IDCPPA Research Seminar - 20th August 2026 - Jesse Zhou - The Architects of Dysfunction: Private Sector Framing and the de- legitimisation of NHI

You are kindly invited to the IDCPPA Research Seminar on 

Thursday, 20 August 2026, 14:00 – 15:30 SAST.

CSSR Seminar Room 4.29

Robert Leslie Social Sciences Building

University of Cape Town

Please request a video link if you wish to attend online. 

Speaker

PhD Student Jesse Zhou 

University of Cape Town, Sociology Department

The Architects of Dysfunction: Private Sector Framing and the de-ligitimisation of the NHI

Abstract: 

This presentation addresses the sub-research question: how do interactions between private-sector stakeholders and the state, represented by Parliament’s Portfolio Committee on Health, during the National Health Insurance Bill (NHIB) public hearings tell us about the nature of state–business relations in post-apartheid South Africa? Drawing on stakeholder submissions and parliamentary proceedings, the presentation shows that private sector stakeholders deployed a deliberate framing strategy, invoking language such as “fixing the public sector,” the “skills exodus,” and the constitutional right to choose healthcare providers to challenge the state’s capacity to deliver healthcare and, simultaneously, to justify calls for delaying the NHIB. The private sector further sought to amend Section 33 of the NHIB to allow existing private sector arrangements to continue unaffected, while threatening judicial recourse should Parliament refuse. The state, in turn, countered with its own narrative, portraying the private sector as profit-driven and exclusionary of the poor, which produced visibly hostile exchanges within the Committee. This state narrative largely rested on the premise that opposition to the NHIB amounted to opposition to universal health coverage (UHC) and, by extension, to the inclusion of the poor.

Drawing on Handley’s (2005; 2008) account of business–state relations, the presentation affirms that the tensions and hostility between the state and the private sector persist and are manifested in the NHIB public-hearing process. However, this does not mean that the private sector is powerless to resist state imposed policy such as the NHIB that would completely change the landscape of the private medical aid industry. Rather, the country’s constitution became the weapon of the private interest, together its high degree of concentration among a few dominant players, provides the private sector the leverage to defend the status quo even in the face of state opposition. The chapter thus positions the NHIB hearings as a site where competing framing strategies translate into a broader struggle over the post-apartheid state’s capacity to discipline concentrated private capital.

Bio: 

Jesse Zhou is a PhD candidate at UCT. Jesse’s work focuses on the politics of healthcare reform in South Africa. My doctoral research examines the implementation of National Health Insurance (NHI) and the influence of sectoral interests on the development of Universal Health Coverage. Drawing on business state relations perspective, his research explores how political, economic and institutional interests shape health policy and the distribution of power within South Africa’s healthcare system.