NHI needs a decade and can’t work as written

Adrian Gore has been one of the most constructive voices on South Africa’s National Health Insurance debate for years. At Discovery’s half-year results presentation this month, he was also one of the bluntest.

The Discovery Group CEO said the NHI, in its current structure, requires a decade or more to reach any meaningful state of maturity, and that the premise underpinning its near-term implementation is simply not grounded in reality. “The idea that NHI is functional and people can walk into any private hospital is not realistic. We don’t have the healthcare, we don’t have the resources, we don’t have the doctors. It cannot be done,” Gore said.

His remarks came against the backdrop of a scheme that has been signed into law but not yet promulgated. President Cyril Ramaphosa and Health Minister Aaron Motsoaledi have agreed not to implement any sections of the NHI Act until the Constitutional Court rules on two pending cases challenging the legislation’s parliamentary process. The pause has created a window for what Gore described as a more rational conversation about how to make universal healthcare achievable.

Gore acknowledged that litigation is not the only front on which the NHI is being contested. “There are court cases going on,” he said. “At a higher level there is a real willingness in the private sector and government to find ways to make it work. The reality is that as a country, we don’t have sufficient resources to offer that kind of healthcare. It will take time, but there is enough space and enough good debate to find solutions.”

The core problem, which Gore has articulated consistently over several years, is structural. The NHI in its current form lacks a credible funding model, a viable implementation plan, and the institutional capacity to absorb and manage the private healthcare system it seeks to bring under centralised control. Without those foundations, the scheme cannot deliver on its promise of comprehensive universal coverage, regardless of political will.

Gore said he is increasingly optimistic that a rational outcome is possible, noting a shift in tone from government toward genuine engagement with the private sector. Discovery has positioned itself not as a litigant but as a potential partner, pushing for amendments that would allow medical aids to operate alongside the NHI rather than be displaced by it. The company has specifically argued for changes to section 33 of the Act to create a more flexible framework for private-sector inclusion.

For Gore, who founded Discovery in 1992 with the explicit goal of making people healthier, the NHI debate is not simply a regulatory threat to manage. It is, he has argued repeatedly, a missed opportunity for South Africa to build something more pragmatic, more fundable, and more capable of actually extending quality healthcare to the millions currently outside the private system. The question, as things stand, is whether the space he sees for good debate will translate into the structural reform the scheme so evidently needs.