Momentum’s NHI cost estimate is ‘mathematical hooliganism’, says Health Minister

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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.

26 thoughts on “Momentum’s NHI cost estimate is ‘mathematical hooliganism’, says Health Minister

  1. NHI A MUST FOR SA NORMAL.CITIZENS BATTLING TO PAY HUGE MED AID FEES. HOW MUCH DOES YHE PUBLIC PAY MONTHLY TO MEDICAL AIDS?,????? MANY PEOPLE CANT AFFORD NET CARE ETC ETC. BUT MASSSIVE PROBLEMS AT GVT HOSPITALS. CASUALTY NO BLANJRTS NO PILLIWS NO TEA NO TOILETS NEAR ONLY PANS. GIVE NECESSITITD AND SIGN FOR THEM BUT.NOW NO CONTROLS AT ALL. DOCTORS EVEN BLACK.LIST YOU AND TELL YOU DONT COME BACK YOUNG.OLD BLACK WHITE SAME SHOCKING TREATMENT TREATED LIKE TRASH

    1. Unfortunately the Minister of Health is an idiot

      1. He’s just another Johnny de Brain.🤣

      2. Surely you mean rhe entire ANC contingent.

      3. How can you call the Minister an idiot?What assessment cretiria did you use to reach your conclusion?You must voice out positive ideas to assist in.

  2. The great number of people who are opposed to NHI are those who benefitting from the current system, such medical aid schemes and to some extend the specialist. Medical schemes premiums are not affordable even to the middle class. Specialist are currently a law unto themselves, they charge what the want.

    1. I don’t know which institution the minister graduated in mathematics, but me as a layman in business for 40 years odd cannot fathom his calculations to mine. Personally, I’ve lost my medical aid but I will not go to a current public hospital if needed. Not now or if the plan is implemented. Simple. You not getting 1 cent of any money I have, had or I might be lucky to acquire. Keep on dreaming……… Not happening

  3. Another eskom situation in the making

    Maybe they must get police, water and electricity services right
    Forget about SAA…

  4. Can the honourable minister explain what is “mathematical hooligans.?

    I will then relate his definition to the context of the subject.

  5. We can’t trust the Government with anything
    The current Health system ain’t working, and it cost billions for nothing
    Show us your serious, and first get the current system working

  6. The minister is right, medical aid is way too expensive, doctors charging up to 6 times. Pre democratic times we, blacks, colored and Indians had no private medical hospitals and our state hospitals were the best in terms of treatment and recovery

  7. The clarity needs to be based on the funding of NHI, if it’s going to raise tax from those who worked hard to get job or work and businesses for people who do nothing and the foreigners. NHI with paying more tax must be put on hold till 95 percent of South Africans work and pay tax and 99 percent issues for foreigners be sorted fully.

  8. 1trillion 22thousand hundred and 62thousand 44million and 60 cent.

  9. The government f’ed the public hospitals due to mismanagement because they don’t give a flying toss about the health of the people of South Africa now you want to bring down the private medical care to that bottom of the barrel level. Rather than upping the level of government medical care that we are already paying tax for. The reason private medical care came about in the first place was because this inept government can’t even run a bath. This will flop just like all the other beloved SOE’s and the poorest will pay the price. Make it law for government officials to use government hospitals, then you will see a change.

    1. Amen to that!

  10. This is not rocket science. Fix the existing infrastructure, appoint competent people to do the job, get rid of those who want the job but not the work that goes with it and those using the braindead rules and regulations to divert crucial funds to the wrong ends. These endless money wasting roadshows is empty talk. Roll up your sleeves and get the job done

  11. I am amazed by the way information is destoted by those who have been previlage and benefiting because of the colour of their skin! Therefore the solution to this matter around NHI must be taken to the referendum to balance the way issues for those who are down trotted are handled, the majority of this country are only voting tools thereafter few groups disguise as civil organisation and NGO are consulted, the question is Who appointed and finding them?

  12. “South Africa is known for dialogue” = read corruption

    Roadshows = will costs millions because ANC is involved

    This “minister” have filled so many portfolios already, and FAILED all of them, what else will he destroy?

  13. Government inherent a working public hospital system in 1994 what is left of it is the same as all soe,s. First fix your own inability government before you start blaming apartheid and do your robbing again. Please minister resign asap.

  14. Best is to ask CMSA and other medical aid schemes to show how much the spend on customers for private health care. Take that number and add to the expenses for public health care. Then they would get a rough idea of how much it will cost. Add 7.5% inflation. To do circumcision in pvt is expensive. Not forgetting about insurance medical professionals pay for post op complications. Currently at this moment in time, all government health posts are frozen because the funds are depleted! I feel that they really need to improve government health services first, like chc clinics, primary and secondary state facilities. To my knowledge, only 2 government hospitals has been built or expanded in the past 30yrs in kzn.

  15. Who is going to pay for the NHI? Who is going to benefit, apart from government employees getting bigger and better salaries, cars and houses? Not forgetting the overseas bank accounts that they have. If the ministers need hospital treatment are they going to wait in line like the “common people”? I don’t think so,
    If you wish to stay with a Private medical aid you should be allowed to do so. I do not want the government to tell me which doctor to see or when I can see them

  16. The thieves and looters must be singing happy days are coming.

  17. Seen that he doesn’t agree with Momentum,So can the Health minister kindly calculate the cost of NHI.

  18. So the minister is saying that at a cost of R1800 for circumcision at a public hospital will be done without specialists by doctors of lesser experience, that is, hit and run doctors without much knowledge. He is nuts.

  19. Can the minister of health please give us his prediction of the annual cost for the NHI will be? Whatever his prediction is, you can multiply with 100. Look at the original budget from government to built the power stations, and the eventual cost, multiply by a 1000…. if not more.

  20. He will talk like this because he knows that his not going to public hospitals or clinics icluding his family unlike people who hav to go to public hospitals without getting any help or they die there, where by our people have to go to the clinics at 3am or 4am untill 4pm nd still sometimes they come back without getting any help..

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