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President signing of NHI on 15 May 2024

President signing of NHI on 15 May 2024

You will have heard that President Cyril Ramaphosa intends to sign the National Health Insurance (NHI) Bill on 15 May 2024. To keep you fully informed, I wanted to share some important points on this matter.

While it is disappointing and unfortunate given the significant technical and constitutional flaws in the NHI Bill and in the legislative processes for adopting the Bill, it is not unexpected. We are therefore well-prepared and have a clear roadmap forward, remaining firm in our stance.

Discovery’s position on the NHI is clear and consistent: we unequivocally support universal health coverage and believe that a workable NHI is central to achieving this. In its current form, the NHI Bill is unconstitutional and unfeasible without private sector collaboration and broader funding sources. We remain strongly of this view and will continue to advocate for an NHI that is viable and to the benefit all South Africans.

No impact on medical schemes for the foreseeable future

Despite the Bill being passed, full implementation remains a long way off – several years at least, likely decades. In the interim, medical schemes and the private healthcare sector will continue to operate as always, without any changes to Discovery Health or the medical schemes administered by Discovery Health. In other words, there will be no impact on medical scheme members or healthcare providers across the health system.

Section 33 of the NHI Bill notes that only once the Bill is ‘fully implemented’ will medical schemes be limited to providing ‘complementary cover to services not reimbursable by the NHI’. The timeframes for ‘fully implemented’ are not clear and the benefits that will be provided by NHI are not defined. Without clear timeframes and unless the NHI provides benefits similar to those offered by medical schemes, medical schemes will continue to play a significant role in the healthcare system in the long-term.

Implementation is many years away

The NHI is an inordinately large and complex initiative that proposes unprecedented reforms to the health system, including extensive reorganisation of the public health sector. Considerable planning and preparation is required before it can be implemented.

Critically, the largest barrier to implementation of a workable NHI is funding. There is no funding plan yet and given the country’s constrained fiscal position, low economic growth and narrow tax base, this can only be solved in the longer term. We unfortunately see no scenario in which there is sufficient funding for a workable and comprehensive NHI in its current form – hence our conviction that private sector collaboration is vital, and the role of medical schemes will remain significant going forward.

Significant flaws in the Bill and the legislative processes followed in promulgating the Bill, will also likely result in the Bill being challenged on numerous fronts, leading to likely delays.

The way forward

Discovery remains committed to fact-based and constructive engagement but also to defending the rights of medical scheme members and healthcare consumers in South Africa.

It is understandable that the President’s signing of the NHI Bill may cause some uncertainty. However, with full implementation a long way out and many matters still to be navigated, it is important to maintain perspective.

Since 2011, Discovery has focused on constructive and collaborative engagement with our partners in government, business, and civil society through every step of the NHI legislative process. We remain committed to this analytical and fact-based approach but also to defending the rights of medical scheme members and healthcare consumers in South Africa wherever this may be required.

We will continue to stand proudly by our healthcare partners and providers across the health system. We will also ensure that members of Discovery Health administered medical schemes continue to have access to the outstanding healthcare services across the system. Finally, we will continue to invest in both the public and private healthcare systems, for the good of all our country’s people.


Ron Whelan
CEO of Discovery Health