NHI white pa­per sketchy on cost to SA tax­pay­ers

CityPress - - News - ZINHLE MA­PUMULO zinhle.ma­pumulo@city­press.co.za

The Na­tional Health In­sur­ance (NHI) white pa­per has fi­nally been re­leased, and ev­ery South African now has a chance to go through it and sub­mit com­ments.

The pa­per, re­leased on Fri­day by Health Min­is­ter Aaron Mot­soaledi, lays the foun­da­tion for mov­ing to­wards uni­ver­sal health­care cov­er­age, which aims to give ev­ery­one ac­cess to de­cent med­i­cal ser­vices, ir­re­spec­tive of whether they are rich or poor.

How­ever, many were ex­pect­ing that the 90-page doc­u­ment would pro­vide clar­ity on how the NHI would be fi­nanced and how much would be needed to run this am­bi­tious plan.

The white pa­per, how­ever, con­tains very lit­tle about how much it will cost tax­pay­ers to fi­nance it. The only fig­ure men­tioned is R256 bil­lion by 2025. This is the same fig­ure that was quoted in the green pa­per pub­lished five years ago.

How will the NHI be fi­nanced?

Mot­soaledi said it was dif­fi­cult to pro­vide an ex­act fig­ure of how much it would cost to fi­nance the NHI as that de­pended on the pub­lic health sys­tem im­prove­ments and med­i­cal scheme reg­u­la­tory re­forms.

How­ever, he said: “The cost of the NHI is in our hands. It will cost what you de­sire it to be.”

It is clear from the NHI white pa­per that the South African pub­lic will fi­nance it. Four po­ten­tial sources – di­rect tax­a­tion (taxes on in­come and wealth), in­di­rect tax­a­tion, pay­roll tax­a­tion (typ­i­cally col­lected from em­ploy­ers and em­ploy­ees) and pre­mi­ums (mem­ber­ship con­tri­bu­tions) – have been listed as op­tions for fund­ing the NHI.

The white pa­per in­cludes five pos­si­ble sce­nar­ios of tax im­pli­ca­tions to fund NHI, one of which is a 4% sur­charge on tax­able in­come by 2025.

There is a sec­tion that breaks down the cur­rent ex­pen­di­ture in both the pri­vate and pub­lic health­care sec­tor, which stretches from the na­tional health bud­get, de­fence de­part­ment, cor­rec­tional ser­vices de­part­ment, Road Ac­ci­dent Fund (RAF) and med­i­cal aid mem­ber con­tri­bu­tions to out-of-pocket pay­ments by med­i­cal aid mem­bers.

Mot­soaledi said all this money would be pooled to­gether to fund the NHI, but he was care­ful not to say whether the to­tal would be enough.

“We be­lieve there is a lot of money for health­care in South Africa, but it’s all sit­ting in dif­fer­ent places. Some of it is in the mil­i­tary, RAF and other ar­eas.”

Ac­cord­ing to the white pa­per, the South African health ex­pen­di­ture in the cur­rent fi­nan­cial year sits at R377 bil­lion. In the 2011/12 fi­nan­cial year it was R263 bil­lion, which was just above what the gov­ern­ment es­ti­mated in 2010 that the NHI would cost.

Dr Humphrey Zok­ufa, ex­ec­u­tive di­rec­tor of the Board of Health­care Fun­ders, said these fig­ures showed that South Africa could af­ford the NHI. “What needs to be done is for Na­tional Trea­sury to pool all the money to­gether be­cause right now it is all over the place and not be­ing used cor­rectly,” he said.

What you should know about the NHI

The NHI is the fi­nance sys­tem de­signed to pool to­gether funds in an ef­fort to pro­vide qual­ity health­care ser­vices to all South Africans based on their needs and ir­re­spec­tive of their in­comes.

It will work in a sim­i­lar way to med­i­cal schemes, in that pa­tients will go to ac­cred­ited doc­tors and hospi­tals with­out pay­ing up­front, and the NHI Fund will re­im­burse doc­tors and hospi­tals for the ser­vices they pro­vide.

The NHI sys­tem will be im­ple­mented in dif­fer­ent phases over the en­su­ing years and it is ex­pected to be up and run­ning by 2025.

The NHI will pro­vide com­pre­hen­sive per­sonal health ser­vices. How­ever, it would not cover ev­ery­thing for ev­ery­one, Mot­soaledi said. He did not re­veal what the NHI would cover. Ser­vices, he said, would range from the low­est level of care to spe­cialised care.

Con­tri­bu­tions to the NHI Fund will be com­pul­sory, but those who want top-up cover will have an op­por­tu­nity to pay for it them­selves.

Aaron Mot­soaledi

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