We have all heard about the National Health Insurance (NHI) plan for South Africa. Following the release of the Green Paper on National Health by the Department of Health in August 2011, it would be worth while to take stock of the progress made so far, what challenges are still faced, and in what direction we are moving in going forwards.
Financing the NHI
The Minister of Health, Dr Aaron Motsoaledi has been actively engaging with the public across many platforms, including radio, the press, conferences and more. Submissions made by the public in response to the Green Paper are being looked at. The next document due for release is the White Paper. This is eagerly anticipated, as more details regarding the financing behind the NHI needs to be understood. It is anticipated that financing the NHI will come from a one or more of the following revenue streams:
- An additional Payroll Tax to the employers
- An increase in the VAT Rate
- A surcharge on the Taxable Income of individuals
SA Treasury is planning to release a discussion document by the end of April 2012, outlining the government’s proposals for meeting the funding gap for NHI. This has been estimated to run to R6bn for the 2014-15 fiscal year.
NHI Pilot Projects
Funding for the current Pilot Projects has come from the national budget, with R1 billion being set aside for the pilot projects and an additional R1.26 billion donated by the European Union. Additionally, KwaZulu-Natal provincial government has volunteered to pilot a third district from its own budget for which it has earmarked R110 million.
A detailed audit of 94% of all health facilities (3900 completed out of the total 4200) has been conducted, where the following key issues have been evaluated:
- Financial Management
- Cleanliness and infection control
- Safety and security
- Drugs and stock-outs
- Long queues
- Staff attitudes
Following the detailed audit, and the determination of where best the pilot sites will serve the public, based on Socio-economic, Health Service Performance and Financial and Resource Management indicators, the following pilot sites have been identified. The initial phase of the NHI will role out to these areas in April 2012:
- Eastern Cape OR Tambo
- Mpumalanga Gert Sibande
- Limpopo Vhembe
- Northern Cape Pixley ka Seme
- Kwa-Zulu Natal uMzinyathi
- Kwa-Zulu Natal uMgungundlovu
- Western Cape Eden
- North West Dr K Kaunda
- Free State Thabo Mofutsanyane
- Gauteng Tshwane
This will cover just over 10 million people initially.
So where to from here with the NHI?
I believe from what we are seeing, that the NHI is certainly here to stay. It is being rolled out as we speak. The principle behind universal care for all South Africans, regardless of their ability to pay can only be supported by those of us with any sense of humanity. The World Health Organisation has developed guidelines in supporting the principle internationally. There are 16% of us that are able to purchase the healthcare that we require. It is the remaining 84% that the NHI is focussing on. The level of basic care that will be afforded to those who fall into the 84% is yet to be seen. Funding will determine the level healthcare offered, but let us at least offer them cover for basic healthcare, including:
- Children’s vaccines
- Child-health services
- Maternal and reproductive health services
- Laboratory and Blood supply services
- Medicines, cleaning materials, infection control and food services
- Essential equipment, its maintenance as well as infrastructure maintenance
These have all been described as Non-negotiables by the Minister of Health, and are to be protected against under-funding.
So what can the private sector do to embrace and support the NHI?
- Re-engineer the way you think about healthcare – Prevention and Promotion, RATHER THAN Curative and Hospi-centric
- Explore alternative reimbursement models – we may see a shift from the standard fee-for-service model to a capitated fee for example
- Prepare yourself for more regulation in the pricing of private healthcare
- Explore ways in which you can partner with, and engage in the NHI
Remember the Gautrain. Remember the World Cup stadiums. Remember the New South Africa. A lot more can be achieved than we give ourselves credit for.
Be a part of the process. Be realistic. Be positively realistic!