The National Health Insurance (NHI) has been under discussion for years, but with the process moving at what Solidarity considers to be a rapid pace, the trade union felt it important to release its report into the NHI.

The union says healthcare workers need the opportunity to contribute their “knowledge, insight and opinion” to the NHI and say why they believe it to be a “bad idea that will weaken” the healthcare system.

A previous study was conducted in July 2019 with participation from Solidarity members only. However, when Health Minister Dr Zweli Mkhize tabled the NHI Bill in Parliament in August 2019, Solidarity sent out questionnaires to 7,443 healthcare practitioners in the private and public sector across South Africa, to which they received 651 responses.

The report focuses on healthcare practitioners who are mostly general practitioners, specialists in their field of study or registered nurses. Most practitioners who took part in the study were from Gauteng, although Solidarity did receive responses from other provinces.

By implementing the NHI, the governments’ main aim is to resolve critical problems in South Africa’s healthcare sectors. One issue is the unequal distribution of quality healthcare and another is that medical aid funds and private medical services are unaffordable for the majority.

“To fund this, we need taxpayers,” said senior researcher at Solidarity Research Institute Morné Malan.

“To be a taxpayer you must be employed… only 12% of South Africans pay tax.”

“This is bad for everyone, not just bad for an elite number of people,” said Solidarity’s CEO Dirk Hermann. “We are going to fight against this.”

Solidarity says all formal processes through which the bill can be fought are being investigated. The trade union has already instructed its legal team to test its constitutionality should the bill not be amended as requested.

“We have been studying and been involved with the NHI for almost three years now. We are well versed in it and we see several constitutional, practical and economic shortcomings that will have a huge negative impact on South Africa as a whole,” Malan said. “Therefore, if necessary, we are ready to fight it, even in the Constitutional Court.”

The report says almost 80% of respondents are negative or sceptical about the NHI as they believe it will not improve the healthcare system and service delivery. The report said 15% of respondents believed that it would be possible to successfully implement the NHI, and 84.5% are of the view that the implementation of the NHI could destabilise the healthcare system and harm the high-quality service already being provided by the private sector.

Nicolien Welthagen, a Solidarity Research Institute research psychologist, said medical practitioners who participated in the study highlighted that there was distrust in government as they felt there was a political agenda in implementing the NHI.

“They feel [as] if the state is very serious about making quality medical care for everyone, especially the poor in this country,” Welthagen told Daily Maverick. “If they were serious about having a quality system, why is our public health system in shambles? So for them (healthcare practitioners), there is a discrepancy between what they are trying to do and what they say.”

The NHI Bill is under consideration by the National Assembly’s portfolio committee on health. If the National Assembly passes the bill, it will be taken before the National Council of Provinces. The final bill is planned to be signed into law in 2026.

Solidarity wants to ensure that the process is stopped before it can go any further than it already has. Part of the decision to “fight against” the NHI Bill is because the report highlighted 41.6% of respondents said they would take steps to emigrate if the NHI was implemented. The report said 20.8% of respondents had already taken steps to emigrate because of the NHI plan.

Welthagen said the risks of implementing the NHI could be a big problem for the future of healthcare in South Africa.

“There are serious concerns about a shortage of healthcare workers,” Welthagen said.

“Most of the doctors said they are going to pack their bags and leave if the NHI is implemented,” Hermann said.

Solidarity is urging the government to take the feedback seriously as most respondents in the report said the state needed to stop “interfering and intending to restrict and control the freedom of choice of the public and healthcare workers”.

“Some comments and proposals conveniently are ignored to ensure that the ideology-driven plans can be steamrollered politically,” Welthagen said.

“This report shows unequivocally that there is a message from the industry that the NHI cannot work and that healthcare practitioners are not interested in participating in a totally centralised, state-run health system.” DM