A group of healthcare organisations, the Universal Healthcare Access Coalition (UHAC), has expressed its belief that the National health Insurance (NHI)  Act is “deeply flawed,” highlighting that its proposals are not “feasible and potentially detrimental” to healthcare access.

The group held a media briefing on Wednesday, where it laid out why it believes the NHI remains unimplementable and presented its proposed framework for healthcare reform in South Africa.

It explained that the NHI plan lacks alignment with the current healthcare system, neglects necessary reforms and fails to address governance and equality issues in public and private healthcare.

The group pointed out that improving governance in the public health system and better regulating the private system for cost efficiency and equity, will address the currently polarised system of “an underperforming public sector and an expensive private sector.”

UHAC steering committee member and SA Medical Association chair Dr Mvuyisi Mzukwa said the NHI does not materially depart from the weaknesses of the current system but instead centralises control without resolving fundamental problems.

“The Act as it stands is unworkable, lacking a clear implementation pathway and timeframes. Crucially, the NHI model of a single tax-financed fund to provide healthcare access and cover for the entire population is unfeasible and unattainable in the country’s current and foreseeable economic future,” he explained.

UHAC steering committee member Dr Aslam Dasoo said governance reform is a key element of the coalition’s proposed framework, which proposes retaining health as a provincial competency to keep management and decision-making closest to service delivery points.

“We propose addressing current governance failures by de-politicising healthcare management through independent supervisory boards to oversee operational decision-making for each public health facility. This would improve accountability, reduce corruption, and enhance service delivery efficiency,” he explained.

The UHAC announced that it has developed a “concrete, workable” reform pathway to address the “evident failures” in the public and private healthcare systems and to help achieve a high-performing system of universal access and coverage in South Africa.

Mzukwa said the UHAC proposes a mixed funding model of medical scheme contributions and general taxes, with some re-alignment of existing taxes, which he said better aligns with the country’s fiscal constraints and will ensure long-term sustainability.

UHAC steering committee member and CEO of the SA Private Practitioners Forum Dr Simon Strachan believes the public health system is failing owing to “institutionalised corruption,” which he said are enabled by “flawed governance structures.”

The coalition suggested that healthcare funding (taxes and medical scheme contributions) and risk management be pooled at a national level to ensure equitable distribution of resources, and that purchasing of healthcare services be decentralised for more efficient, localised decision-making.

“The UHAC approach introduces multilateral tariff negotiations, independent regulation, and competitive alternatives to address rising costs in the private sector, which are more targeted and nuanced than the NHI’s reliance on centralised purchasing,” said Strachan.

The UHAC proposes mandatory medical scheme coverage for higher-income groups, to leverage the strengths of the private sector.

“Unlike the NHI which bars the private sector from covering services offered under the NHI, the coalition’s proposal would see medical schemes continuing to offer the full spectrum of cover and services, albeit more tightly regulated for competitiveness and efficiency,” the group said.