NHI Bill needs crucial rewrites to get us to Universal Health Coverage

The NHI must be fair to patients and taxpayers, well managed and corruption-free or it will fail.

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02/12/2019 12:12:33

NHI Bill needs crucial rewrites to get us to Universal Health Coverage

The Organisation Undoing Tax Abuse (OUTA) has asked Parliament to rewrite sections of the National Health Insurance (NHI) Bill to protect patients, block unreasonable extra taxes, strengthen governance of health facilities and introduce strong safeguards to prevent looting of the colossal fund.

The proposals are outlined in OUTA’s submission to Parliament’s Portfolio Committee on Health, as part of the public comment process on the Bill.

OUTA believes that universal health coverage (UHC) is both a social and moral necessity for our country.  UHC is the long-term, over-arching policy goal for our country’s health system while NHI is a specific funding model. The NHI should be shaped to allow us to move towards the long-term destination of UHC. However, OUTA believes this may require large-scale revisions to the NHI Bill.

“As an organisation, we fully support the objective of universal health coverage. However, we believe that the National Health Insurance Bill, as currently presented, has several major flaws that call for an urgent revision – without such revision the long-term goal of UHC will remain tragically out of reach for South Africans,” says Dr Heinrich Volmink, OUTA’s Executive Director for Policy.

“No person living in South Africa should have to face financial ruin because they have a particular illness or injury.”

Four big concerns

OUTA’s submission raises four key areas of concern with the NHI Bill and proposes revisions to address these. The submission includes comparisons with aspects of similar systems in other countries. 

1. Protect the NHI fund with Red Scorpions

The NHI fund must be protected from corruption. OUTA proposes the establishment of an independent, well-resourced anti-corruption and enforcement agency – the “Red Scorpions” – which is separate from the internal investigating unit proposes in the Bill. This new agency must monitor the fund and have the power to investigate and prevent corruption. The fund must also be guarded against political interference.

Corruption “is one of the biggest threats to achieving universal health care,” warns OUTA’s submission. “The NHI Fund will represent a colossal sum of public money.”


2. Protect districts from maladministration

The health districts will be key recipients of NHI funding. Health districts must be protected from maladministration by strengthening governance and establishing stringent accountability measures. OUTA proposes designating the District Health Management Offices as “accounting authorities” in terms of the Public Finance Management Act, to improve financial controls and accountability. OUTA also proposes establishing District Public Health Offices to support cost-effective purchasing of health services.


3. Protect taxpayers from unreasonable taxes

The rights of taxpayers who will fund the NHI must be protected. Many taxpayers are concerned that the advent of the NHI will result in the erosion of their own healthcare. Taxpayers face potential tax increases to fund the NHI, along with the likely loss of existing rebates for medical expenses, and the prospect of ongoing out-of-pocket expenses. This places households in peril and raises justifiable concerns of the use of their tax money.

OUTA finds that the Bill is not clear enough about the sources of funding, which includes vague references to “payroll tax (employer and employee)” and “surcharge on personal income tax”. OUTA proposes that the surcharges suggested in the Bill be capped or removed as a source of revenue. “Surcharges can only be justified by proven efficiency and accountable, transparent financial management in government,” says the submission.

OUTA also proposes clearly defining the role and powers of the Bill’s Stakeholder Advisory Committee to combat tax abuse of the fund.


4. Protect the patients

The rights of those who use the NHI must be protected, which includes issues of quality of care, waiting times and access to information needed for patients to make decisions on their health care. “If the NHI is to succeed, it must be grounded on a rights-based approach,” says the submission. OUTA proposes the well-supported and accessible User Service Centres be established in each health district.

Access to vulnerable groups, including asylum-seekers, must be carefully considered. The Bill excludes asylum seekers from all but emergency care, but OUTA believes this is morally and fiscally irresponsible, so proposes that active asylum seekers be allowed to register. Managing an asylum seeker with diabetes at the primary healthcare level, for example, is far more cost-effective than treating a diabetic emergency.


Thanks to our supporters

OUTA would like to thank all of our supporters and members of the public who shared their views with us on the NHI Bill. As an active member of civil society, we will continue to engage throughout the public participation process. We must seize the opportunity to turn our country’s health system around and fight, tirelessly, for better health care for all.

OUTA’s submission is here.

The NHI Bill [B11-2019] is here.

Track the NHI Bill’s progress through Parliament here.

OUTA is a proudly South African civil action organisation, that is purely crowd funded. Our work is supported by ordinary citizens who are passionate about holding government accountable and ensuring our taxes are used to the benefit of all South Africans.