The National Education, Health and Allied Workers’ Union [NEHAWU] welcomes the judgment by the Pretoria High Court ruling against the Board of Healthcare Funders [BHF] and its proposal for Low-Cost Benefit Options [LCBOs] as an alternative to the National Health Insurance [NHI].
The so-called LCBOs were marketed as an affordable medical aid option for low-income earners, but in reality, they represent a step backwards in the quest for universal, equitable healthcare. These stripped-down benefit packages would have excluded the Prescribed Minimum Benefits [PMBs] — a core set of essential healthcare services that all medical schemes are legally required to provide under the Medical Schemes Act. Excluding PMBs would not only have contravened the law but also reversed years of progress in expanding access to necessary healthcare services through the regular review and improvement of PMBs.
The BHF’s proposal effectively sought to create a two-tier health system that entrenches inequality by offering second-rate healthcare to the poor while preserving high-quality care for the affluent. This undermines the principles of Universal Health Coverage [UHC], which is based on solidarity — where the healthy subsidize the sick, and the rich contribute toward the care of the poor. Introducing a separate benefit option for low-income earners is not only discriminatory, but it dilutes the cross-subsidisation model that lies at the heart of a fair and effective health system.
The High Court ruling validates NEHAWU’s longstanding position: it is impossible to realise UHC without pooling all healthcare resources and providing services based on health needs rather than income levels. Segregating healthcare access by income is both unjust and inefficient. It leads to medical schemes competing on the basis of benefit options rather than service quality or health outcomes, further disadvantaging the poor and entrenching preventable health disparities.
The reality is that without the implementation of the NHI, South Africa will remain trapped in a fragmented and deeply unequal healthcare system. The NHI offers the only viable path forward — a system grounded in social solidarity, equitable access, and value-based care that prioritises the health needs of the population, not their ability to pay.
It is time to abandon outdated models that commodify healthcare and instead commit, unequivocally, to building a unified, inclusive healthcare system that serves all who live in South Africa.
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Issued by NEHAWU Secretariat.
Zola Saphetha (General Secretary) at 082 558 5968; December Mavuso (Deputy General Secretary) at 082 558 5969; Lwazi Nkolonzi (NEHAWU National Spokesperson) at 081 558 2335 or email: lwazin@nehawu.org.za
