Health Minister Aaron Motsoaledi has officially released the first draft regulations for the National Health Insurance (NHI) Act, even though several objections and court challenges remain unresolved.
Signed into law by President Cyril Ramaphosa in May 2024, the NHI aims to overhaul South Africa’s healthcare framework and promises universal healthcare access—though it has yet to become fully operational. The recently published draft regulations focus on section 55 of the Act, outlining both the NHI Fund’s proposed governance structures and the procedures under which it will function.
Central to this plan is the NHI Fund, envisioned as the exclusive purchaser of medical services for patients, thereby ensuring eligible citizens receive free healthcare at the point of service.
The announcement has met with backlash from key industry players. The Board of Healthcare Funders (BHF) criticized the Minister’s move to publish the regulations while the NHI Act’s constitutionality is still subject to multiple court proceedings.
BHF’s Managing Director, Dr Katlego Mothudi, stated: “Instead of collaborating with the private healthcare sector to meet urgent national healthcare needs, the National Department of Health is pressing on with an NHI Act that we deem unworkable, unaffordable, and unconstitutional.” Mothudi noted that BHF will review the new regulations extensively and continue its legal action to achieve universal healthcare, insisting that the current form of the NHI will not deliver on its promise.
Simultaneously, the Hospital Association of South Africa (HASA), the nation’s largest hospital group, has initiated its own legal challenge. In documents filed with the North Gauteng High Court in Pretoria this January, HASA contends that the Act should be nullified based on constitutional and financial concerns.
A key point in HASA’s argument is that the proposed NHI scheme breaches Section 27 of the Constitution, which guarantees every South African the right to healthcare. Moreover, HASA claims the government has not conducted a recent, comprehensive financial feasibility study, making the NHI’s affordability questionable. The group cautions that pushing forward without resolving these issues could undermine the entire healthcare system’s stability.
