Some details of the proposed National Health Insurance scheme have finally been revealed on the ANC website. The full article can be read here. The official document is still doing the red tape rounds in government circles and it is not sure when it will be released.
Herewith extracts from the article which was dubbed a “Robin Hood” approach in Sake24 - the term taking from the rich and giving to the poor being replaced with "social solidarity". This is the second instance where it is proposed that current tax incentives be removed or reduced, then using the additional tax revenue to fund the poor (the other example being capping of RA contribution tax deductions).
WHAT IS THE NATIONAL HEALTH INSURANCE?
The broad objective of the NHI is to put into place the necessary funding and health service delivery mechanisms, which will enable the creation of an efficient, equitable and sustainable health system in South Africa. It will be based on the principles of the right to health, social solidarity and universal coverage.
WHO WILL FUND THE NATIONAL HEALTH INSURANCE?
NHI will be funded through a combination of current sources of government health spending, including the removal of tax subsidy for medical schemes and a modest mandatory or compulsory contribution by employer-employee contribution which will be split equally.
Contribution will be less than what members and their employers currently pay to medical schemes. Certain categories of workers, due to their low-income status, will be exempted from the contribution. All these funds would be placed in a single pool that would be available to fund all health care in the public and private health sector under conditions that would apply to all health care service providers.
WHAT THEN ARE THE KEY FEATURES OF NHI?
The National Health Insurance will:
Create a publicly administered and publicly funded National Health Insurance Fund (NHIF). The NHIF will be a single-payer fund that receives funds, pool resources and purchase services on behalf of the entire population.
Expand health coverage to all South Africans. This means there will be no financial barrier to access health care. All South Africans will be equally covered to access comprehensive and quality health care. Health services covered by NHI will be a free at the point use - no upfront payment will be required by the doctor or hospital.
Provide comprehensive coverage of health services. South Africans will be entitled to a comprehensive range of health benefits, including primary care, inpatient and outpatient care, dental, prescription drugs and supplies. The services will be provided on a uniform basis at all health facilities.
Publicly and privately delivered health care. NHI will be simply a financing system, with government collecting and allocating money for health care. Health care is provided by private and public sectors but paid for publicly by NHIF. To ensure improvement in quality standards, all providers will be accredited before NHI funds them.
Social Solidarity: Services delivered based on need rather than on ability to pay. In this case, coverage by NHI will not be interrupted and will be equal to everyone, thus ending the dependency of health on access upon employment status. Social solidarity also means those who can afford to pay for health care will subsidise those who cannot afford to pay.
Save enough on excessive administrative costs that characterize the current multi-payer medical scheme system, thus requiring no increase in total health care spending as a percentage of GDP.
Control costs through cost-effective payment methods through negotiated capitation methods for doctors, global budgeting for hospitals and bulk purchasing of drugs and supplies.
There can be few reasonable people who do not wish this project the best of luck, given the conditions which the poor have to face in most public healthcare facilities, and the problems encountered by healthcare practitioners in these facilities.
I am always skeptical when I hear expressions like "...a modest mandatory or compulsory contribution..." We all know that it takes one stroke from a Minister's pen to delete the word "modest" from that sentence. Given the government's track record over the past 15 years, it appears to be wishful thinking for them to suggest that they will save through reducing administrative costs when we have seen the opposite happen since 1994.
Of concern for us is how the implementation of the NHI will impact on the provision of private healthcare; it is an old negotiation trick to start off with totally unreasonable demands, after which any concession is used to soften up the opposition.
A FIA delegation has secured an appointment with the Deputy Minister of Health on 20 August. They will be well aware of this, and we trust that they will meet with a receptive ear for the future of advisors in this field.