I am a first-generation medical aid member and come from a family which was largely dependent on public health.

My parents really struggled with inadequate healthcare for all their lives and I wonder if my dad’s life would have been lengthened with better care.

My mom, who is now 89, is on medical aid because the governing ANC forced changes to medical aid coverage to expand the definitions of dependents from the industry’s Western notions of what family is. She is now on my brother’s medical aid. Some years ago, my old lady fell and broke her hip. It was replaced in two days and she was walking in seven days. The waiting list for that operation at public hospitals is months long.

The ANC also legislated that the private health insurance industry cover prescribed minimum benefits to provide a guaranteed bottom line of services. The managed care industry is notorious for limiting its risks, maximising its profits and cherry picking its clients, so public health regulation has been excellent at expanding and extending service levels in the private sector.

The democratic government introduced free health care for women and children, which changed many lives for the better and stronger, as I saw when I reported health just as apartheid gave way to freedom.

Life extending and health enhancing public health policies have made meaningful changes in the lives of so many South Africans. But government has decided these are insufficient as the health imbalances are still acute.

Higher tax burden

Its national health insurance initiative is a further attempt at health reform but the idea is poorly conceived and will add to the burden of already stressed income taxpayers who have over recent years faced the highest tax increases.

There’s more to come once the NHI Bill becomes law, although it’s important to bear in mind that that is only in 2026 – possibly much later – because the law as it stands faces many constitutional hurdles, says Wits University health economist Dr. Alex van den Heever.

Stripped of choice

It strips individuals of choice, since we will all become mandatory members of the national health insurance scheme, a gigantic medical aid for the entire country. But here’s the rub: government envisages that it will be run by a CEO and an 11-person board appointed by the Minister of Health.

There is no history of democratic South Africa running either its funds or its state-owned companies with its people in mind. And the panic that has greeted the unveiling of the NHI bill is therefore understandable.

What it means for us is that, as envisaged by the draft law, your personal income tax bill could shoot up by between 19% to 20%, says Van den Heever, according to his early calculations.

This is because the drafters assume enough fiscal space to tax an additional 3% of GDP and this tax is likely to fall on our (working South Africans’) shoulders.

Corporate taxes are reckoned to be at their ceiling, and there is no way government can push a VAT increase through without inciting a “revolution”, says Van den Heever.

The draft law says you can still buy a medical aid policy, but schemes will be highly constrained in what they can offer because the formative idea is to cover all South Africans in the national scheme.

Article by Ferial Haffajee and News 24

The new National Health Insurance (NHI) Bill, tabled in parliament on 8 August, sheds some light on the new universal health coverage will be funded.

The main question for medical aid members and other taxpayers is whether they can still belong to medical aids and if so, whether they will be forced to pay not only their medical aid contributions, but to also contribute towards the NHI.

According to Aneria Bouwer, partner at law firm Bowmans, the answer to both questions is ‘yes’, although the details have not yet been released.

Bouwer said that the NHI will be funded by way of:

General tax revenue, which will include transferring funds from provincial health budgets to the NHI Fund;
A payroll tax (employer and employee); and
A surcharge on personal income tax.
Taxpayers’ medical scheme fees tax credit will be reallocated to the NHI Fund;

Tax credits

The proposal that Taxpayers’ medical scheme fees tax credit be reallocated to the NHI Fund has previously been mooted as a way for funding the NHI.

“However, it seems more certain that taxpayers will no longer receive medical scheme fees tax credits, which for a family of four, currently provides relief of just more than R12,000 per year,” Bouwer said.

This amount is determined annually by SARS which states that the taxpayer who paid the medical scheme contributions is entitled to R310 per month in rebates.

This rises to R620 per month for the taxpayer and one dependant; or R620 in respect of two dependants.

Taxpayers are also entitled to R209 per month for each additional dependant on the scheme.

Total cost to taxpayers?

“There is as yet no indication as to how much this will cost taxpayers,” Bouwer said.

“The taxes will be imposed by a money Bill to be introduced by the minister of Finance. According to the memorandum, these tax options will only be evaluated as part of the 6th and final stage of implementation, which will presumably not be before 2022.

“Interestingly, it refers to the evaluation of the new tax options ‘in a favourable economic environment’,”.

