10. Conclusion

Covid-19 and its associated interruptions to normal political processes decelerated parliamentary processes around the NHI Bill. The pandemic has also shown the importance of a high-quality, accessible health system that provides care to everyone who needs it. For the foreseeable future, South Africa’s public funding for health is likely to be constrained by a tough fiscal environment. The political pause, together with a dramatically changed context, provides an opportunity to reconsider the UHC policy pathway that would work best for South Africa.

This cost modelling highlights that many of the policy objectives underpinning NHI as Described in the Bill can be achieved by other lower-cost and higher-quality (i.e. better value) UHC policy pathways. The selection of policy options should not only be about money, but also about service delivery design. Services and the way they are delivered drive both costs and patient outcomes over the longer term.

The imperative for economic growth and employment growth is evident when we take a long-term perspective and consider how best to achieve health-system objectives within fiscal constraints. An expansion of the economy will permit much-needed investment in the health system, whilst employment growth will allow for a more robust tax base to enable income cross-subsidies and sustainable social solidarity.

Should the wrong path be taken, system choices made now are likely to lead to unsustainable costs over the longer term. If the goals of UHC are considered relative to how they can be achieved with other policy trajectories, it should be evident that NHI as Described in the Bill is not South Africa’s only option for achieving policy objectives. There are other choices available that provide stronger governance, better quality, and a choice to South Africans, who deserve accessible, affordable and high-quality care when needed.