Com­pul­sory con­tri­bu­tions en­vis­aged for new NHI We take a closer look at the re­cently re­leased White Pa­per on the new Na­tional Health In­surance, which is ex­pected to start op­er­at­ing a decade from now.

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changes in the country’s health sec­tor and med­i­cal schemes in the com­ing decade are en­vis­aged in the White Pa­per on the new Na­tional Health In­surance (NHI).

The White Pa­per was fi­nally is­sued in De­cem­ber af­ter a wait of al­most three years. The pub­lic has un­til the end of May to make com­ments on it.

It is pro­posed that in about a decade from now there will be an NHI fund that will of­fer a pack­age of ben­e­fits for the en­tire pop­u­la­tion. In­di­vid­u­als will have NHI cards that they will use for vis­its to a doc­tor for which the fund will then pay.

The NHI will be im­ple­mented in three phases and in­volves, in the first five years, the im­prove­ment of pri­mary health­care – which has al­ready started.

Health min­is­ter Dr Aaron Mot­soaledi said pri­mary health­care will be the “heart­beat” of the sys­tem, and gen­eral prac­ti­tion­ers and pri­mary health providers will be the “gate­keep­ers” of the sys­tem and re­fer pa­tients to spe­cial­ists and hos­pi­tals.

Gen­eral prac­ti­tion­ers in the pri­vate sec­tor are al­ready be­ing con­tracted to pro­vide ser­vices to the NHI.

One pro­posal in the White Pa­per is that in a decade from now med­i­cal aid schemes will have only a “com­ple­men­tary role” and may not pro­vide the same cover as the NHI. By then com­pul­sory con­tri­bu­tions to the NHI by in­di­vid­u­als will be re­quired, prob­a­bly through tax­a­tion. It is not yet clear how the NHI will be fi­nanced.

Fur­ther de­tails from the Na­tional Trea­sury are be­ing awaited. The White Pa­per pro­poses five po­ten­tial sources to raise rev­enue to fund the NHI, in­clud­ing com­bi­na­tions of a sur­charge on taxable in­come, a VAT in­crease and a pay­roll tax.

The White Pa­per says the NHI will pro­tect in­di­vid­u­als and house­holds from out-of-pocket ex­penses and fi­nan­cial catas­tro­phe re­lated to health­care.

House­holds will ben­e­fit from in­creased dis­pos­able in­come as a re­sult of a sig­nif­i­cantly lower manda­tory pre­pay­ment level, sav­ings that will be made due to economies of scale, ef­fi­ciency gains as a re­sult of re­duc­tions in non-health­care costs, and af­ford­abil­ity of health­care as a re­sult of strate­gic pur­chas­ing ar­range­ments.

It is en­vis­aged that when the NHI is fully im­ple­mented, the num­ber of med­i­cal schemes will de­cline from the cur­rent 83 to a much smaller num­ber that will pro­vide “com­ple­men­tary” cover. The re­main­ing schemes will not be al­lowed to cover the ben­e­fits cov­ered by the NHI. How­ever, Mot­soaledi said re­cently he ex­pects the role of the med­i­cal schemes will still be de­bated.

It is pro­posed that in about a decade from now there will be an NHI fund that will of­fer a pack­age of ben­e­fits for the en­tire pop­u­la­tion.

Dr Aaron Mot­soaledi Min­is­ter of health

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