Bouwer said that the NHI bill also envisages that the payroll tax will be ‘small’ although there is no indication as to what this means.

“In the part of the memorandum dealing with the financial implications for the state, it refers to the various financing options, and then states that ‘due to the current fiscal conditions, tax increases may come at a later stage of NHI implications’,” she said.

“It thus appears that further taxes will only be imposed at a later stage after evaluation of the potential impact thereof, taking into account the economic and fiscal environment.

“There is no doubt that taxpayers will find the additional tax burden a bitter pill to swallow,” she said.

Article by BusinessTech

‘The EFF is more honest than the ANC’

FF Plus leader Pieter Groenewald said while the ANC said they wanted expropriation without compensation with strict preconditions, the EFF was more honest.

“The EFF is more honest than the ANC. For them, it is an ideological issue because they say they want the land.”

He said sometimes it was difficult to tell whether the EFF and ANC were fighting, or in love.

Groenewald added the motion should have been named the “motion to destroy the economy and the future of South Africa”.

ACDP MP Steve Swart noted that the experts, who made presentations to the previous ad hoc committee, advised to tread carefully in amending the Constitution.

GOOD MP Shaun August said section 25 in its current form made provision for expropriation.

“Public land must be used for public good,” he added.

NFP MP Munzoor Shaik-Emam said while his party supported an amendment, it should be done in a way that does not disadvantage anyone.

“Two wrongs do not make a right,” he added.

ANC MP Mathole Motshekga said South Africa’s original sin was the violent dispossession of the Khoi and San people, and that the 1913 Land Act had consolidated the dispossession of the Khoi, San and black African people, which “degraded and dehumanised our people”.

Before voting, ANC MPs started singing, with EFF MPs joining in.

The motion was passed with 189 votes to 67, with no abstentions.

The new ad hoc committee will consider work and recommendations in the reports of the constitutional review committee and the previous ad hoc committee on the amendment of section 25 of the Constitution.

It will have 11 voting members, six from the ANC, two from the DA, one from the EFF and two from the other parties.

There will also be 11 non-voting members, two from the ANC, one from the DA, one from the EFF, and 10 from the other parties.

The deadline for the committee to report back to the National Assembly is March 31, 2020.

The ANC indicated earlier that it would nominate Motshekga as chairperson of the committee. Agriculture, Land Reform and Rural Development Minister Thoko Didiza was the chairperson of the fifth Parliament’s ad hoc committee.

Article from News 24

The NHI Bill was meant to help equalise health care and guarantee access to the best kind of care to everyone in the country whether they are well off or poor.

JOHANNESBURG – Health Minister Zweli Mkhize has called for calm following concerns raised by the private healthcare sector about the National Health Insurance model.

The minister last week submitted the NHI Bill.

The bill was meant to help equalise healthcare and guarantee access to the best kind of care to everyone in the country whether they were well off or poor.

Numerous bodies, including the South African Private Practitioners’ Forum, and political parties said it was unrealistic, too expensive, and would potentially damage the healthcare sector.

However, Mkhize was confident the model would be successful and not steer the sector in a financial crisis.

“The issue is not whether there is something wrong with the private sector. Both the public and private sector need to be realigned and that’s what we are doing. And it’s not like we are taking money from the one and giving it to the other,” he said.

“The reality is that the country needs a much more equitable redistribution of the resources inside the same system,” he added.

After Parliament’s health committee discussed the bill, it would be open for public consultation.

Article by Mia Lindeque and EWN

Public hospitals have become a death-trap for the poor‚ says Refiloe Nt’sekhe of the Democratic Alliance.

The party has produced this checklist of the top eight problems that it says require urgent intervention‚ following inspection visits to hospitals and clinics over the past month by DA provincial health spokespersons Jack Bloom MPL (Gauteng)‚ Dr Imran Keeka MPL (KwaZulu-Natal)‚ Dr Tutu Faleni MPL (North West) and Langa Bodlani MPL (Limpopo).

Here is a summary of their report:

1. Chronic staff shortages and long waiting times

All the facilities lacked staff in critical positions.

At the Bongani Hospital in the Free State‚ they found that the facility only had one nephrology Sister to attend to patients suffering from kidney diseases. This was despite health norms and standards indicating that hospitals should have nine.

