“With significant legal and logistical uncertainty still surrounding the NHI's implementation, making precipitous changes to the tax system could have unforeseen and damaging consequences for millions of South Africans.” - Business Day(17 October 2025)
This follows the announcement that the Department of Health, in collaboration with the National Treasury, plans to establish thresholds for medical tax credits to redirect the estimated R34bn lost to the fiscus annually, confirming the plan to forge ahead with implementing NHI, despite multiple legal challenges against the Act.
The announcement follows the reassurance of Dr Nicholas Crisp, the Department's Deputy Director-General for NHI that the changes will be gradual, describing the initial steps as “modest changes impacting high-income earners only”.
“The proposal has ignited concerns about overburdening the country's already strained taxpayer base. Personal income tax in SA already constitutes a larger portion of GDP compared to many other developing and even some developed nations.”
According to 2023 figures only R2.8bn of the R25.3bn in assessed medical tax credits was allocated to taxpayers earning over R1m.
Meanwhile, the Board of Healthcare Funders (BHF) reacted that medical tax credits “are a subsidy for the wealthy” as nearly 67% of medical scheme members are from previously disadvantaged backgrounds.