Legislation aimed at reforming South Africa’s health system through a controversial national insurance plan was approved by a second parliamentary chamber, which ignored pleas from opposition parties, doctors and business groups to change it.

The National Council of Provinces passed the National Health Insurance Bill at a sitting in Cape Town on Wednesday with backing from eight of the nine provinces. It seeks to ensure all South Africans have access to quality health-care services and provides for the establishment of a fund that will be used to pay for almost all medical treatment from accredited providers, with rates to be set by the state. Private insurers will only be able to pay for products and services that aren’t covered by the fund.