Cov­er­age for all

Gord­han an­nounced the im­mi­nent es­tab­lish­ment of a na­tional health in­sur­ance fund as he al­lo­cated R606bn over the next three years to the ail­ing health sys­tem

Financial Mail - Investors Monthly - - Budget 2017 - Michelle Gumede gume­dem@busi­

Na­tional health in­sur­ance (NHI) is fast mov­ing to­wards a re­al­ity, with trea­sury an­nounc­ing that an NHI fund will be es­tab­lished this year as the coun­try heads to­wards the next phase of pro­vid­ing univer­sal health cov­er­age.

While the white pa­per on the NHI is still be­ing re­vised and fi­nalised, trea­sury and the health de­part­ment are work­ing on a sus­tain­able long-term fi­nan­cial frame­work.

The fund aims to im­prove ac­cess to ser­vices such as ma­ter­nal health care, wheel­chair ac­cess, fam­ily plan­ning and men­tal health care. Ini­tially it will also serve to ex­pand school health-care pro­grammes.

Fi­nance min­is­ter Pravin Gord­han said that, in set­ting up the fund, trea­sury will weigh all the op­tions, in­clud­ing pos­si­ble ad­just­ments to the tax credit on med­i­cal scheme con­tri­bu­tions.

The pri­vate health-care sys­tem in SA is utilised by a small per­cent­age of the pop­u­la­tion, though ex­pen­di­ture in pri­vate care is well over 50% of to­tal health-care spend.

Abieyuwa Ohonba, a health eco­nomics ex­pert at the Univer­sity of Jo­han­nes­burg, says even though public hos­pi­tals have con­sid­er­ably lower rates for adults, and free pri­mary health care for chil­dren un­der six and pen­sion­ers, pri­vate health care is first choice for most peo­ple.

“Even the very poor would rather in­cur outof-pocket ex­penses to con­sult with a pri­vate doc­tor,” she says.

Against the back­ground of a dis­parate and un­fair health sys­tem, where a greater per­cent­age of the pop­u­la­tion is ser­viced by a se­verely un­der­funded and de­prived public health sys­tem, “the NHI is cer­tainly a vi­tal trans­for­ma­tion tool in the process of eco­nomic growth and de­vel­op­ment in SA”, Ohonba says. “How­ever, there are many chal­lenges, like the source of fund­ing which is ex­pected to be de­rived mainly from gen­eral taxes.”

Over the next three years, gov­ern­ment will spend R606bn on health, con­cen­trat­ing funds pri­mar­ily on HIV/Aids treat­ment and preven­tion pro­grammes, re­vi­tal­is­ing health-care fa­cil­i­ties and pro­vid­ing spe­cialised ter­tiary ser­vices.

Trea­sury com­mit­ted R19.1bn more to the health bud­get than in 2016. Be­tween 2012 and 2018/2019 health ex­pen­di­ture will have grown in real terms by 1.3%.

For the 2017 fi­nan­cial year, R187.5bn is re­served for the health sec­tor and district health ser­vices will get the lion’s share of R83.6bn.

Cen­tral hospi­tal ser­vices will re­ceive R35.9bn, R32.3bn is set aside for pro­vin­cial hospi­tal ser­vices, and other health ser­vices will have R25.8bn to spend. R9.9bn is re­served for fa­cil­i­ties man­age­ment and main­te­nance.

With SA’s short­age of med­i­cal per­son­nel and train­ing fa­cil­i­ties, higher ed­u­ca­tion & train­ing min­is­ter Blade Nz­i­mande has sent thou­sands of stu­dents to Cuba to ob­tain med­i­cal de­grees and ex­pe­ri­ence in a coun­try with one of the best health-care sys­tems in the world.

Gord­han said that over the next few months he will work with health min­is­ter Aaron Mot­soaledi, Nz­i­mande and eco­nomic de­vel­op­ment min­is­ter Ebrahim Pa­tel to plan the de­vel­op­ment of the Lim­popo Cen­tral Hospi­tal and launch a new med­i­cal school in the area.

Prof Laeti­tia Ris­pel, who heads the Cen­tre for Health Pol­icy at Wits Univer­sity, says all cat­e­gories of medicine need to be de­vel­oped to en­sure a rea­son­able ra­tio of prac­ti­tion­ers.

Ris­pel says gov­ern­ment also needs to pro­vide in­cen­tives to health-care work­ers across the board. “Our prob­lem is that the ma­jor­ity of doc­tors are in the pri­vate sec­tor and those in the public sec­tor are based mainly in ci­ties,” she ex­plains.

Though the health-care sec­tor faces huge chal­lenges, there have been some gains in the treat­ment of HIV/Aids. Mother-tochild trans­mis­sion has been dras­ti­cally re­duced in the coun­try through var­i­ous in­ter­ven­tions.

Gord­han set aside an ad­di­tional R885m for the im­ple­men­ta­tion of the univer­sal test-andtreat pol­icy for HIV/Aids.

More than 3.5m peo­ple are ac­cess­ing an­tiretro­vi­rals (ARVs) and the health de­part­ment ex­pects ARV treat­ment to reach 5m South Africans by 2018/2019.

Trea­sury says it has saved about R1.6bn/year through the cen­tralised pro­cure­ment of med­i­ca­tion, but sav­ings have been off­set by a weaker rand, which has driven up prices.

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