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NHI funding model far from decided

By Londiwe Buthelezi Time of article published Jul 25, 2013

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Johannesburg - The government’s launch of the National Health Insurance (NHI) programme, scheduled for next year, may be delayed as the pilot districts still have boxes to tick, with only 125 out of 556 primary health-care facilities ready to contract with private doctors.

The Department of Health initially intended to start rolling out the NHI system in 2014, but the director-general, Precious Matsotso, has indicated that next year was likely to be a period for the piloting of the NHI funding model.

The model, which is central to the success of the NHI system, was not piloted during the initial programme.

Matsotso said discussions on the NHI funding had only begun yesterday with the National Treasury and the department was proposing that the funding model be piloted in the next financial year.

“But the source of revenue is an area that we want to leave in the hands of Treasury specifically, because with the current macro-economic environment, Treasury has to juggle between what is available and what is not,” Matsotso said.

The health-care outcomes facilitator at the Department of Performance Monitoring and Evaluation, Thulani Masilela, said the department was recommending a model that would not require poor communities to pay.

“There is one thing in the literature of universal coverage that is seen as the least progressive and that is out-of-pocket expenditure. We believe that it should not be encouraged and the department agrees with us,” Masilela said.

Apart from the funding challenges, Matsotso said there was high optimism that the NHI system could be rolled out to other districts but this was not possible in the existing environment. The district health authorities needed a revamp and these authorities required their own budgets and the power to execute plans.

At the moment, no district health authorities have been appointed under the NHI pilots and only four of the 10 districts have appointed NHI project managers. Only three districts had refurbished all their hospitals in the 12 months of the NHI piloting period.

However, most districts had used a major portion of their NHI conditional grants. Even the Pixley ka Seme district in the Northern Cape, which did not refurbish any hospital in the year to March, had exceeded its NHI grant, spending 114 percent of it.

The parliamentary portfolio committee on health said it was surprising that a district could use up its entire conditional grant without delivering a single hospital.

The department has managed to contract 300 general practitioners but it will only place 125 doctors as the majority of the primary health facilities are not ready. Matsotso said 39 more facilities would have been ready if they did not have staff shortages.

At the beginning of the pilot programme in April last year, the department had targeted to contract 600 private medical practitioners to provide services to the NHI pilot districts.

Matsotso said the department found it difficult to attract anaesthetists and another model had since been proposed which relied on using anaesthetist nurses instead.

“Of the specialists, we have 170. If we move them from hospitals to districts we’ll create a gap in hospitals and you don’t want to create that gap,” Matsotso said.

Alex van den Heever, the chairman of social security at Wits University and a health economist, said the NHI pilot programme was unlikely to achieve the intended outcomes even if the district health authorities and NHI project managers were appointed on time, because the pilot was not testing the crucial aspects of universal health-care coverage.

“From the pilot design itself, it’s not clear that they are testing things that are required to set up such an authority. It does not talk to the governance model, how they’ll integrate private and public providers,” he said.

On the funding model, Van den Heever said the government should open a public debate and this should not only be the Treasury’s determination. - Business Report

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