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The South African Communist Party today welcomes the release of the National Health Insurance (NHI) Bill intended to strengthen and unify our health system and guarantee comprehensive quality health care coverage for all. The NHI must equalise access to quality health care and therefore eliminate inequalities in health provision. This must be the bottom line.

South Africa has enough financial and other resources to provide good quality health care for all, yet the health care outcomes in terms of the burden of diseases and mortality rates have been disappointing. The root causes of the problem lie in our fragmented, and therefore wasteful, and unequal multi-tiered health system, particularly in health care funding and access to quality health care provision.

The NHI Bill is founded on the core principles of universality and social solidarity. The Bill makes an important and bold advance to ensure that access to quality health care is based on need rather than on one’s ability to pay. This process of transformation in health care provision seeks to remove financial barriers to access. This means after the NHI is successfully implemented, our people will no longer need to worry about making direct out-of-pocket or own account payment in order to gain access to quality health care.

The current situation where South Africa is the world’s most unequal country in terms of access to quality health care is unacceptable. Right-wing think tanks such as the Free Market Foundation, the “South African Institute of Race Relations” and the party of the bosses, the “Democratic Alliance” and their ilk are pushing for the expansion of the discriminatory, profit motivated, market-driven health care financing dominated by medical aid schemes and private monopoly interests. This will worsen inequalities and fragmentation in access to quality care and move South Africa further away from universal quality health coverage.

Despite the notable achievements recorded in our public health system over the last 24 years – including achievements such as the roll-out of primary health care in rural areas and townships, and HIV treatment – the persisting reality is that many of our people still lack access to good quality care. Our people are still required to make out-of-pocket and own account payments in health facilities that are designed to exclude them on the basis of their class position in society. This is contributing to their further impoverishment. Our public health sector must be continuously developed to become the backbone of our health care and this requires that it must be adequately resourced.

One of the primary contradictions at present is that the largest proportion of our country’s health care spending is concentrated in multiple private medical schemes designed to serve a small section of our population. These schemes are used to fund profit-driven health care provision in which the ability to pay takes precedence over access to decent health care.
 
It is however important that the implementation of NHI must be premised on strengthening primary health care throughout all of society and our health institutions.
 
In releasing the NHI Bill, the ANC-led government remains true to its 2014 elections manifesto commitment to establish a “publicly funded and publicly administered” NHI Fund to drive the roll-out of the NHI programme.
 
The SACP will further study the NHI Bill and develop a comprehensive contribution to strengthen the Bill towards the realisation of the objective of quality health care for all. However, in anticipation of a counter offensive from the capitalists in the health sector, the SACP aims to be part and in the forefront of the mobilisation of a broad front of forces to defend the implementation of the NHI in the interests of the workers and poor.
 
The Medical Schemes Bill and NHI
 
The release of the NHI Bill comes at a time when there is growing concern about the affordability of medical aid schemes. Premiums consistently exceed general inflation and workers are unable to cope as their share of national income has increasingly come under a downward pressure.
In addition to the ever increasing medical aid premiums, workers are also required to make additional out-of-pocket payments as their annual medical scheme “benefits” become exhausted. They are, over and above that, charged for services not covered by the schemes. These out-of-pocket payments contribute more than 18 per cent of health spending (which was about R27 billion in 2015).
 
South Africa must roll-back the dominance of medical schemes in health care financing through the creation of a single NHI Fund. It is in this context that the SACP welcomes the release of the Medical Schemes Amendment Bill, and will measure the amendments by the extent to which they pave the way for a transition towards a comprehensive quality health care coverage under the NHI.
 
Any amendment to the Medical Aid Schemes Bill must be subordinated to the changes required by NHI Bill when it is finally passed by Parliament.  The Council of Medical Schemes must not usurp the powers of the NHI Fund.  In this context, the provisions in the Medical Schemes Amendment Bill that are in conflict with the functions of the NHI Fund must be scrapped.
 
The SACP will fully participate in public engagement to improve the provisions of the Medical Schemes Bill and mobilise a broad range of popular forces supporting the NHI.

Isued by SACP