NHI contributions will be compulsory

Pretoria - Those who earn above a certain income will be required by law, with no exceptions, to contribute towards the National Health Insurance (NHI) scheme once it starts up, Health Minister Aaron Motsoaledi said on Thursday.

Speaking at a media briefing in Pretoria, he said the level of income above which NHI contributions were compulsory had still to be determined by the National Treasury.

"If you earn above a certain income you will be required by law to make a contribution to the NHI fund. It won't be possible to opt out of this responsibility.".

The NHI aimed to give all South Africans and legal long-term residents access to essential health care, regardless of their income, Motsoaledi said.

Speaking at the same briefing, Finance Minister Pravin Gordhan spelled out how the government proposes to fund the NHI, which is to be implemented in stages over the next 14 years.

Not a war

The money required would come from four sources.

"One is through the fiscus, that's the tax that everybody contributes; secondly, through mandatory contributions from individuals, [and] from employers.

"The third is co-payments and user charges from the individual himself or herself. Also, there are certain instances where we could enter into public-private partnerships, for example, on the infrastructure side. You could bring in funding from the private sector as well," Gordhan said.

Neither minister put a figure on the total cost of the scheme.

Motsoaledi told journalists that the proposed NHI was "not a war between the public and the private health care sectors".

If it was seen in this light, South Africa's people would be the real losers.

"The private sector is held up as an example of good service and quality of care - and this is mostly justified.

"What is not justified is the price tag that comes with certain forms of private health care provision.

"This is not only a burden to people using private health services, but a disservice to our country as a whole because it distorts pricing across the board," he said, adding that this was not sustainable.

Neither was NHI intended to destroy the private sector.

"It will actually make the sector more sustainable by making it levy reasonable fees,' he said.

It was also not the government's intention to abolish private medical schemes.

Pilot projects

Gordhan told reporters that a conditional grant would be allocated in the 2012 budget to fund NHI pilot projects, which would start next year, and run for five years.

Once implemented, the NHI will be one of the biggest changes brought in by the ANC since it came to power in 1994.

The government has begun auditing the country's health facilities in preparation for starting the NHI pilot schemes next year. These will be set up in 10 selected districts.

Motsoaledi said the pilot projects would help the department finalise the design of service benefits, and establish how the population would be covered and how the service would be delivered.

He said the selection of districts would be based on the results of the audits. Factors which would be taken into account included a district's health profile, demographics, income levels and other social factors that had an impact on health.

Motsoaledi said that over the next five years, the government intended strengthening the management of health facilities and health districts, improving quality, developing infrastructure and establishing the NHI fund.

He said it was too soon to say whether the government would do away with government medical aids after the project was fully rolled out.

He re-affirmed the government's commitment to appoint the right people in the right positions to ensure there was no abuse of the system.

"We will start with management," he said, adding that a plan would be detailed in a Green Paper to be made public on Friday.

The private health care sector has raised concerns about the introduction of the NHI.
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