Court battles, fierce resistance as government forges ahead with universal health plan

THE government of the country continues to forge ahead with plans to implement the National Health Insurance (NHI), despite resistance and legal threats.

Meant to ensure quality health services for everyone, the NHI has had detractors continuing to tear it apart, saying they would take their disagreements to the courts to ensure it did not get implemented, at least not in the current form.

This follows years of discussions and various stages of planning, its passing by Parliament last year, and the recent allocation of R1.4 billion by the Treasury, and as various government agencies and personnel spoke favourably for its implementation.

In justifying the healthcare plan which would close the gap between those who could afford medical aid and public health service and the poverty stricken, the government said since the dawn of democracy, the health sector had undergone many reforms to try and create a more equitable, accessible and affordable healthcare system that could service all South Africans.

But, reforms have been too little and too slow, and all the while everyone deserved equal access to quality and affordable healthcare, government said.

As such fundamental changes were needed in order to create a strengthened healthcare system: “The problem is, South Africa’s health system is very complicated and expensive. The health outcomes do not match the resources invested to the system. Both the public and private sector have challenges that make the healthcare delivery system unsustainable to service all South Africans,” the Department of Science and Innovation said.

And so they plough ahead with processes to implement the plan, which is expected to be signed into existence before the May elections.

The government said the NHI would strengthen the health system as South Africa was a member of the United Nations and had as such committed to implementing universal health coverage for all.

The Department of Health said the desired outcome was that all “people have access to the full range of quality health services they need, when and where they need them, without financial hardship”.

“The National Health Insurance is South Africa’s strategy to achieving universal health coverage. The NHI is a fund from which the government will buy healthcare services for South Africans from healthcare providers both in the public and private sector, and it will make healthcare more affordable, by reducing the cost of healthcare for all.”

As such, the plan would therefore act like a medical aid for everyone, and everyone would contribute to the fund through taxes and special contributions in line with what they could afford. “It will ensure that everyone is entitled to free healthcare when they need it. There will be no fees charged at the facility because the fund will cover the costs of care.”

They agreed that where it was now was in its early stages, it would still take many years to be fully realised. “It requires input from all sectors to ensure no one is left behind. For the NHI Fund to be effective, the entire health system will undergo reform for many years to come.

“These reforms include partnerships between the private and public sectors, making both sectors more effective and more efficient, and implementing robust governance structures.”

But despite what is a perfect plan to ensure the country moved forward and away from the effects of apartheid, medical and health, and other organisations said they wanted it dismantled and the plan drawn up from scratch. In this way no one, especially medical aid providers and private hospitals, did not end up on the losing end.

Solidarity is among organisations which have taken the legal route, and last week they said they were ready to submit court documents against the larger NHI Bill after the Pretoria High Court passed a verdict on the validity of the premature creation of related jobs.

Their application was around the advertising of jobs and recruitment for the NHI, even before the bill was accepted. That they wanted declared invalid.

“Admittedly this verdict does not change the essence of Solidarity’s larger NHI fight and on all fronts, things are already being prepared for that battle,” said Anton van der Bijl, deputy chief executive and head of legal matters at Solidarity. “The true battle has not even started yet – and this will only follow when the NHI Bill is signed by President Cyril Ramaphosa.”

Theirs was for the heart of healthcare in South Africa, he said: “This is only the beginning of the battle regarding the NHI. We want to hold Ramaphosa personally liable if the bill is implemented, as our research has proved that the plan is unaffordable, unworkable and unnecessary.”

Independent legal consultant, Dr Debbie Pearmain, spoke to the possible constitutional legal challenges the NHI Bill would face. “I think a general concern that stretches across the entire proceeding so far is that stakeholders in the private sector feel that they've gone unheard. And I've heard many stakeholders complain that the Parliamentary Portfolio Committee on Health had a very dismissive attitude towards their representations on the Bill.”

The Bill left too much decision-making to the Minister of Health, and this was likely to see constitutional or legal challenges on an ongoing basis, she said. “This as other regulations and other information emerges because the Bill itself is, at this stage, quite vague.

“It's still, I believe, unconstitutional, it is not as complete as it would be when there are regulations to explain how the government sees the implementation of the Bill going forward.”

She said the term “basic healthcare services” had to be defined and clarified in the Bill. “It is not the same as ‘healthcare services’.”

There were also barriers to access of healthcare created by the Bill. “The registration provisions of the Bill may be challenged as unconstitutional barriers to access. Documentation to be provided for registration may prejudice vulnerable persons such as aged persons, the mentally ill etc.” Immigrant children also faced discrimination, she said.

Access to emergency medical treatment was also dependent on prior registration with the fund, she said, and this was a barrier.

ntando.makhubu@inl.co.za