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Who Really Pays for NHI?
The Citizen
|July 28, 2025
"The state will prevent people from protecting their own families."
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Do you think the working class will not pay for the national Health Insurance (NHI)? As government presses ahead with implementing the plan, you must ask a difficult but necessary question: who will pay the real price?
Contrary to popular belief, it is not the wealthy elite who will be hardest hit but the working class, warns Thoneshan Naidoo, CEO of the Health Funders Association.
"Medical scheme members are often painted as a privileged minority but the truth is very different. Of the 9.1 million South Africans on medical schemes, more than six million (68%) are black and up to 83% of employed members earn under R37 500 per month," says Naidoo.
"They are teachers, nurses, police officers, civil servants and union members, the engine of South Africa's economy. These South Africans make extraordinary sacrifices to secure access to health care. Medical schemes are not luxury products and working families are stretching their disposable income to protect themselves and their families.
"Of the 9.1 million beneficiaries, 4.1 million are employed and form a critical part of the country's taxpayer base."
Government promises that the NHI will provide comprehensive, high-quality care for all – free at the point of service. But at what cost? According to an economic feasibility study by Genesis Analytics, achieving this vision would require personal income taxes to more than double.
Taxes would have to increase to 2.2 times the current average rate and health care would consume 33% of the national budget.
In less efficient scenarios this could mean tripling taxes and health expenditure consuming up to 44% of the budget.
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