From CompliNEWS | Financial Service Intelligence Watch

NHI’s governance model dooms it to failure

Legalbrief Today

Government’s proposed National Health Insurance (NHI) has been centre stage of national health policy for 15 years, with the overarching aim to nationalise the country’s private health system by amalgamating it with the public sector into a centralised state-run monopoly called the NHI Fund. However, Michael Settas, chair of the health policy unit at the Free Market Foundation, says the fund’s governance model – based purely on political appointees so much like those of existing SOEs and public sector departments, ‘dooms this proposal to catastrophe even before it commences’.

In his opinion piece in Business Day, Settas says if the government had truly concerned itself with better healthcare as a primary goal, two critical outcomes would have transpired: the existing public health system would have performed substantially better than it has; and the critically necessary analyses of the NHI policy would have been undertaken free of political influence. ‘Such analyses would almost certainly have highlighted the folly of such a ludicrous proposal, based on failed statist economic policies. The deficiencies are as obvious as they are plentiful.’

Settas notes Parliament’s Legal Services Unit recently raised alarm bells with the institution’s Health Portfolio Committee over several aspects of the constitutionality of the NHI Bill, including clause 33, which seeks to outlaw medical schemes from continuing in their present form. ‘This was despite the private sector, NGOs and numerous academics having repeatedly raised the same concerns throughout the lengthy NHI policy development process.’ Settas says this is a ray of light that ‘hopefully spells the end of the NHI calamity’.

He points to the Gauteng High Court (Pretoria) ruling in June 2022 striking down the constitutionality of the National Health Act’s certificate-of-need provisions, which sought to apply draconian impositions on doctors and medical facilities. That ruling, he notes, is on the roll of the Constitutional Court for ratification. ‘The certificate-of-need is pivotal to the NHI proposal since it provides for authoritarian state diktat on where, how and on whom doctors may practice. If it fails to pass constitutional muster, as it surely must, the NHI will be dealt a devastating blow.’ Settas concludes: ‘Along with the valid concern raised in Parliament on the NHI Bill, we may shortly get to a point where the NHI proposal finally gets relegated to where it belongs – the dustbin of history.’

Read the full opinion piece in Business Day here