Now that the National Health Insurance Bill has been passed in the National Council of Provinces on the back of support from eight provinces, the controversial legislation will land in the in-tray of President Cyril Ramaphosa, who must decide what to do next.

The options are limited, but not without significance. According to the Constitution, a President can return a law to Parliament over procedural issues and concerns that it may not meet constitutional muster. Or he can refer the legislation directly to the Constitutional Court for a decision on its compatibility with South Africa's supreme law.

At a media briefing on Wednesday immediately after the National Council of Provinces (NCOP) passed the National Health Insurance (NHI) Bill, Health Minister Joe Phaahla said the legislation would be implemented in stages once it got the presidential nod.

"The passage of the Bill does not close the door on consultations. This is just the beginning... In terms of implementation, all these stakeholders are key. The detail will emerge in regulations, directives and further policy and implementation plans," Phaahla said.

"The implementation of the NHI, the fact that this will be disruptive, I can't deny it, [but] the current situation is not sustainable."

Shortly after Wednesday's NCOP vote, the South African Health Professionals Collaboration called on President Cyril Ramaphosa to refer the NHI Bill back to Parliament for reconsideration. The collaboration represents more than 25,000 private and public healthcare workers from nine medical, dental, and allied...