Budget 2023
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VAT hike may fund NHI

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Cape Town - A hike in VAT is one of the options that government will consider to fund its planned national health insurance (NHI) scheme, Finance Minister Pravin Gordhan said on Wednesday.

"We will consider and consult on options for meeting the funding requirements, including a payroll tax (payable by employers), an increase in the VAT rate and a surcharge on individuals' taxable income," he said in his Budget speech.

"We will have to consider the pros and cons of each option."

In the budget review tabled along with his speech, National Treasury said this year's budget "takes the first steps" in establishing NHI.

"Government is intensifying investment in health services as part of the ten-point plan to restructure public health, which includes NHI," it said.

A health infrastructure grant had been established, new facilities were being built and existing ones upgraded.

In addition, a "family health approach" to primary health care was being launched, at a cost of R1.2bn, over the next three years.

It said the "family health" approach drew on a successful programme in Brazil.

Teams comprising nurses, doctors and community health workers would look after families in "revitalised public health facilities", with an emphasis on prevention rather than cure.

The quality of care in hospitals was being improved - thanks to an amount of R2.7bn.

A total of R117m had been allocated to set up an Office of Standards Compliance, an independent authority that would include an inspectorate and an ombudsman.

"These and other improvements to the public health system will require higher revenues to ensure adequate financing over the long term," the review said.

Gordhan said in his speech that these interventions would be "laying the foundations for NHI".

The review said the NHI would also rely on efficient delivery structures for health services, and a sound payment approach for health providers.

"Joint work of the National Treasury and the department of health is in progress on the fiscal and financial arrangements for these reforms."

The national department of health said in its spending estimates that this year a detailed plan for implementing NHI would be produced, a public discussion paper released, and draft legislation compiled.

The review said spending on the health sector was expected to grow from the current R102.5bn to R113bn in 2011\12, and R127bn in 2013/14 - an average annual growth rate of 7.5%.

The budget allocated an additional R1.4bn to improve maternal and child health services through a range of interventions that included training 400 nurses and midwives, improved school health services, and better supervision of obstetric and paediatric services in district hospitals.

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