There could be “major battles” when it comes to hashing out the details of SA’s proposed National Health Insurance, says Di McIntyre, a researcher at the health economics unit at UCT.
McIntyre was speaking at the opening of the SA National Health Assembly at the University of the Western Cape this week.
She said while the NHI proposed “universal coverage” for a comprehensive range of health services, major stumbling blocks could already be indentified in the green paper detailing the NHI.
The biggest of these would be how the NHI would be funded.
There is little detail in the green paper about the funding model the Treasury is going to look at and a discussion document,
which should have been released in April, has not yet appeared.
But McIntyre says there are a few funding options.
The first is to increase taxes for employees and employers, and the second is to increase VAT “which will affect the poor much more than it will affect the rich”.
Nehawu deputy general secretary Suraya Jawoodeen agreed that increasing VAT and taxes would have a heavy impact on the poor, while the model they believed the government would take - public-private partnerships - would not be ideal either.
McIntyre said another bone of contention could be that the green paper referred to health care under the NHI being “free at the point of service”, but later also mentioned that users could be required to make co-payments.
The structure of the National Health Insurance Fund, where all the money for services wouldl be pooled, could also become contentious.
McIntyre warned that the model “assumes there is good governance” and, in order to ensure that there was no corruption and fraud in the fund, management would need to be held accountable.
Other issues raised included improving resourcing and addressing huge staff shortages.