The Universal Healthcare Access Coalition (UHAC), which represents the majority of healthcare professional associations in South Africa, has presented an alternative to the National Health Insurance (NHI) to President Cyril Ramaphosa.
These include a proposal to separate funding from service purchasing, improve public healthcare services, and expand medical scheme coverage.
The NHI represents the African National Congress (ANC)’s controversial initiative to provide universal healthcare access and effectively dismantle the medical aid industry in South Africa.
The plan intends to establish a government-managed fund that would finance medical services for all qualifying individuals, thereby diminishing the influence of private health insurance schemes.
While medical aids could still technically exist under the NHI, key sections of the law stipulate that they cannot cover the same services the NHI covers—service which are, as yet, completely unknown.
Having assessed the situation, the UHAC said that the NHI is “fiscally and institutionally unimplementable”, and suggested that healthcare should be expanded through medical schemes, rather than dismantling them.
“In particular, there is no feasible scenario in which a single tax-financed fund can provide all the coverage for the entire population of South Africa,” said the coalition in a statement.
The UHAC published a report titled Universal Healthcare Access for South Africa, which identified critical roadblocks to achieving a healthcare system that provides universal access, quality care, and financial sustainability and offered sustainable reform solutions.
Current issues
Looking at roadblocks, these include:
South Africa’s healthcare system faces systemic challenges:
The public sector is struggling with governance failures, inefficient allocation of resources, and a decline in the quality of services.
At the same time, the private sector is dealing with rising costs and regulatory gaps in medical schemes, which are limiting access to healthcare and affecting sustainability.
A 20-year policy vacuum has stalled strategic health reform:
While the NHI proposals were put forward to address this gap, the UHAC believes they are not fiscally or institutionally feasible.
Specifically, the UHAC argues that it’s not possible for a single, tax-funded entity to provide comprehensive coverage for the entire South African population and this policy vacuum could lead to a continued deterioration of both the public and private health systems.
Current system lacks a balanced approach to financing healthcare:
The UHAC argues that universal healthcare access in South Africa can only be achieved through a combination of tax financing and private contributions, as seen in other countries.
To achieve this, the government needs to establish governance frameworks that support this approach in both the public and private sectors, which it lacks.
Political influence over healthcare governance is a problem:
The report emphasises the need to depoliticize healthcare governance by creating a separation between political oversight and the administration and management of healthcare organisations.
Key proposals
The UHAC provided three key features of their proposed reform framework, which includes:
Separation of pooling and purchasing functions:
This feature focuses on improving the efficiency and fairness of healthcare financing.
It involves separating the collection of funds (“pooling”) from the process of using those funds to buy healthcare services (“purchasing”).
Pooling would occur at the national level, ensuring resources are distributed equitably across the country.
However, purchasing would be decentralised, giving local authorities like district health authorities and public hospitals more control over how healthcare is delivered in their communities.
Strengthening public healthcare services:
Recognising the issues within the public healthcare system, such as governance failures and declining service quality, this feature aims to improve the performance of public healthcare providers.
This involves granting more autonomy to district health authorities and public hospitals, allowing them to make decisions about workforce planning and procurement independently.
It also emphasises the need for a robust governance framework to support these changes.
Expanding the contributory system:
This feature aims to expand access to healthcare through medical schemes.
It proposes making medical scheme membership mandatory for higher-income earners, while providing financial support for lower-income contributors.
This approach seeks to achieve a more balanced healthcare financing system, with tax revenues focused on supporting lower-income households and a strengthened contributory system providing coverage for higher-income groups.
To ensure fairness and prevent risk selection, the framework recommends implementing risk equalisation and social reinsurance mechanisms within the medical schemes system.
Going forward
“The UHAC’s proposed reforms offer a pragmatic pathway to achieving universal healthcare access in South Africa,” said the coalition.
“By addressing governance failures, integrating public and private systems, and ensuring financial sustainability, the framework aims to uphold the constitutional right to healthcare for all who live in South Africans,” it added.
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