ANC aims to implement NHI in 2012
South Africa’s National Health Insurance (NHI) will kick off in 2012 and be implemented over a period of 14 years, African National Congress (ANC) health sub-committee chairperson Zweli Mkhize told journalists at the ANC national general council (NGC) in Durban on Tuesday.
The second media briefing of the day at the ruling party’s mid-term conference tackled the party’s controversial plan to provide universal and compulsory access to healthcare for all South Africans. While the details have long been hazy, members of the ministerial advisory committee made some specifics available from the discussions they’ve been having since late last year.
A funding model for the expensive plan has tentatively been put in place, in agreement with the national treasury, said Dr Olive Shisana, the CEO of the Human Science Research Council who chairs the ministerial advisory committee on the NHI.
“The ministerial advisory committee, together with treasury, is exploring several options on how to fund the NHI,” she told journalists. These included:
- A surcharge on taxable income
- Payroll taxes for employees and/or employers
- An increase in value-added tax (VAT), dedicated to the NHI
- Removal of the tax credits that currently exist with regards to medical aids.
Critics have slammed the affordability of the plan, but the proposal says that the NHI will cost less than public and private health-sector spending combined. Mkhize said that the figures the private sector had arrived at were not the same because of the private sector’s elevated costs. “We believe things can be done cheaper than what they are doing,” he said.
It is a view that other stakeholders have agreed with, with the latest research from the University of Cape Town’s Health Economics Unit finding that spending on the NHI would roughly match what is currently spent on healthcare.
Mkhize said on Tuesday that preliminary calculations put the increase at just 2,5%, from 12% to 14,5% of the budget.
The project’s first phase in 2012 would see a roll-out to areas with very little access to quality healthcare.
In addition the proposal, which will be discussed by delegates at the NGC in closed sessions, will in the first phase:
- Create a national health fund—“operating like Sars” and situated within the Department of Health.
- Revitalise the country’s crumbling public health infrastructure
- Introduce quality improvement and assurance programmes, and
- Develop human resources programmes, after an acknowledged 10-year gap in this area under the reign of former health minister Manto Tshabalala-Msimang from 1997 to 2007. “There is a shortage of 80 000 health workers that should have been appointed during that period,” said Shisana, while steering clear of apportioning blame for the crisis of healthcare workers in the country. Fixing this will include scholarship programmes and possibly bringing in foreign health workers.
The details discussed focused on primary healthcare, which Mkhize said was the core of the NHI. But the plan is to provide a “comprehensive cover of health services—primary, secondary, tertiary and quaternary [high-care services]”.
The Mail & Guardian has previously reported that South Africa spends just more than 8% of GDP on healthcare, more than any other country on the continent. This is more than most upper middle-income countries and similar to some high-income countries.
Electronic record-keeping has the potential to revolutionise healthcare, and Shisana said the committee was investigating low-cost and successful options such as that used by Singapore.
Singapore has been developing its e-health system for years and at low cost, yet it has no plans to implement the system for at least 10 years. The city-state spends 4,1% of GDP to insure all five million of its inhabitants. The government covers 80% of the total bill in acute care hospitals and patients pay the rest through a medical savings scheme.
In contrast, though 64% of South Africans rely exclusively on the public health sector, most of the money spent on healthcare in South Africa is spent through private sector.
‘We welcome your contributions on this matter’
A point raised repeatedly during the briefing is that richer South Africans would be able to continue using private healthcare at an additional cost, should they wish to do so. However, this would be in the form of private hospitals, which would opt out of the NHI funding and regulation plan.
Patients would not be able to choose their hospital under the NHI plan, but would be referred via a primary healthcare clinic.
The document will now be taken to delegates at the NGC to debate. Committee members were confident the plan would be approved, given the political will and enthusiasm from the organisation on the matter. “This is not the first time we are briefing the ANC on this matter,” said Mkhize.
But ANC spokesperson Jackson Mthembu emphasised that the organisation was open to input from all stakeholders.
“If there is one organisation that likes to have people involved in what it does, that’s the ANC. We welcome your contributions on this matter,” he said, adding mischievously to the gathered journalist: “Like we welcome your contributions on any matter, including the [media appeals] tribunal.”