The World Health Organisation has advised the Department of Health not to focus on the cost of universal health coverage but to implement it in manageable phases, starting with providing services to the most vulnerable population groups, Minister Aaron Motsoaledi said this week.
Motsoaledi was speaking at a Leader’s Angle briefing in Cape Town organised by the University of Stellenbosch Business School, where he laid out the objectives of the National Health Insurance (NHI) and how it would be implemented.
In June, the government gazetted the National Health Insurance Bill and the Medical Schemes Amendment Bill, which are aimed at overhauling the country’s health system, bridging the gap between private and public health care, and introducing regulations for the private health care sector.
Motsoaledi said the NHI was a health financing system that pooled funds to provide all South Africans, irrespective of their socio-economic status, with access to quality health services. He said the creation of the NHI was necessitated by the exorbitant cost of health care in the country, and was an attempt to ensure the provision of the same quality health care to all citizens. “I often get asked, can we afford the NHI? but the question should be, can we afford not to have NHI?” the minister said.
He equated the comments made about the cost of the project to those that had been made about the cost of providing antiretroviral drug treatment to HIV-positive patients, saying, “If we had focused on the cost of the provision of ARVs, we would still be calculating to this day”.
Motsoaledi said other countries spent on average 5% of GDP on health care but South Africa spent 8.7%, including expenditure in the private and public sectors. The country’s private sector spent 4.5% of GDP on health care in the provision of care to 16% of the population while the public sector spent 4.2% of GDP providing care to 84% of the population.
Motsoaledi said an NHI Act would open the way for the establishment of an NHI Fund, which would be used to cover the health costs of those who were not insured with medical schemes. Those covered by health schemes would receive their primary health-care benefits through the NHI, and their schemes would provide complementary cover to pay for advanced or specialised care.
“Primary health care is at the centre of the NHI. We are moving away from using a specialist for something that can be treated by a GP,” he said.
During the implementation phase priority would be given to groups within the uninsured part of the population, including pupils, women who were pregnant and those with other “women’s health issues”, the mentally ill, the elderly and people with disabilities.