19 May 2022

The National Assembly's Health Committee has issued a media statement confirming that it has decided to proceed with processing the National Health Insurance Bill. This follows yesterday's 'motion of desirability' vote - a routine procedure required for every Bill tabled in Parliament. The committee will now begin formal deliberations on the Bill, which has been the focus of public hearings since October 2019. They ended in February.

Interestingly, the NCOP committee (to which the Bill will be sent once it has been passed by the National Assembly) is scheduled to be briefed on the Bill on 7 and 21 June. This tends to suggest that the National Assembly committee is about to complete its work on the Bill and that it could be tabled in the House for a second reading before its two-month winter recess begins on 20 June. The Bill is one of several being prioritised this year, according to a media statement Iissued in December 2021.



Speaking during a presentation on concerns regularly expressed throughout the long, recently concluded public participation process, Acting Director-General Nicholas Crisp reminded Nationa Assembly Health Committee members that the 'bulk' of finances needed to run NHI 'are already in the system'. It's 'just a matter of channelling existing resources differently'. 

Only when the Office of Health Standards Compliance has completed the process of accrediting public and private healthcare service providers will the system be ready for operalisation, which will be phased in over time.

'Ultimately', it will no longer be necessary to purchase most services through medical schemes, which will play a 'complimentary' role.

A framework is in place for building human resource capacity, but this 'will take time' and needs 'commitments' from various stakeholders to making the necessary investments.

In Crisp's view, concerns about the Bill's potential to undermine the constitutionally enshrined right to choose a healthcare service provider may well be unfounded.




The National Health Insurance (NHI) Bill (developed by the national Department of Health and tabled by its Minister) does not propose a funding model. This will be dealt with separately by National Treasury in what we call a 'money Bill'.


The Bill simply seeks to create a fund from which payment for certain services will be drawn to cover the treatment of South Africans registered according to certain procedures and criteria spelled out in the Bill.


Sub-paragraph 8.3 of a memorandum on the Bill's objects clearly states that the 'preliminary work' outlined in sub-paragraphs 8.1 and 8.2 'will need to be further developed'. When the Bill was tabled in August 2019, sub-paragraph 8.3 referred to the 2020 Budget. Since then, the picture has changed drastically - mainly because of the Covid-19 epidemic.


This notwithstanding, 'the funding for NHI will be through a combination of various mandatory pre-payment sources, primarily based on general taxes'.


According to a booklet compiled by the Health Systems Trust, 'every person in South Africa will make a contribution to the fund because we will all pay some kind of tax. People with low income will not make any direct payment to the NHI Fund. Every person earning above a set amount will be required by law to contribute'.


'Monthly contributions made by ... employees ..., in almost all cases, will be lower than medical aid tariffs - and the direct NHI payment will be larger for higher-income earners. Employers will assist the NHI Fund by ensuring that their workers' NHI contributions are collected and submitted, in a manner similar to UIF contributions. Employers will match their employees' contributions to NHI.' 


The task of the National Assembly's Health Committee in processing the Bill, informed by input during hearings held between October 2019 and February 2022, does not include finalising a suitable funding model.


The time for stakeholder input on this model will come when one is proposed by National Treasury in a draft Bill of its own.


And as Health Minister Enoch Godongwana made clear in his written reply to questions from the DA's Ashor Sarupen, ' The need for and timing of further updates to the model will be determined by practical progress with preparing for the implementation of NHI, spending on the existing NHI allocations, as well as progress with processing the NHI Bill in the two chambers and relevant committees of Parliament'.      


THE NATIONAL HEALTH INSURANCE (NHI) BILL public hearings (a timeline)


  • October 2019: Mpumalanga and the Northern Cape province

  • November 2019:​ Limpopo province and KwaZulu-Natal

  • December 2019: Eastern Cape province

  • January 2020: Free State and North West provinces

  • February 2020: Western Cape province and Gauteng ​

  • 8 May 2021 to 23 February 2022: public hearings on oral representations in support of written submissions