All Eyes on NHI Bill as Profmed CEO Voices Funding and Control Concerns

In a recent interview, Profmed CEO Craig Comrie expressed significant concerns over the National Health Insurance (NHI) Bill in South Africa, emphasizing the issues of its funding model and the centralization of fiscal control under a single government minister. The NHI Bill, which is on the brink of becoming law following the green light from Parliament’s National Council of Provinces, has ignited a fiery debate over the future of South African healthcare.

Comrie’s principal worry lies in the funding of the ambitious NHI scheme. Current estimates suggest it requires between R450 billion to R800 billion, but existing public sector healthcare budgets sit around R260 billion, leaving a stark gap. The question of how to secure at least an additional R160 billion remains a puzzle that the NHI Bill does not seem to address.

Beyond the funding shortfall, there are growing trepidations about the governance of the funds. The NHI Bill proposes that the Health Minister would have exclusive control over the healthcare purse. Drawing parallels, Comrie alluded to the monopoly issues faced by Eskom, the national electric utility, suggesting that healthcare could be headed in a similarly precarious direction, creating a monopoly in healthcare provision that stark contrasts with the movement towards diversifying electricity provision.

Corruption within state systems forms the crux of the worry for experts like Wits School of Governance Professor Alex van den Heever. He echoes Comrie’s disquiet, arguing that the NHI’s structure is ripe for misuse. Van den Heever cautions that systemic corruption still plagues the state, negating any idealistic view that the focus of NHI is solely on healthcare improvement.

Attempting to counter such critiques, Health Minister Joe Phaahla recently claimed the fears are “overblown,” citing clean or unqualified audits for public health entities. However, a scrutiny of the Auditor-General’s report tells a different story. The report criticizes the National Department of Health for unreliable reporting and noted disclaimed opinions on its achievements. The AG also indicated that the health system struggles to meet service demand, which fuels skepticism about the government's capability to manage the NHI effectively.

With legal challenges anticipated, the NHI Bill’s fate hangs in the balance. While President Cyril Ramaphosa has pledged to sign it into law, the criticisms and warnings from healthcare professionals and governance experts suggest a need for a comprehensive review. As the bill moves closer to ratification, the South African government must confront these issues head-on to ensure the NHI not only is a sustainable healthcare solution but also one which is transparent, well-managed, and immune to the corruption that has marred other state entities.