While inspecting the Paediatric Ward in Taung District Hospital in North West‚ the DA found that there was no qualified resident paediatrician to treat children and that the ward is severely understaffed‚ including nurses‚ cleaning staff and cooks.

Tembisa Hospital in Gauteng only has 40% of the nurses that are required‚ they found. According to international norms and standards‚ the hospital should have at least 628 more nurses to provide proper health services to patients.

The Soweto-on-Sea Clinic in Port Elizabeth is only visited once a week for four hours by a doctor while the clinic services 3‚000 patients per month. This was mirrored in the visit to KwaZulu-Natal’s St Mary’s and RK Khan Hospitals‚ where KZN’s Health Department has vacancies of 5‚926 critical staff.

2. Equipment shortages

At the RK Khan Hospital in KZN‚ the DA found that the X-ray department still has no defibrillator despite MEC Sibongiseni Dhlomo being alerted in 2014 that it was broken.

At Bongani Hospital in the Free State‚ the hospital has nine theatres but only three are operational due to ineffective equipment. The renal plant has not been operational since its inception.

3. Oncology crisis

There is not a single radiation oncologist in Limpopo or Mpumalanga.

At the RK Khan Hospital in KZN‚ waiting times for CT scans are as long as three months while the next available mammogram appointment is in 2019.

4. Shortages of consumables and medicine

While inspecting various hospitals in Nelspruit and Barberton in Mpumalanga‚ Emergency Medical Care personnel told the DA that they have resorted to buying vital medical equipment such as high blood pressure machines out of their own pockets due to the department failing to provide such equipment.

In the Northern Cape at the Kimberly Hospital‚ there are shortages of basic supplies such as toilet paper.

For the past two months at Maphutha Malatji Hospital in Limpopo‚ the pharmacy has not had an iron supplement drug‚ a vital medicine for pregnant women and HIV patients as well as Panado Syrup – a painkiller for children.

At St Mary’s Hospital in KZN‚ doctors and nurses complained of shortages of simple and everyday disposables such as syringes‚ needles and “jelcos” which are used for intravenous access to set up drips.

5. Negligence and claims

Medical negligence claims have led to large payouts which have put a strain on the health budget. Last year‚ the Gauteng Health Department had R18.6-billion in negligence claims‚ Eastern Cape had R16.7-billion and KZN had over R9.2-billion.

6. Transport and ambulance related issues

In a Mpumalanga hospital‚ only two out of four ambulances were operational. The other two had mechanical problems. “Many of the ambulances had travelled more than 400‚000 kilometres and posed a risk to patients and medical personnel‚” the inspection team said.

7. Infrastructure/Lack of Maintenance

The Department’s Annual Report shows that out of the 44 community health centres which were to be constructed and revitalised‚ only 22 were completed‚ the DA said.

Out of the eight hospitals that were supposed to be constructed or revitalised‚ only three were completed.

“No maintenance has taken place at the Bongani Hospital since it was built 20 years ago. Shockingly at our visit to the Schoemansdal Clinic in Mpumalanga‚ the toilets haven’t been working for a very long time causing embarrassment to both patients and staff. The pit toilet which is currently being used leaves an unbearable stench which is aggravated by rain.”

8. Mental health crisis

“Following the Life Esidemeni tragedy in Gauteng‚ government is yet again failing to stop future mental health tragedies in South Africa‚” the politicians asserted.

At Tembisa Hospital‚ psychiatric patients are kept for long periods of time as there are not enough beds for them at Weskoppies Mental Hospital – they should only be at Tembisa Hospital for 72-hour observation before they are discharged or sent to a longer-term facility.

While at Life Esidimeni in Limpopo; rather than increasing their budget to assist with the maintenance of the facility‚ a decision has been made to halt the funding of the non-profit and for the Limpopo Department of Social Development (DSD) to take over the management and functions of the centre.

Given the bad track record of the DSD in Limpopo‚ its financial constraints and record of mismanagement‚ every effort must be made to ensure that the mental health centre in Shiluvana remains in the hands of Life Esidimeni.

“The findings from our #HospitalHealthCheck oversight inspection campaign makes it clear that all is not well in our public health sector. Although there are financial constraints facing the Department‚ it is evident that at the heart of our failing health system is maladministration (and) poor oversight‚” said Nt’sekhe.

