While Budget 2025 covered numerous sectors, the notable absence of National Health Insurance (NHI) from Finance Minister Enoch Godongwana’s speech has sparked significant discussion.
Despite its omission from the speech, references to NHI are present within the medium-term expenditure framework, signalling its continued, albeit challenged, presence in the government’s long-term plans.
NHI: More aspiration than reality?
Craig Comrie, CEO of Profmed, argues that the lack of direct mention of NHI underscores its current status as more of an aspiration than a tangible reality. He said the absence of direct mention of NHI in the speech is more telling than many South Africans realise.
Comrie points to the need to delve into the medium-term expenditure framework to find any NHI-related information, highlighting the “financial and practical roadblocks ahead”.
Comrie emphasised the private sector’s long-standing concern that universal healthcare coverage must be grounded in feasibility, not just political intent.
He suggested that the current healthcare budget allocation focuses on maintaining the status quo, with a R52 billion increase over three years aimed at stabilising the existing system and retaining healthcare workers rather than building the foundation for NHI.
Financial constraints and USAID withdrawal
The budget also fails to address the anticipated R8 billion funding gap left by USAID’s withdrawal, which will impact critical healthcare services. Comrie noted that the increase in healthcare allocation is a positive step to ensure continuity of care, but it did not set the foundation for NHI.
He said that the budget acknowledges financial constraints, with the Finance Minister making it clear that there is no funding for new programmes, structures, or committees.
The lack of detailed costs for NHI further complicates matters. According to the Department of Health’s initial estimates, NHI would require at least R200 billion, a figure far beyond the current state coffers. Comrie argues that even a phased implementation of NHI would remain a policy promise without a carefully costed plan.
Alternative approaches to healthcare improvement
Comrie proposes that improving public healthcare should focus on targeted reforms that enhance accountability, combat corruption, and improve service delivery, efficiency, and accessibility. He cites the successes of Operation Vulindlela, which involves private sector participation in stabilising energy and transport sectors, as a model for healthcare.
He also suggests making public sector facilities more attractive to medical scheme members, allowing for a sustainable revenue flow. He said if we cannot reform the whole system, we can start by creating centres of excellence in the public sector to get the ball rolling.
Private sector collaboration and NHI regulations
Comrie clarified that the private healthcare sector is not universally opposed to universal healthcare but calls for meaningful reform beyond the sole focus on NHI. He emphasised the need for financial sustainability, sectoral collaboration, and effective governance structures.
Despite the budget’s lack of NHI funding and the Act’s inoperable status, Health Minister Aaron Motsoaledi recently published NHI regulations. The SA Medical Association has criticised these regulations for failing to address critical transparency, accountability, and operational independence issues.