South African private hospitals challenge National Health Insurance Act in court

SOUTH AFRICA – In February 2025, the Hospital Association of South Africa (HASA), representing major private healthcare providers such as Life Healthcare, Netcare, Mediclinic, and independent groups like Lenmed and Joint Medical Holdings, initiated legal proceedings against the National Health Insurance (NHI) Act.

HASA contends that the NHI Act is unconstitutional, financially unviable, and could disrupt citizens’ access to healthcare services.

The association’s primary concern is that the NHI Act infringes upon Section 27 of the South African Constitution, which guarantees every citizen the right to access healthcare services.

HASA argues that the government’s failure to conduct a recent financial feasibility study on the NHI’s implementation costs raises doubts about the scheme’s affordability and sustainability.

Melanie Da Costa, Chairperson of HASA, expressed the association’s commitment to constructive engagement, stating, “As an organisation, we have always preferred to resolve matters through dialogue, and we believe that effective healthcare solutions are urgently needed and achievable through a reasonable and collaborative approach.”

HASA’s decision to pursue legal action follows the government’s lack of response to several constructive and practical proposals, including those from Business Unity South Africa (BUSA).

The association remains open to engaging with the government to find sustainable solutions for universal health coverage.

The legal challenge by HASA adds to the growing opposition to the NHI Act from various healthcare associations.

The Universal Healthcare Access Coalition (UHAC), comprising 28 signatories, including the South African Medical Association (SAMA), the Progressive Health Forum, and the South African Private Practitioners Forum, has proposed alternatives to the NHI to improve healthcare quality and affordability.

UHAC argues that its reforms are more feasible and cost-effective than the current NHI scheme and could enhance the healthcare system within three to five years, compared to the decade or more anticipated for the NHI’s full implementation.

Despite these concerns and legal challenges, President Cyril Ramaphosa’s administration has shown no indication of reconsidering its stance on the NHI.

The government maintains that the NHI is essential for achieving universal health coverage and addressing disparities in the healthcare system.