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Mulling Over the NHI
| Opinion by Matt WoodWould an NHI scheme in SA really be that simple?
A green paper proposing a National Health Insurance scheme in South Africa was released on Thursday (11 August), aimed at providing every citizen with equal access to healthcare.The green paper proposes a scheme in which all South African citizens are compulsory members, regardless of whether they are members of a private medical aid scheme.
It said the government-managed scheme would be introduced over the next 14 years, beginning in 2012, and would cost R125-billion for the first six years, R414-billion in 2020 and R255-billion in 2025.
The green paper said public health expenditure should increase over time from 3,5 percent of gross domestic product (GDP) to 6,2 percent.
While South Africans would not have to contribute to the scheme initially, the green paper does state the case for introducing mandatory payments and the establishment of an NHI fund in 2014.
What amount these mandatory contributions would be is unclear, but the paper refers to current medical aid contributions which range from 5,5 percent to 9 percent of individual salaries.
Despite the increased costs being proposed to South Africans, however, the paper also raises the possibility of incorporating private-sector hospitals and medical professionals into the scheme, but states that the way these employees are paid should change dramatically.
The document states that medical workers should be paid using a “risk-adjusted capitation system … linked to the size of the registered population, epidemiological profile and target utilisation and cost levels”, instead of the way private medical workers are currently paid, which is on a “fee-for-service” basis.
In effect this would mean that healthcare professionals would be paid per enrolee and not per service, which would likely mean a significant drop in income.
How the scheme would encourage healthcare workers to take such a drop in salary is unclear, as is what measures would be put in place to avoid a mass exodus of medical professionals seeking to maintain (or improve) their standard of living.
The green paper will undoubtedly stir much debate and spark genuine concern among various members and groups of the South African public, including the Congress of SA Trade Unions (Cosatu), who have already stated that it was “extremely worried” about the role of private-sector healthcare proposed in the document.
“In particular Cosatu is totally opposed to the proposal to introduce a multi-payer system, under which private medical schemes will be allowed to charge the government for a proportion of the treatment they deliver to their clients,” said Cosatu.
“This flies in the face of the African National Congress’ commitment to create a publicly administered and publicly funded National Health Insurance Fund, which will be a single-payer fund that receives funds, pools resources and purchases services on behalf of the entire population.”
Cabinet on Thursday approved the green paper to be released for public comment.
Cabinet added that it “believes that this is a major step towards improving the access and quality of health care for all the citizens of SA”, but that “the success of this policy will largely depend on a whole range of other important variables such as clean water, nutrition, general physical exercise etc.”
Source: www.bizpremises.co.za
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