The party offered to assist national government tackle these issues.

Article by Times Live

President Cyril Ramaphosa on Tuesday vowed that the National Health Insurance is here to stay.

Ramaphosa was speaking a week after health minister Zweli Mkhize made public the NHI bill, which has been the subject of a lot of criticism.

Most of the critics have pointed out a lack of clarity about its funding, questions over the future of medical aids and fear that health professionals and specialists would leave the country.

But addressing an ANC Women’s League event, dubbed a “Conversation with the President” on Tuesday night in Johannesburg, Ramaphosa came out in full support of the NHI.

“I would like to say that the NHI is here to stay. Whether people like it or not, it’s going nowhere,” said the president to loud applause.

Earlier, while speaking about the economy, Ramaphosa said that his government would hold another investment summit in November.

He emphasised the need for investment, but cautioned that infighting in the ANC was chasing foreign investors away.

“They don’t want to see us fighting among ourselves… They think that there is political instability and they walk away with their dollars and their euros and their pounds,” said Ramaphosa.

He said his government was focusing the economy to ensure sustainable growth.

Ramaphosa said they needed to work together because where there is unity, there is growth.

“We will turn our economy around, we are going to turn it around whether people like it or not. We are going to do it because we have it within us to be able to focus more closely to what needs to be done. And we are going to do, watch this space,” he said.

Article by BY APHIWE DEKLERK and Times Live

The National Health Insurance (NHI) Bill, tabled last week in Parliament, has been forwarded to the chairperson of the Portfolio Committee on Health, Dr Sibongiseni Dhlomo.

Dhlomo said the committee will meet and discuss the programme of the NHI Bill, which will have an extensive public consultation process.

Analysts and economists meanwhile, have been digesting the plan and its implications for the economy.

While the bill lays out the groundwork for the NHI and how it will be funded, it still lacks much-needed detail, particularly when it comes down to exactly how much the scheme is going to cost each year.

The original NHI white paper estimated that the scheme would cost the economy around R256 billion a year – however, former health minister Aaron Motsoaeldi admitted that this was a “guesstimate” that was thumb-sucked by a local firm.

The Department of Health said that National Treasury plans to release a revised paper with a revised costing estimate.

According to Intellidex analyst Peter Attard Montalto, NHI is expected to cost an additional R165 billion to the fiscus in current prices, per year from 2026, based on PwC estimates used by the Davis Tax Committee (DTC) in 2017.

In its findings on the NHI and its implications for South Africa, the DTC said that even at R256 billion a year, in a 3.5% GDP growth environment the scheme would still likely hit a shortfall of around R72 billion by 2025. At a growth rate of 2% the shortfall would be R108 billion.

South Africa’s projected growth rate for 2019 is 0.6%.

Deputy director-general for NHI, Anban Pillay has moved to allay fears of immediate taxes – saying that no new taxes will be introduced in the short term, and will only be introduced in the ‘late stages’ of the scheme’s rollout, once it is up and running.

However, the bill was explicit that its funding will come from taxes in the end.

This includes:

General tax revenue, including the shifting funds from the provincial equitable share and conditional grants into the Fund;
Reallocation of funding for medical scheme tax credits paid to various medical schemes towards the funding of National Health Insurance;
Payroll tax (employer and employee);
A surcharge on personal income tax, introduced through a money Bill by the Minister of Finance and earmarked for use by the NHI fund.
Attard Montalto said that no specifics for these taxes were given in the published report, but the DTC previously determined an option that included many of the taxes that the department has now said it will eventually be implementing.

These early projections included a 2% increase to payroll tax on employers and employees, a 2% surcharge on taxable income and a 2.5 percentage point increase in VAT.

However, these figures were based on 2010 pricing, Attard Montalto said, and overestimated fiscal buoyancy.

“Overall the DTC outlined that NHI would only be feasible with strong growth in the economy, and seeing new revenues directed towards NHI,” he said.

In line with current buoyancy rates, the DTC’s original figures would result in a shortfall of around R45 billion a year, and a negative impact on wider tax collection maybe of the order of R50-75 billion.

