A call for reducing of minister’s powers in NHI

A CALL has been made for the clipping of the powers of the Minister of Health in the anticipated National Health Insurance (NHI) scheme.

Five experts in the fields of health, law and economics have urged Parliament’s portfolio committee on health to amend the National Health Insurance Bill and limit the minister’s powers in the operations of the NHI.

GC Solanki, JE Cornell, S Wild, RL Morar and V Brijlal, attached to institutions including the SA Medical Research Council, University of Cape

Town and the Clinton Health Access Initiative, analysed 82 submissions made by the public on the National Health Insurance Bill.

Their analysis article, published by the SA Medical Journal, detailed the general concerns about the governance powers in the functions of the NHI.

In the pipeline for more than a decade now, the NHI is a health funding system that will allow even the poorest to access private health institutions.

“The central concern of respondents commenting on the role of the Minister of Health was that the Bill vests too much power in the Minister of Health,” wrote the five experts.

They pointed out that the SA Human Rights Commission (SAHRC), among other organisations, was concerned that the NHI’s proposed governance structure concentrates power in the minister.

The proposed governance structure did this by making the board accountable to the Minister of Health and giving the minister powers to appoint and remove members of the board or dissolve the entire board, according to the SAHRC submission.

The Board of Healthcare Funders (BHF) argued that “the Bill gives the minister the power to potentially veto every significant decision that the board can make”, the five experts pointed out.

“This means that the board cannot be held accountable for its decisions. This is contrary to well-established principles of corporate governance. The board must not be able to escape accountability because of a decision by the minister,” said the BHF’s submission.

Stellenbosch University raised the concern that the “extensive powers” assigned to the Health Minister in the Bill may undermine the effective operation of the National Health Insurance Fund.

The Dullah Omar Institute called for Parliament to “play a bigger role in the NHI than currently envisaged”.

Solanki, Cornell, Wild, Morar and Brijlal pointed out the health portfolio committee faced constraints in shifting NHI’s accountability and reporting lines directly to Parliament. The NHI will not be a Chapter 9 institution.

“However, the scope to amend the Bill to devolve more power to the (NHI) Fund, constrain the Minister of Health’s power and/or amend the process for appointments/removals is greater and more feasible, as these changes could be made by relatively minor wording changes to the Bill,” they said.