Minister of Health Dr Aaron Motsoaledi and Finance Minister Pravin Gordhan brief the media at the GCIS in Pretoria on the release of the Green Paper on National Health Insurance. Photo: Chris Collingridge
Minister of Health Dr Aaron Motsoaledi and Finance Minister Pravin Gordhan brief the media at the GCIS in Pretoria on the release of the Green Paper on National Health Insurance. Photo: Chris Collingridge

Experts examine NHI draft

By Marianne Merten Time of article published Aug 13, 2011

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Though it is expected to cost R214 billion by 2014 – more than double the current health expenditure – details of what exactly will be on offer under proposed benefits of the national health insurance (NHI) remain vague, while contributions will be mandatory for most working South Africans.

The NHI Green Paper, released on Friday, makes it clear cosmetic surgery, like botox and liposuction, and expensive spectacle frames would be excluded, as would treatment of anyone who did not go through the referral system.

But details yet to be fleshed out include:

* The income threshold above which contributions will be mandatory;

* What treatment packages would be available at which hospitals or clinics;

* Funding models for the NHI, although it is expected it would draw on individual and employers’ contributions and the national coffers;

* The actual role of private health care providers contracted to deliver services.

This week Health Minster Aaron Motsoaledi again emphasised the NHI was “not a war between the public health sector and the private health care sector – not even a competition or a beauty contest”.

While the public health sector must be urgently improved and costs in private health care reduced, he said, both were needed to make the NHI viable.

The Green Paper argues South Africa’s health spending – at 8.5 percent of gross domestic product – is already significantly up from the World Health Organisation’s recommended 5 percent, but still without the related health benefits, as HIV/Aids, tuberculosis, maternal and child mortality and road accidents and violence take a heavy toll.

Although funding models put NHI costs at R214bn in 2014, rising to R255bn in 2025, the Green Paper argues it is important to include private health spending in any cost modelling.

Currently, the health budget is R110bn, excluding separate spending by the Defence and Correctional Services departments, but almost as much, R90bn, is spent on medical aid scheme contributions.

This means South Africa spent R227bn on health last year. Thus, the Green Paper argues, the estimated NHI costs are comparable and affordable.

Those in the health field – from the South African Medical Association (Sama) representing doctors, the Board of Healthcare Funders (BHF) representing most medical aid schemes and the Hospital Association of South Africa (Hasa), which represents 97 percent of private hospital beds – said this week they were keen to participate in the unfolding public comment and consultations.

The hospital association will discuss the Green Paper in detail with its members next week. “We look at it as an opportunity – not only a business opportunity – but an opportunity to open access (to health care) to people who previously had no access,” said Hasa chairman Nkaki Matlala.

Sama chairman Norman Mabasa said doctors, 70 percent of whom worked in the private sector, were key. “If we want to improve people’s access, we can’t do that if there are no doctors to see them…” he said.

The BHF said it supported universal access to health care. “There’s a lot of expertise and infrastructure in the private sector,” said board spokeswoman Heidi Kruger, adding it was a matter of engaging.

“At this stage we are still engaging with (the Green Paper) and how the department sees our role,” said Aleksandra Serwa, spokeswoman for the Council for Medical Schemes.

In the making for eight years, moves towards the NHI accelerated after last September’s ANC national general council resolution in its favour. During his budget speech earlier this year, Motsoaledi said the NHI was definitely on its way, as South Africa’s skewed two-tier system needed to be re-engineered.

Just 8.2 million South Africans have private medical cover – battling with above-inflation medical aid premium increases for the past few years and spiralling hospital and specialist fees – while 84 percent of the population rely on the public health sector.

Motsoaledi said discussions were under way to get private health care providers around the table to discuss price setting. However, this has yet to take shape, as the Competition Commission and its principal, Economic Development Minister Ebrahim Patel, must give the go-ahead for an exemption so discussions would not be regarded as anti-competitive.

But the NHI is not without controversy: opposition political parties and many economists have said the mandatory contributions would effectively introduce another tax; Cosatu expressed concern about the role of private health providers in a state-funded scheme and health lobbyists worried about the NHI’s autonomy, given it would report to the Health Minister and Parliament.

Everyone, including the government, points to the appalling state of public hospitals and clinics where staff and equipment are in short supply and infrastructure often filthy and crumbling.

* Meanwhile, the South African National Aids Council (Sanac) on Friday approved the roll-out of anti-retroviral treatment to those with a CD4 count of 350 or less. Previously, the threshold was a CD4 count of 200, which many in the health field described as too late for effective intervention.

The meeting in Bloemfontein, chaired by deputy president Kgalema Motlanthe, announced that 13.7 million South Africans had been tested for HIV/Aids as part of the government’s push to reach 15m.

Also, Sanac approved the first draft of the national strategic plan on HIV/Aids, TB and sexually transmitted infections for public release and comment next week. - Saturday Star

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