“This would mean by our calculations the funding wrapper would need to be more like 2.7% payroll tax, 2.7% surcharge on taxable income and 3.5 percentage point increase on VAT – and that is only to address the NHI hole, not the wider revenue shortfalls,” he said.

Attard Montalto said that Treasury likely wants to avoid a tax ‘doom cycle’, and is thus focusing more on the expenditure side than revenue side (ie, funding by reprioritising budgets), but the wider risks of the scheme still persist – specifically medical workers salaries under NHI, and emigration of skills.

“Overall we think NHI is unworkable in the current economic and fiscal context, even if sorely needed. Indeed it can do more harm than good at a macro level,” he said.

“The implications need to be thought through.”

Article from BusinessTech

The National Health Insurance bill published on Thursday (8 August) fails to answer a number of key questions around universal health coverage.

According to the Institute for Race Relations, these issues include the final costs of the system, and exactly which benefits will be covered.

“The main purpose of the NHI bill is to establish the NHI fund and its nine sub-units, allow the appointment of a host of advisory committees to help guide the Fund, and introduce a state-controlled Appeals Tribunal to decide on people’s complaints against the fund,” it said.

“But neither the bill nor its explanatory memorandum answers any of the key questions about the NHI.”

Below it outlined some of the key issues that have not been adequately addressed by the bill:

1. What NHI will cost?

The IRR noted that current costs for healthcare in South Africa is over R450 billion, based on both public and private healthcare spending – for true universal healthcare, costs could at least amount to that.

Original estimates for the cost of the scheme were put at R256 billion a year – however it is now up to National Treasury to determine the true costs. For now, it’s unknown.

2. How will it be financed?

While the bill has earmarked payroll and other taxes to be levied in time, it would be on an already overburdened tax base, the IRR noted.

Beyond the broad plans, there were no specifics about when these taxes will come, or how big they would be. The NHI director general noted that the taxes would only be a ‘late game’ addition to the funding, once the scheme was close to full implementation.

3. What benefits will it cover?

The NHI Bill does not go into the specifics on what will be covered. This is because coverage under the NHI is expected to evolve over time. For now, all we know is that coverage is to be “bureaucratically decided” at some point, the IRR said.

4. How will the supply of healthcare services be increased to match demand?

The IRR noted that the scheme faces a supply/demand problem with many public facilities not qualifying to participate in the scheme, and private healthcare practitioners may opt to rather emigrate.

Assessments of the NHI trials have already revealed some major issues at some state hospitals in the early testing stages for the scheme – while the issue of healthcare workers willing to leave and actively leaving the country ahead of the system is well-reported.

5. How will the enormous administrative burden be met?

The state has an extremely poor track record when it comes to fiscal management and running state companies.

While the NHI is not a state owned entity, it still follows similar structures – and will be bigger than Eskom in fiscal scale, which carries with it much bigger risk.

The IRR highlighted the problem of cadre deployment and inept leaders (and a general lack of skills to manage the scheme) as something that needs to be addressed.

6. How will corruption be curbed?

South African state institutions already face major problems with inflated prices tainting up to 40% of procurement, the IRR said. With the NHI and procurement falling to one person (or at least on department), this opens up the whole scheme to corruption.

The Department of Health has only said that it ‘stands ready’ to combat any corrupt activities related to the scheme.

7. Why are medical schemes being so drastically limited?

The role of medical aids under the NHI is one of the biggest sticking points. Under the NHI, medical aids are not allowed to cover the same services that are covered by the NHI, which will ultimately limit consumers’ choice in where to receive healthcare.

The IRR argues that this will limit the possible membership pool of private medical aids, and end with the result of making these schemes completely unaffordable to all but the very rich.

Under the NHI, the State will control every aspect of healthcare, the IRR said.

“This means the State will decide on the healthcare services to be covered; the fees to be paid to doctors, specialists, and other providers; the medicines to be prescribed; the blood tests to be allowed; the medical equipment to be used; the health technologies to be permitted; and the prices to be paid for every item, from aspirins and ARVs to sutures and CAT scanners.

“The government claims these controls will be effective in cutting costs and enhancing quality. But the huge bureaucracy needed to implement them will be costly in itself – while pervasive regulation will also stifle innovation, reduce efficiency, and promote corruption.”

