The recent re-tabling of the National Budget Address made one thing abundantly clear: National Health Insurance (NHI) is still more of an aspiration, than a reality. The absence of any direct mention of NHI in the speech is more telling than many South Africans realise. One has to search the accompanying medium term expenditure framework to find references to NHI. It speaks volumes about the financial and practical roadblocks ahead.
As the private sector, we have long cautioned that any attempt at universal healthcare must be rooted in feasibility, not just intent and empty political rhetoric. With no NHI in sight, now more than ever, we need a pragmatic approach to healthcare reform that builds on the healthcare assets we already have rather than chasing an unrealistic, unbound and unfunded ideal. Let’s take a look at the numbers.
The numbers tell the story
The announced healthcare budget allocation prioritises maintaining the status quo rather than expanding into an NHI framework. A R52 billion increase in the healthcare budget allocation over the next three years aims to stabilise the existing system, including retaining healthcare workers. The loss of USAid and is also not provided for in the Budget and this is set to make a R8 Bill hole in critical services. The increase in the healthcare allocation is a positive step in ensuring continuity of care, but it doesn’t set the foundation for NHI. If anything, the budget signals an acknowledgment of financial constraints rather than pushing ahead with unrealistic ambitions.
The Minister of Finance made it clear. There is no money for new programmes, structures, or committees. The lack of an actual costing effort of NHI means the Finance Minister will not budget for any NHI services. In the initial estimation by the Department of Health more than a decade ago , NHI requires at least R200 billion – a figure far beyond the depths of state coffers. Even if implemented in phases, without a carefully costed plan, it will remain a policy promise rather than a deliverable outcome. So, how should we proceed?
Time for practical solutions
The best way to improve public healthcare is not through a massive, unfunded overhaul but through targeted reforms that enhances accountability, roots out corruption, improves service delivery, efficiency, and accessibility. And it’s not like we are not already making progress on this path. The budget speech indicated the successes of operation Vulindlela where the privates sector participates in the stabilisation of the Energy and Transport sectors. It is however totally the opposite of the current health minister who seems to ignore yesrs of well researched recommendations on how to partner the private sector to bring about universal healthcare coverage. Why not replicate Vulindlela in healthcare? We could use some incremental but meaningful change right now.
Another opportunity lies in making public sector facilities attractive to all South Africans, including medical scheme members. In the past, many schemes willingly funded treatment in public hospitals when quality was high. If incremental investments are made in public healthcare institutions were skilled staff are supported, well-managed, and equipped, they could attract a significant portion of the R280 Billion medical scheme funding, creating a sustainable revenue flow that benefits all South Africans. Simply put, if we can’t reform the whole system, we can start creating centres of excellence in the public sector to get the ball rolling.
The private sector’s role in sustainable reform
It is a massive misperception that private healthcare is universally opposed to universal healthcare. The private sector is ready to collaborate, but meaningful reform must go beyond the singular, politically motivated focus on NHI. Like every sector of our economy, healthcare must be built on financial sustainability, sectoral collaboration, and governance structures that ensure quality outcomes for all.
Let’s use a home-building analogy to sum up where we’re at: The NHI promise was designed like a grand mansion with ensuite rooms for everyone, but no one has figured out how to pay for it. It looks like a great house but the architect (Minister of Health) has designed something aspirational, but the financier (Minister of Finance and tax payers) raises valid concerns about affordability and have not been appraised of what the budget is. Its like having a property owner trying to build a new house and get a bond with a poor credit history (confirmed by the budget speech). It would never have gotten off the ground if it were a construction project.
As significant financiers within the current healthcare system, we cannot afford to waste time and money on structures that do not deliver services. Instead, we should focus on reforms and partnerships hich strengthen healthcare delivery…now.
Healthcare reform is not about a single policy – it’s about taking practical steps towards a system that works for all South Africans. It’s time to drop the politicking and move forward with healthcare solutions that are realistic, funded, and work. Let’s move on expanding access to health in a more pragmatic approach which partners government and private sector.