum arrived at the estimate by multiplying the R21 000 in annual claims costs per beneficiary of the private sector with a population estimate of 61 million people.
The report quoted Damian McHugh, the chief marketing officer for Momentum Health Solutions, as saying that even if one assumed a lower total NHI cost of about R900 billion a year, it was significantly higher than the combined expenditure of the public and private healthcare systems, which was estimated at slightly more than R500bn a year. This figure was arrived at by adding the estimated R230bn spent by the private healthcare sector to the R271.9bn allocated to public healthcare in the 2024/25 Budget.
“I found it quite unacceptable, and I think scaring people like that to me is tantamount to mathematical hooliganism […] which an advanced country like ours should not be doing,” said Motsoaledi, who used the phrase “mathematical hooliganism” several times thereafter.
He compared Momentum’s NHI cost estimate to the Minister of Human Settlements’ announcing that all South Africans must be housed and have decent shelter and someone estimating how much that would cost by finding the selling price of the most expensive house in an exclusive suburb and multiplying the price by 61 million people.
He said Momentum assumed, incorrectly, that NHI means the state must pay “whatever amount” for every South African to receive healthcare.
According to Motsoaledi, it costs R1 800 to have a child circumcised by a general practitioner practising in a township. But if the parents take the child to a private hospital, they will pay between R15 000 and R18 000 because the procedure will be performed by specialists, a urologist and an anaesthetist, as well as an assistant to the urologist. Specialists charge higher fees because they require 15 years’ training.
He said Momentum’s calculation was based on NHI’s following this type of system, which makes healthcare “unnecessarily expensive”.
“We won’t follow that, obviously, but Momentum is assuming we will do that.”
Motsoaledi said Momentum also incorrectly assumed that once NHI is introduced, public healthcare facilities will be rendered “irrelevant” because everyone will go to a private facility.
Purpose of the NHI roadshows
News24 interpreted Motsoaledi’s announcement that he will consult widely on the NHI Act as a “major change in his stance”. It said the ANC refused to make significant changes to the legislation in the lead-up to the NHI Bill becoming law despite input during the parliamentary process and lobbying by private sector stakeholders against aspects of the Bill.
But Motsoaledi, during his department’s budget vote in July, expressed his willingness to discuss differences over the legislation with those who accept the need for universal health coverage in principle.
Read: Ramaphosa and Steenhuisen say differences over NHI can be resolved
Answering questions from journalists during the briefing, Motsoaledi said engaging with people who are in favour with universal health coverage but who have problems with aspects of the NHI Act is only one of the reasons the Department of Health will embark on roadshows and hold workshops.
He said the first purpose of meeting stakeholders is to “give a voice” to the people who will benefit from NHI and whose views are not reflected in the media.
Second, Motsoaledi said he has received many requests from people who want to understand NHI better. Most of the media is biased against NHI and therefore only provides a platform for those who are opposed to NHI, he said.
15-year implementation timeline
Motsoaledi said NHI will not be “an event” and might take up to 15 years to implement. Even countries that introduced systems similar to NHI decades or years ago are still implementing aspects of these systems.
One of the private sector’s main objections to the NHI Act is the provision, in section 33, that medical schemes may only offer complementary cover to services not reimbursable by the NHI Fund once NHI has been “fully implemented” as determined by the Minister of Health.
Comment: Based on the wording of section 33, and assuming an implementation timeline of 15 years, it is not unreasonable to conclude that medical schemes are unlikely to be “phased out” anytime soon. It seems the disagreement over the role of medical schemes is a “can” that may be kicked down the road for some time.
Section 57 of the NHI Act deals with transitional arrangements while NHI is being implemented. It states that NHI must be implemented in two phases, from 2023 to 2026 and from 2026 to 2028.
Motsoaledi said we are in the middle of phase one. During this phase, regulations must be drafted, and a number of committees must be appointed, such as the Ministerial Advisory Committee on Healthcare Benefits and the Ministerial Advisory Committee on Health Technology Assessment.
He said now that the NHI Act is law, at least 11 other pieces of legislation must be amended. These include the Dental Technicians Act, the Health Professions Act, the Medical Schemes Act, the Medicines and Related Substances Act, the Mental Health Act, the Occupational Diseases in Mines and Works Act, and the Traditional Health Practitioners Act.
