The Hospital Association of South Africa (HASA) has joined the line-up of organisations that are challenging the National Health Insurance Act in court.
HASA represents the owners and managers of most of the private hospital beds in South Africa. Its members include the JSE-listed groups Life Healthcare and Netcare, Mediclinic, and independent groups such as Lenmed and Joint Medical Holdings.
The organisation said on Tuesday it has deferred filing a legal challenge to the NHI Act because it believes that sustainable and affordable solutions to achieve universal health coverage for all South Africans are within reach.
“However, the government’s lack of response to several constructive and practical proposals, including those of Business Unity South Africa (BUSA), and the Minister of Health’s recent public statements concerning the NHI, including regarding the imminent publication of NHI regulations, have necessitated that HASA move forward with its legal challenge to the NHI legislation,” HASA said in a statement.
HASA said despite its decision to proceed with legal action, it remains hopeful that the Presidency will respond positively to the constructive proposals that have been made. “HASA remains open to engaging with government on the way forward in parallel to the legal process.”
The organisation said it believes NHI is neither sustainable nor affordable, “and dialogue and collaboration between all stakeholders is critical to finding and developing solutions to achieve universal health coverage”.
In addition to HASA, the organisations that are challenging the NHI Act in court are trade union Solidarity, medical schemes representative body the Board of Healthcare Funders, and the South African Private Practitioners Forum, which represents healthcare professionals. The South African Medical Association is also preparing a legal challenge.
BUSA’s proposal
In September last year, BUSA met with President Cyril Ramaphosa, the Minister of Health, the Deputy Minister of Health, and senior officials from the Presidency and the health department to discuss the NHI Act. At Ramaphosa’s request, BUSA submitted a proposal in terms of which sections of the Act will be deleted or amended to provide more space for medical schemes once NHI is implemented. The details of the proposal are confidential.
Section 33 of the NHI Act states that schemes will be restricted to providing “complementary cover” only for benefits not covered by NHI once the system has been declared “fully implemented” by the Minister of Health.
Earlier this month, Health Minister Dr Aaron Motsoaledi poured scorn on a media report that the ANC would table a compromise proposal at the first Cabinet lekgotla of 2025 on how NHI can be implemented. The Cabinet will meet on 29 and 30 January.
Read: Motsoaledi to disclose plans for private healthcare reform
According to Rapport, the compromise proposal is to make medical scheme membership compulsory for everyone who is in formal employment.
In an article published in Spotlight, Chris Bateman explains that under mandatory health insurance, everyone who is in formal employment, or who earns above a certain threshold, would be forced by law to be a member of a medical scheme.
“This, it is argued, would result in medical scheme membership swelling substantially and pressure being taken off the public healthcare system. It is also expected to result in medical scheme premiums being reduced because more healthy, younger people will join the schemes. People who are unemployed or who cannot afford health insurance will still be taken care of by the public healthcare system, which would also take paying medical aid members.”
According to Bateman, mandatory health insurance was part of the government’s longer-term health reform plans until the pendulum swung in favour of NHI at the ANC’s national conference in Polokwane in 2007, when Jacob Zuma became president of the party.
He said the idea was placed back in the spotlight in September last year when Dr Richard Friedland, the immediate past chief executive of Netcare and a key member of BUSA’s health delegation, made the case for it at HASA’s conference.
According to HASA, the number of people who could potentially over time be covered by private insurance would increase from 9.2 million to 27.5 million out of a population of 63 million. This estimate is based on a formally employed population of 11.5 million and an average beneficiary ratio of 2.4.
City Press reported that HASA’s proposal received “high-level support in the ANC”, particularly from “senior members close to” Ramaphosa.
Motsoaledi, in an interview, denied that such a proposal was on the table and mocked City Press’s claims that “the president and his allies are warming to it”.
Read: No proposed compromise on NHI is on the table, says Health Minister
