Unmasking SAMA: the real motivations behind their NHI court challenge

IOL News

29-04-2025

Mr Kgaile Mogoye works for the National Health Laboratory Services (NHLS) responsible for National Health Insurance. He is also a member of Progressive Professionals Forum (PPF)
The South African Medical Association (SAMA) has initiated a legal challenge against the National Health Insurance (NHI) Act, claiming it poses a significant threat to the healthcare system.
However, SAMA has yet to clearly articulate its real motives for rejecting the NHI, and their approach appears more rooted in fear of the unknown than in substantive concerns.
Throughout the extensive public consultation processes surrounding the NHI Bill, nearly every province and the overwhelming majority of South Africans supported its enactment.
Yet, SAMA has consistently failed to specify what they fundamentally oppose about the NHI. Their assertions, particularly concerning the administration of user registration, seem alarmist and exaggerated - suggesting that such a process could collapse the entire NHI system is sheer absurdity.
The country already has a comprehensive database of all citizens through the Department of Home Affairs, with advancements in biometric systems that will further enhance the reliability of this system.
The National Department of Health already operates a health patient registration systems (HPRS) and HMS2, which have digitised patient records.
Regulation can ensure a seamless transition of data from medical schemes to the NHI.
Currently, most medical scheme users are subsidised by their employers and enjoy tax credits, meaning their information is readily available.
A simple transition of this information into the national patient database managed by the NHI Fund should not warrant threats of impending collapse or claims that it will take years to achieve. The logic simply does not hold.
Assertions that the handling of complaints about poor service delivery by the NHI Fund as 'wholly inadequate' seems to conveniently overlook the existence of a well-functioning digitised patient complaint system.
Every complaint is directed to the relevant provincial authorities, who follow up with districts and facilities.
This system promotes accountability, ensuring that healthcare facilities address and resolve complaints while keeping the complainants informed.
Certainly, no system is perfect, and a quick look at complaints handled by the Council for Medical Schemes against private medical schemes reveals significant inadequacies in the private sector.
As the Health Market Inquiry noted, there are serious issues regarding information asymmetries, where patients sometimes struggle to understand what their risk pools cover.
The NHI simplifies this by creating a single risk pool that promotes transparency. Regarding their claims about the "lack of clarity" on covered services in the act, it's clear that SAMA misunderstands legislative processes.
Acts inherently provide a broad framework, with finer details defined through subsequent regulations.
Expecting the NHI Act to outline every detail is misguided, revealing an alarming lack of understanding - or worse, a blatant dishonesty in their intentions.
The act clearly states that a Benefits Advisory Committee (BAC), comprised of experts, will be tasked with defining the service package.
The NHI governance regulations have already been published, detailing the BAC's appointment and functions. Instead of constructively engaging with these regulations to improve any perceived flaws, SAMA has opted to rush to the courts in an attempt to undermine legislation that enjoys support from the majority.
Ironically, their concerns about "impossible accreditation standards" are quite rich.
Their leadership seems to suggest that striving for high-quality care is something to be frowned upon.
Yet, they simultaneously lament poor service delivery, which the NHI aims to address and improve through the Office of Health Standards Compliance.
This discrepancy raises questions about SAMA's true intentions. I suspect that SAMA's leadership does not genuinely represent the views of its membership, who will benefit from predictable patient volumes and alternative reimbursement models such as capitation.
There's an undercurrent of an elitist's perspective within SAMA, concerned that the NHI will disrupt certain commercial interests. The growth of universal health coverage - widely supported globally, including by the World Health Organization - poses a threat to those invested in the lucrative private healthcare market.
For these individuals, healthcare must remain a commodity to be exploited for profit. Any noble efforts towards universal access to quality services, based on patient needs rather than financial ability, will be resisted.
Looking beyond the smokescreen, it is evident that SAMA's legal challenge against the NHI is nothing but a tactic to protect commercial interests. It is not a legitimate concern for the quality of healthcare in South Africa.
The NHI represents an important step towards equitable healthcare for every citizen, without risks of financial hardship in accessing services. Efforts to subvert it, particularly through unfounded claims, are neither constructive nor in the public interest.
* Kgaile Mogoye works for the National Health Laboratory Services (NHLS) responsible for National Health Insurance. He is also a member of Progressive Professionals Forum (PPF)