Reaction to NHI positive but concerns raised
Johannesburg - Reaction to the release of the government's green paper on National Health Insurance on Friday was marked by support in principle tempered with concerns.
The discussion document, which the public has three months to comment on, set out some long-awaited initial details, including an estimate of R125bn to be spent next year on preparations which include establishing 10 test sites.
The Federated Unions of SA (Fedusa) wanted to know where the money would come from, given the 5.9 million taxpayers SA Revenue Services had for the 2009/10 year compared with the population of over 50 million people living in the country.
"Fedusa is deeply concerned that South Africa's small tax base will genuinely not be able to bear the financial brunt of this large socio-economic need," Fedusa general secretary Dennis George said.
R214bn by 2020
By 2020 it would need R214bn, according the paper presented to Cabinet.
The National Union of Metalworkers of SA supported NHI fully, even though most of its members, besides garage workers, already had private medical cover.
They found that although wage increases were fixed at set percentages, their medical aid contributions could increase by as much as 15%, unilaterally. In spite of paying contributions the whole year, most found that their cover ran out early in the year.
Their main reason for supporting NHI was because it was a break from the apartheid era's unequal healthcare system and that it would ensure equal access to quality healthcare for all South Africans, especially the poor.
According to a study, about 16% of people in South Africa have private healthcare.
However, Numsa shared Cosatu’s concerns on the proposed introduction of a multi-payer system, which it felt might see private health schemes being allowed to charge the government for a portion of their services.
This could allow medical schemes to "continue to rip off their clients" and be subsidised by taxpayers.
Consultation period too short
The Helen Suzman Foundation felt three months for consultation on the NHI was too short, given the long-term effects of the system. It wanted clarity on the taxation aspects of NHI, urged transparency to avoid corruption, wanted staff shortages to be dealt with and to know more about the envisaged relationship between public and private health facilities.
In a statement to mark the release of the paper, Health Minister Aaron Motsoaledi said: "It will actually make the sector more sustainable by making it levy reasonable fees."
He continued: "Over the past decade, private hospital costs have increased by 121%, while over the same period, specialist costs have increased by 120%."
The Treatment Action Campaign and Section 27, a public interest law centre, raised concerns regarding refugee, asylum seeker and non-citizen access, and the structure and governance of NHI.
They wanted to see measures to ensure transparency of tariff structures, reasonableness of prices, significant improvements in the quality of public health and a proposed office of health standards compliance.
Legal requirement to contribute
According to some details of the NHI released on Thursday, everybody over a yet-to-be-determined income threshold would be legally required to contribute.
Money would come from four sources: the tax everybody contributes; mandatory contributions from individuals and employers; co-payments and user charges from individuals; and certain public-private partnerships.
Details that the TAC and Section 27 believed the green paper did not cover included the future role of medical scheme administrators, and what the benefit packages would be.
Business Unity SA warned that the cost, design and institutional changes would require vigorous debate.
"If additional funds are to be allocated to public health, it is imperative that they be effectively used." The concepts contained in the green paper would affect household budgets, public finance and the labour market, so phasing in and consultation with the National Economic Development and Labour Council was also called for.
The People's Health Movement, an NGO that promotes "health for all" and social justice movement, the Alternative Information Development Centre, stressed the importance of strengthening district health facilities and not losing sight of other health-related factors such as good nutrition, sanitation and access to clean water.
Potential for fraud
The Board of Healthcare Funders say it would encourage a review of the current Prescribed Minimum Benefits to reflect this focus in line with National Health Policy.
Regarding payment of providers under NHI, it said the proposed risk-adjusted capitation (adjusting rates according to factors like age or illness) system would constructively promote good quality outcomes and would minimise the potential for fraud and over servicing.
It also supported the use of diagnosis-related groups (reimbursing according to the treatment required for a condition such as heart failure, instead of just costs incurred), which it had used for years, as a method of analysing quality and reducing risk for reimbursing hospitals.
But it would like to see the establishment of "Healthcare Pricing Forum" so that medical schemes can remain sustainable in the run up to the implementation of NHI.
The Hospital Association of SA (Hasa) welcomed the green paper on NH1.
"We acknowledge the challenges facing South Africa's health system, and the department's intention to ensure that all South Africans have access to affordable, quality healthcare services regardless of their socio-economic status," said chairperson Dr Nkaki Matlala in a statement.
"We now have a document that sets out at a high level where we are headed."
It was a "pragmatic" document and a step towards achieving universal healthcare coverage. Hasa looked forward to working with government to find ways of making healthcare more accessible.
"Hasa does however feel that, given the extensive and lengthy time taken by government in the development of this paper, the public consultation period of only three months appears unusually short for necessary and valuable input from the general public and civil society," the association said.