Article by BusinessTech

The Department of Health published the long-awaited National Health Insurance Bill on Thursday (8 August).

The bill promises universal health coverage for all South Africans and is set to bring big changes to the country’s health industry – including how South Africans pay for health coverage and a changed role for medical aids.

One industry which is also likely to see a major shake-up is private hospitals.

The bill states that all South Africans covered under the bill must register as a user with the NHI fund at an accredited health care service provider or health establishment.

Whenever users need to access healthcare, they will first need to visit this primary facility. This facility may then refer the user to a specialist or another facility.

The bill states that if these ‘referral pathways’ are not followed, users will not be covered by the NHI fund and will have to pay out of pocket or make use of a medical aid.

While the NHI bill does not specify if ‘accredited health care service providers’ will be limited to public hospitals, it does set out a minimum set of requirements that need to be followed before a hospital is given accreditation.

These requirements include:

• A minimum required range of personal health care services as specified by the minister; 
• Allocation of the appropriate number and mix of health care professionals;
• Adherence to treatment protocols and guidelines, including prescribing medicines and procuring health products from the formulary; 
• Adherence to health care referral pathways;
• Adherence to the national pricing regimen for services delivered.

Also, as previously covered, medical aids will also be prevented from covering services that will be covered under the NHI, limiting options for those seeking private healthcare.

Impact on industry

The Hospital Association of South Africa has previously warned that the NHI could lead to the loss of up to 132,000 jobs, and impact the industry’s investment in South Africa.

According to the group, close to R180 billion is spent on private healthcare in South Africa each year – a third of which is spent on private hospitals.

The three JSE-listed hospital groups – Netcare, Mediclinic and Life Healthcare, which make up about two-thirds of the sector – contribute about R55.5 billion to GDP a year.

It warned that if the state did not purchase any private hospital services under the NHI, 99,600 jobs may be lost in the private sector, and R31 billion could be shed from the GDP.

In a situation where the prices are capped at 23% lower than they are at present, 132,000 jobs may be lost, it said.

Article by businessTech

Experts have warned that the incoming National Health Insurance (NHI) may be dead on arrival as a large number of doctors plan to leave South Africa or have already left.

The incoming NHI will rely on a large network of doctors to service patients around the country, with government promising ‘universal health coverage’.

However, the Sunday Times reports that the bill has renewed fears about mass emigration of doctors and other health professionals, which would kill any health plan that relies explicitly on there being more doctors.

Speaking to the paper, Dr Chris Archer, CEO of the South African Private Practitioners Forum said that his members are extremely concerned and that the bill may drive emigration as “those who want to leave see it as a reason to do so”.

Profmed medical aid CEO Craig Comrie said that health professionals are already emigrating.

Comrie said Profmed’s members are mainly health professionals, of whom 17% leave each year. This rose to 30% in June and July.

Alex van den Heever, Wits School of Governance professor, added that he expects medical professionals to emigrate in their hundreds, joining their countrymen in countries like Dubai and Australia.

Research

These concerns align with research published by Solidarity, which has previously warned that the introduction of the NHI could lead to a mass exodus of doctors from the country.

One of the most worrying findings in the survey was that 83.2% of healthcare workers believed that private health professionals will leave the country if the NHI is implemented. 43% of the respondents said that they themselves would consider emigrating.

There was also a firm belief that the scheme would completely destabilise the country’s healthcare as a result.

The major points of concern are:

• Shortages of specialists, doctors, nursing staff and other healthcare workers;
• Financial management of the NHI;
• Purchasing and distribution of medicines and equipment; and
• Maintenance of infrastructure and equipment.Article by BusinessTech

The Department of Health has published its revised National Health Insurance Bill, promising to bring universal health coverage to every South African.

Since being mooted, the NHI has faced constant controversy including questions around how it will be funded, which medical issues will be covered and how private medical aid users will be impacted.

These concerns have been compounded by a lack of clarity from government, and a pilot project which showed ‘mixed results’.

However, minister of Health Dr Zweli Mkhize has made it clear that his department will tackle these issues ‘as and when they appeared’, and that the NHI will be introduced ‘whether you like it or not’.

“I believe that too much discussion, analysis and diagnosis has been done and it is time for us to jump into implementation,” Mkhize said in his departmental budget speech in July.

