NHI: Rich will subsidise poor

Cape Town - Taxpayers and members of medical schemes are still chewing over the implications of a national health insurance system (NHI).

The expectation is that higher income groups will carry the health burden of the lower income groups.

Last month, Deputy Minister of Health Dr Molefi Sefularo declared that the provisional document on the NHI would be announced by the end of June. However, the department has yet to say when official documentation will be made available.

Spokesperson Charity Bengu said the department is still in the process of sending NHI documentation to the various government agencies concerned.

But a document setting out expectations for such a system has recently been published on the ANC's website. Among other things, it proposes that health services will be determined according to need rather than a person's ability to pay. The document refers to the system as "social solidarity".

Social solidarity will also mean that people who can afford to pay for healthcare will subsidise those who cannot, the document explains.

In effect, the NHI would be financed by a combination of government money - which would include the removal of the current tax exemption for medical-scheme members - and a compulsory contribution by employers and employees, divided equally between them. Workers in the lowest income groups would not contribute.

"The extension of health cover to all South Africans means there will be no financial limit on access to healthcare. All South Africans will be equally covered for comprehensive and quality care."

According to the document, the NHI will be introduced in stages and should be implemented by 2014, thus achieving the country's millennium development goals.

Given the appalling condition of state hospitals and the dearth of medical personnel, industry observers consider it an open question whether there will be sufficient public healthcare facilities, doctors or nurses to realise such a system.

South Africa's taxation system will also have to be adjusted.

Alex van den Heever, an independent health economist, deems it particularly worrying that evidently inadequate technical research has been done.

"A system such as this is a massive undertaking, for which comprehensive research and negotiation with industry players are required. The plan is clearly to publish a White Paper, present it direct to Cabinet and consult on it while the provisional bill is being drawn up.

"It would be a mess if an abstract shell called the NHI was created and problems tackled only when they arose. It is important to confront the realities before the policy is implemented."

By Sake24's deadline neither the Department of Health nor Dr Olive Shisane of the ANC's NHI task team, under whose guidance the provisional policy document is being drawn up, had responded to Sake24s request for comment.

- Sake24