“It is not a matter of ‘if’ there will be an NHI in South Africa, but ‘when’,” according to Dr Zweli Mkhize, MEC, KwaZulu Natal Ministry of Finance and Economic Development.
The objective of the proposed National Health Insurance (NHI) system is to implement an efficient, equitable and sustainable health system in South Africa between 2009 and 2014. This has sent a ripple of concern through the world of healthcare experts.
The worry is that the NHI will be a financing system, with government collecting and allocating money for healthcare, and unless it is administered efficiently, the repercussions may well be very negative. “The creation of the NHI is one of the health department’s priorities,” says deputy health minister Dr Molefi Sefularo. Yes, it’s a fact that the South African Bill of Rights guarantees everyone the right to access medical care of a reasonable standard. But there are approximately 5,4 million (overtaxed)taxpayers who will have to foot the additional tax bill to cover 48 million people.
An unrealistic time frame
It took Germany 100 years to achieve an inclusive social insurance system, while it took South Korea, a technologically rich country, which is currently the third largest economy in Asia, and the13th largest in the world, 12 years to cover the entire population including the poor, the unemployed and the self employed. South Africa proposes the creation of a “utopia-type” NHI system in just five years.
NHI is expected to acquire funding through a combination of the current sources of government health spending, the removal of tax subsidy for medical schemes and a modest mandatory employer-employee contribution which will be split equally. It’s undeniable that membership of medical schemes has become increasingly unaffordable for many. The proposed NHI plan aims to ensure that all South Africans will be equally covered and have access to comprehensive and quality healthcare.
The proposed health services covered by NHI will be free at the point of use – no upfront payment will be required by the doctor or hospital. South Africans will be entitled to a comprehensive range of health benefits, including primary care, inpatient and outpatient care, dental, prescription drugs and supplies.
Creating the infrastructure
The system will be funded by eliminating excessive administrative costs, the implementation of cost-effective payment methods through negotiated capitation methods for doctors, global budgeting for hospitals and bulk purchasing of drugs and supplies. It appears to be a logical plan, but past experience from other international models of this kind has proven that they are not easily achieved.
There is no doubt that a change in healthcare financing in South Africa is needed, but the government will have to consult with all sectors that will be affected especially workers, employers,health providers, suppliers and health funders, to ensure that there is a strong infrastructure, and effective, fair and efficient management, especially in the financial arena, for the NHI to be a success.