“If we continue analysing the problem we will never end up tackling the problems.”

The revised NHI Bill published on Thursday (8 August) appears to answer at least some of the questions around the bill, including how it will be funded, what will be covered, and when the timeframe around when the NHI will be rolled out.

Who will be paying for the NHI?

While the bill is still light on some specifics around funding for the NHI, it is clear that South African taxpayers will be paying for a portion of the service.

The bill states that funding for the NHI will be collected ‘in accordance with social solidarity’ through a number of direct and indirect taxes.

These taxes include:

• General tax revenue, including the shifting funds from the provincial equitable share and conditional grants into the Fund;

• Reallocation of funding for medical scheme tax credits paid to various medical schemes towards the funding of National Health Insurance;

• Payroll tax (employer and employee);

• A surcharge on personal income tax, introduced through a money Bill by the Minister of Finance and earmarked for use by the NHI fund.

“Once appropriated, the revenue allocated to the fund must be paid through a budget vote to the fund as determined by agreement between the fund and the minister and subject to the provisions of the Constitution and the Public Finance Management Act,” the bill states.

The National Treasury had previously estimated that the cost of the NHI will be R256 billion, but this figure is set to change after the publication of this revised bill.

What will happen to medical aid?

Once the National Health Insurance has been fully implemented as determined by the minister through regulations in the Gazette, medical schemes may only offer complementary cover to services not reimbursable by the fund.

This echoes previous statements by Mkhize, where he said that medical aids should not cover services that fall under those covered by the NHI, and only cover those that do not.

Research published by Solidarity has previously warned that the introduction of the NHI could lead to a mass exodus of doctors from the country.

According to the report, the overall sentiment among healthcare professionals towards the NHI is generally negative, with many complaining about a lack of information around the whole scheme, and worries that the plans will completely destabilise healthcare in the country.

Who will the NHI cover?

The NHI will cover all South African citizens, permanent residents, refugees, inmates and certain groups of individual foreigners.

The bill states that asylum seekers or illegal foreigners will only be entitled to emergency medical services and services for ‘notifiable conditions of public health concern’.

All children, including children of asylum seekers or illegal migrants, will be entitled to basic health care services in line with the Constitution.

The bill states that a person seeking health care services from an accredited health care service provider or health establishment must be registered as a user of the NHI fund, and must present proof of such registration to the health care service provider or health establishment in order to secure the health care service benefits to which he or she is entitled.

The bill indicates that registration is not optional and that the above group of people must all  must register as a user with the Fund at an accredited health care service provider or health establishment.

Children will be considered registered from birth.

The bill does not specify exactly what medical services will be covered, but does state that all users will  ‘receive necessary quality health care services free at the point of care from an accredited health care provider or health establishment upon proof of registration with the NHI fund’.

When will the NHI be introduced? 

While the bill does not appear to have a hard starting date for the introduction of the NHI, it does state that the system will be implemented in a multiphase approach.

The current timeline stated in the bill is as follows:

• September 2019 – March 2021:  Initiate the establishment of the NHI Fund whilst simultaneously introducing a national quality improvement plan that helps facilities to be certified and accredited to provide health care services to be funded under National Health Insurance (‘NHI’). During this phase health facilities that are certified and accredited will start to provide health care services for users of the fund;

• May 2020 – March 2021: The fund and its executive authority will bid for funds through the main budget as part of the budget process to expand coverage using certified and accredited public and private sector health facilities. This phase will focus on fully establishing the purchaser-provider split and associated reforms, such as changing provider payment mechanisms and the implementation of the Fund’s institutional arrangements

• April 2021 – March 2022:  Shift some of the conditional grants such as the National Tertiary Services grant and the HIV/AIDS and TB grant from the Department of Health into the fund and continue with step 2.

• April 2022:  Shifting some or all of the funds currently in the provincial equitable share formula for personal health care services (currently the main public health funding stream to the fund to gradually extend these delivery and management reforms to all districts and public hospitals

• The final phase will largely relate to expanding coverage in terms of being able to accommodate the maximum projected utilisation rates and gradually increasing the range of services to which there is a benefit entitlement. In a favourable economic environment, there will be an initiation of the evaluation of new taxation options for the fund including evaluating a surcharge.

  Article by BusinessTech