The South African Medical Association is challenging the National Health Insurance Act in court. Picture: Oupa Mokoena Independent Newspapers
Image: Oupa Mokoena Independent Newspapers
The South African Medical Association (SAMA) is taking what it calls a bold and comprehensive legal stand against the National Health Insurance (NHI) Act, as it says the legislation threatens to destabilise South Africa’s healthcare system.
SAMA’s constitutional challenge, filed on April 1, aims to address what the organisation perceives as significant flaws in the Act’s provisions that could severely impact doctors, patients, and the country’s healthcare framework.
Unlike other legal objections to the NHI, which predominantly focus on the Act’s potential to undermine private healthcare and medical schemes, SAMA’s challenge looks at the "system-wide consequences."
“This is not just about protecting the private sector. This is about ensuring that South Africans, regardless of their income, have access to a healthcare system that works without sacrificing quality or efficiency," SAMA stated.
The heart of SAMA's case revolves around several major concerns. Among these is the Act’s requirement that all South Africans must register as NHI “users” to receive healthcare. This registration is to be done at accredited facilities, which SAMA says raises concern about access for people living in remote areas.
“If a facility is overcrowded or incapable of treating a patient, there is no clear plan for how that patient would be transferred elsewhere,” SAMA stated.
This is compounded by fears that the NHI’s centralised structure will introduce bureaucratic delays that undermine timely access to care.
Furthermore, SAMA is concerned about the lack of clarity surrounding the scope of benefits under the NHI. “The Act contains conflicting definitions of what services are covered, leading to confusion about what patients can expect and what doctors will be reimbursed for."
With procurement of medical supplies also unclear, the risk of stock shortages is another point of contention. “Without a clear understanding of what is available, how can we be confident that the system will function effectively?”
The challenge also raises alarms over the Act’s impact on doctors, particularly those already stretched in both public and private sectors.
SAMA’s analysis shows that a private surgeon, who currently works at 158% of normal capacity, would be required under the NHI to work at 368% capacity, resulting in significantly reduced pay.
“This is unsustainable,” the spokesperson stated. “Doctors are already under pressure, and this system would only push them further.”
In terms of coverage, SAMA argues that the NHI would replace existing medical schemes for most South Africans, potentially leaving them with limited or unclear benefits. “The NHI is not just a healthcare policy; it’s an overhaul of the entire healthcare financing system. If the implementation is not handled correctly, it could lead to a decline in care quality,” SAMA warned.
The South African Medical Association Trade Union (Samatu) said while it fully supported the NHI, it acknowledged the complexities involved in its implementation.
Samatu's general secretary, Dr Cedric Sihlangu, said: “We believe that the NHI is a crucial step towards addressing the disparities in healthcare access between the public and private sectors. However, we are concerned that without sufficient human resources and proper governance structures, the system could face significant hurdles.”
Sihlangu continues: “While our members, especially those working in public hospitals, are optimistic about the NHI’s potential to address long-standing issues like medical personnel shortages, we believe that the NHI cannot be successfully implemented without addressing these resource gaps. The NHI represents an opportunity to improve healthcare delivery, but it must be properly resourced.”
However he said Samatu was steadfast in its support of NHI’s broader goals including the streamlining of resources and reducing inequities in the healthcare system.
"We view it as a necessary step forward, even though we recognise there will be challenges along the way."
The DA, a vocal critic of the NHI, said it supported SAMA’s legal action against the Act.
Michele Clarke, the DA’s spokesperson on health, said: “The Act centralises power in the hands of the Minister of Health, stripping provinces of their ability to govern their own healthcare services. This violates the constitutional framework and undermines the ability of local authorities to address the specific needs of their communities.”
The DA also raises concerns over the financial sustainability of the NHI, particularly in light of the country’s strained fiscal resources.