Most organisations litigating against the National Health Insurance (NHI) Act have poured cold water over finance minister Enoch Godongwana’s suggestion that they reach a settlement with the government. Many expressed scepticism about the state’s willingness to consider their standpoint, as few changes were made when the policy underpinning the act was drafted or when parliament considered the NHI bill. NHI, the ANC’s controversial plan for achieving universal health coverage, seeks to provide healthcare services that are free at the point of delivery to all eligible patients, regardless of their socioeconomic status.
It paves the way for a single, government-controlled fund that will pay for all health services and envisages a sharply reduced role for provincial health departments and medical schemes. The finance minister’s call for consultation to reach a settlement was exactly what parliament’s lawmaking process should have facilitated, said Mireille Wenger, the Western Cape’s minister for health and wellness. “However, when the NCOP [National Council of Provinces] considered the NHI Bill, it failed to facilitate proper public participation, especially regarding the act’s major impact on provincial healthcare,” she said.
“We therefore continue to believe that the public process was flawed and that the NHI Act should be declared invalid and unconstitutional.” TheWestern Capeprovincial government is one of eight parties that have challenged the NHI Act in court. The others include trade unionSolidarity; theBoard of Healthcare Funders(BHF) and theHealth Funders Association(HFA), representing medical schemes; the South African Private Practitioners’ Forum (SAPPF) and the South African Medical Association (Sama), representing doctors; the Hospital Association of SA (Hasa), representing private hospitals; and business lobby group Sakeliga. In a debate in parliament last week, Godongwana said that since the health department and the litigating parties had all expressed support for universal health coverage, they should “meet and craft a settlement”.
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Hasa said it would not have embarked on litigation had the government been willing to engage in constructive discussion. It remains open to working with the government to improve access to healthcare, but that would require the government “fundamentally revisiting” its approach to NHI legislation, said Hasa CEO Dumisani Bomela.
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