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Roundtable on the potential constitutional implications on the National Health Insurance (NHI) Bill

Government has announced their intention to introduce a National Health Insurance Scheme for South Africa. The Minister of Health has published a bill in this regard, which is currently being discussed at the Parliamentary Portfolio Committee on Health. The introduction of the bill has met with mixed reaction, inter alia, trade unions who have expressed their support, and medical aid schemes and private hospitals raising concerns regarding the financial viability of the scheme. The bill has been published without an accompanying financing paper.

The institute has commissioned research to inform a way forward that is cognisant of the shortcomings of the current system, both public and private, and the advantages and disadvantages of the proposed reforms. In questioning the way forward, it will be useful to conceptualize an inter-connected set of reforms – enabling thinking about a series of policy choices and the sequencing of the implementation of the various choices. In its research, the institute wishes to develop a framework against which reform pathway choices can be assessed by also providing a technical costing model which can be used to contextualize the fiscal implementation of alternatives. This research is currently ongoing.

In December 2019 the institute hosted a highly successful roundtable on the NHI, in which organisations drawn from across the health sector, government, labour and business participated.

One important aspect that was raised on a number of occasions during the discussion, was the concern that the bill would not pass constitutional muster. A further desktop study identified a number of constitutional arguments that were raised by various stakeholders in this regard.

In order to test and assess the validity of the constitutional arguments being raised, a roundtable dialogue (via video-conferencing) was held on Tuesday, 19 May 2020 with representatives from the legal and academic fraternity. In the course of the discussion it became quite clear that the constitutional questions associated with the NHI Bill are complex and needful of intensive interrogation. The institute intends to obtain formal legal opinions to accurately inform its research and advocacy work with regard to the legislation.


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