South Africa pursues universal health cover in face of headwinds

[June 14, 2023]  CAPE TOWN (Reuters) - South African lawmakers agreed a new health insurance bill on Tuesday, paving the way for universal healthcare to millions of poorer citizens in a major overhaul of a two-tier system.

The National Health Insurance Bill (NHI) aims to level the playing field in the world's most unequal society, amid concerns its implementation will be undermined by widespread corruption and a weak economy struggling to fund basic services.

The bill, which will implemented in stages at a cost of billions of dollars, proposes a special fund that will pool public and private resources and limit private medical aid providers, such as South Africa's Discovery, to offering cover only for services not reimbursable by the NHI Fund.

While Discovery broadly supported the proposed reforms, in submissions to parliament last year it rejected the NHI's current single-funder model as unworkable, favouring a blended funding model to help reduce the risks of failure.

"We accept that the NHI will not be the silver bullet that will fix all our health problems but it is the necessary foundation to build on for a progressive improvement of access with quality and equity," Health Minister Joe Phaahla said.

The health system in Africa's most industrialized economy reflects broader racial and social inequalities that persist three decades after apartheid ended.

South African surgeons Dr Tim Forgan and Dr Imraan Mia use a robot called DaVinci to perform delicate operations at the Tygerberg hospital in Cape Town, South Africa, July 15, 2022. REUTERS/Shelley Christians/File Photo

An estimated 15% or 9 million of South Africa's population of 59 million people currently pay for comprehensive private healthcare, while a majority of poor Blacks typically queue for hours at understaffed state hospitals short of equipment.

"The NHI is not the purported miracle the ANC purports it to be," Michelle Clarke, the official opposition's shadow health minister said when rejecting the bill during a debate.

Parliament's lower National Assembly, dominated by the ruling African National Congress (ANC), voted 205 in favour to 125 against the bill, which must now be passed by the upper house before moving to President Cyril Ramaphosa for his signature into law.

(Reporting by Wendell Roelf; Editing by Alexander Smith)

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