Health minister says NHI will be implemented over next four years

Health minister Dr. Joe Phaahla says the National Health Insurance (NHI) will be implemented over the next four years, although he did not refer directly to how exactly government expects to fund it, with the country already spending 8.5% of gross domestic product on a health system that is essentially broken.

He answered questions from the media after President Cyril Ramaphosa signed the NHI Bill into law.

Asked about the memes doing the rounds on Wednesday of people going to get a gold tooth or visiting a private hospital for a headache without being a member of a medical scheme, Phaahla just laughed and said even if South Africans are stressed they always find a place for humour.

He said the NHI will be implemented in two phases and that the first phase has already started and will continue until 2026. This phase deals with the establishment and strengthening of the health platform, as well as implementing quality improvement programmes in all provinces, he said.

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The second phase will run from the second half of 2026 to 2028 and will include a more intensive conclusion of implementing NHI programmes that will be built up in the first phase. He added that the first phase of NHI will not only be funded from the fiscus and that other funding measures will have to be considered. Government already has “some low hanging fruit” in mind, he said.

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Although government already offers free health services, there is still not sufficient access to physiotherapy, audiology, dentistry and general practitioners providing services from their own rooms, he said.

How will NHI funds be protected against corruption?

Asked about how government will ensure that NHI funds will not be open for corruption, as happened with the Covid funds, Phaahla said the Health Sector Anti-Corruption Forum is already in place, while the SIU and the police will also be able to investigate corruption. The NHI will also have to report to parliament as part of its commitment to be accountable and transparent.

While as many as seven organisations have already said that it will challenge the constitutionality of the NHI Bill in court, Phaahla said if you have a real radical departure from your comfort zone, people with a vested interest will always be unhappy, referring to private healthcare that he says benefitted from the previous dispensation as well as the past 30 years.

“But we live in a democratic country and the courts are part of it. People with serious vested interest will take us on and we have to be ready to present our case.”

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He also said that private healthcare must make a profit for their shareholders in a commodified health system and accused the sector of overcharging and inflating prices, which he said will not happen with NHI.

“I spoke to the CEO of a big group that did not make it in the UK because it could not compete with the NHS where the private health sector handles the backlog of treatment, but only at the NHS standard price.”

He added that if you had to break your leg, you would be charged different prices for treatment at different private hospitals in Pretoria.

NHI will build reliable biometric system

Phaahla said part of the NHI will also be to build a reliable system where citizens will be able to register once with biometrics and go to various facilities for service.

He denied that the NHI Bill was passed by the National Assembly and the National Council of Provinces without any amendments after a public consultation process but did not volunteer any specific changes.

“All comments were considered and it is not true that it was parachuted in. It is not electioneering to sign the NHI Bill now.”

He also urged health professionals not to leave the country. “Stay here, things will get better.”