The constitutionality of the National Health Insurance (NHI) Act is being challenged in court, causing delays, but these do not negate South Africans’ constitutional right to healthcare under Section 27. South Africa spends 8.8% of GDP on health, yet 51% goes to the private sector, serving 16% of the population, while 49% serves 84% through the public sector. The NHI aims to address this inequality through a unified healthcare system focused on prevention, wellness and universal access.
Under the NHI, patients will register at accredited public or private facilities, with services provided free at the point of care and providers reimbursed by the Fund. Primary healthcare will use population-based capitation payments, while hospitals and specialists will receive global budgets or diagnosis-related payments. The Office of Health Standards Compliance will ensure common quality standards across both sectors.
Medical schemes will remain voluntary but will provide complementary cover for services outside NHI benefits. Funding will come mainly from general taxation, supplemented by payroll taxes, medical scheme tax-credit reallocations and an income-tax surcharge. Implementation will be phased according to available resources.
The NHI could also create employment opportunities for doctors, community health workers and healthcare businesses, particularly in rural and township areas. Although legal challenges may delay implementation, the author argues that they cannot extinguish the constitutional right to equitable healthcare. Delay is not denial: universal healthcare remains a constitutional imperative. – Daily Maverick (18 October 2026}
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