Medical schemes are voluntary health insurance providers that finance members' access to for-profit hospitals and primary healthcare facilities.
The Public Health Department established a Committee of Inquiry into NHI in 1935, which advocated for social insurance for employees in urban areas who earned below a specified threshold, to be provided on a non-racial basis.
[5] The early 1940s saw sustained interest in the development of the South African welfare state, amidst the release of the Beveridge Report in the United Kingdom and calls from medical associations to establish a national health system.
[5] The call for universal free medical care featured prominently in the 1955 Freedom Charter adopted by the African National Congress,[9] which would later come to power following the abolition of apartheid.
Budgetary constraints and the ascendancy of neoliberal economic policy led to significant deregulation of private healthcare in the 1980s, including the removal of racial restrictions on medical scheme membership.
The Social Health Insurance Working Group of 1997 similarly proposed a system that would cover those formal sector employees who were not members of medical schemes.
[5] The comparatively populist agenda of the Zuma administration included the urgent implementation of a publicly funded and administered system of national health insurance.
[20] South African citizens, permanent residents, refugees, inmates, "certain categories of individual foreigners" and all children will be eligible to receive healthcare services purchased by the Fund.
A Contracting Unit will consist of a district hospital, clinics (community health centres), "ward-based outreach teams" and private providers in that area.
[31] The Stakeholder Advisory Committee will comprise representatives from various health professions councils provided for in terms of South African law, as well as interested persons from civil society and labour unions.
[33] The Act contemplates that National Health Insurance would be "gradually phased in using a progressive and programmatic approach based on financial resource availability".
Similar concerns were raised in a 2020 report by the Institute of Risk Management in South Africa, and the submissions made to the Department of Health by several civil society groups following the publication of the draft NHI Bill in 2018.
Legislative reform has been widely regarded by academics as an inadequate intervention to address the deficiencies in the South African healthcare system, which include mismanagement, failing infrastructure and staffing shortages.
[4] A petition against the NHI Bill by the South African Medical Association, which has garnered approximately 78,000 signatures as of October 2023, has been supported by the official opposition Democratic Alliance.
[38] The passage of the Bill was welcomed by the Congress of South African Trade Unions,[39] and described as a "catalyst for universal health access" by the national spokesperson of the governing ANC.
[40] The CEO of Business Leadership South Africa has criticised the Act's cost implications, as well as the absence of provisions facilitating public-private partnerships.
[41] The CEO of Discovery Health, Adrian Gore, raised similar concerns, and advocated for amendments to the Bill to provide for private-sector collaboration.
[44] On 24 July 2024, the Gauteng Division of the High Court ruled that certain provisions of the National Health Act 61 of 2003 — the statute that provides the legal framework for the South African healthcare system — were unconstitutional.