Here is the abstract:

The National Health Insurance (NHI) Bill seeks to establish universal health coverage in South Africa through a centralized, publicly-funded system. While its aims of reducing inequity and fragmentation in health care access are laudable, this opinion argues that the Bill is unconstitutional in several respects:

First, it concentrates excessive power in the national sphere and Minister of Health, undermining the concurrent provincial functions and cooperative governance principles in the Constitution. Second, the transparency and accountability provisions for the NHI Fund are inadequate, lacking robust Parliamentary oversight, public reporting and independent regulation. Third, the blanket prohibition on private medical schemes offering NHI service coverage unjustifiably restricts freedom of choice and association. Fourth, the intrusive controls on health care providers and facilities unduly infringe freedom of profession. Finally, there are insufficient funding guarantees and needs-based allocation criteria to ensure the progressive realization of the right of access to health care.

To remedy these defects, the Bill requires amendments to: empower provincial governments; strengthen NHI Fund governance; permit limited top-up insurance; revise provider regulations; and entrench an equitable funding model. If reformed thus, the Bill could provide a constitutional pathway to universal health care. But in its current form, it fails to strike the delicate balance the Constitution demands between the NHI’s transformative goals and the web of individual and institutional rights it enshrines.