Deputy Health Minister

National Health Insurance ‘not the end’ of medical schemes industry

DEPUTY Health Minister Gwen Ramokgopa has given a strong signal that the introduction of the National Health Insurance (NHI) will not spell an end to the medical schemes industry, a spectre feared by many middle-class consumers who have opted to pay for private medical care rather than deal with the uneven quality of services in the state sector.

"The medical schemes industry will still be with us for a while," said Dr Ramokgopa on the sidelines of the 14th annual Board of Healthcare Funders conference.

The government’s plans to introduce National Health Insurance (NHI) would not preclude anyone from continuing to purchase private health cover, she said.

National Health Insurance ‘not the end’ of medical schemes industry

DEPUTY Health Minister Gwen Ramokgopa has given a strong signal that the introduction of the National Health Insurance (NHI) will not spell an end to the medical schemes industry, a spectre feared by many middle-class consumers who have opted to pay for private medical care rather than deal with the uneven quality of services in the state sector.

"The medical schemes industry will still be with us for a while," said Dr Ramokgopa on the sidelines of the 14th annual Board of Healthcare Funders conference.

The government’s plans to introduce National Health Insurance (NHI) would not preclude anyone from continuing to purchase private health cover, she said.

Minister finally gets going with universal health plan

Motsoaledi picks up baton dropped by predecessors for more than decade to bring NHI to life, writes Tamar Kahn

NATIONAL Health Insurance (NHI) has technically been on the political agenda since 1994, when the African National Congress (ANC) proposed a mandatory insurance scheme in its health plan, but it has taken more than a decade for the issue to become headline news.

The Cabinet is expected to endorse a government policy on NHI at its next meeting early next month , a development anxiously awaited by business, consumers and healthcare providers alike.

Since the ANC took power, five government commissions of inquiry have agreed that health reform is needed. But the issue remained relatively low on the government’s agenda until 2007, when the ANC included NHI among the resolutions taken at its elective conference in Polokwane.

President Jacob Zuma ’s administration is under political pressure, particularly from the Congress of South African Trade Unions , to deliver on this commitment to universal access to healthcare.

Former deputy health minister Molefi Sefularo was given the job of driving NHI, which in September 2009 he promised would be in place within five years.

At the end of that year, Health Minister Aaron Motsoaledi announced a 25-member ministerial advisory committee on NHI, headed by Human Sciences Research Council CEO Olive Shisana.

Its work has been kept hidden from public scrutiny, and three members who this week spoke on condition of anonymity complained that Dr Shisana had declined to allow the committee members to see the final report she submitted to Dr Motsoaledi at the end of last year. She did not return messages requesting comment.

To date the only hints of how the government might implement NHI are those that emerged from the ANC’s national general council last September, when the ruling party released its own discussion document. The widely criticised plan, which promised free care at the point of service, raised questions about how the ANC’s health reforms would be financed .

It said NHI would be implemented over 14 years, starting next year , with the annual cost rising from R128bn to R376bn by 2025. The document came as a surprise to members of the committee, several of whom have told Business Day it had no hand in it.

Since then the Treasury has said it is looking at a variety of funding models for NHI, which include raising VAT (a move likely to be opposed by the unions), a dedicated payroll tax, and user fees. It is also proposing changes to the way medical scheme tax breaks are calculated, to make them fairer to rich and poor alike.

While the policy work has slowly ground on, the health minister has been steadily pushing a series of reforms that potentially lay the groundwork for NHI. This fiscal year, health gets 11,5% (R104bn) of the R907bn budget.

SA spends a greater proportion of gross domestic product on health (9% in 2008) than Brazil (8%), Russia (5%), India (4%) and China (4%), yet scores worse on indicators such as its maternal mortality rate and tuberculosis (TB).

The public health system in most provinces lurches from one crisis to the next. Clinics and hospitals lack basic supplies and equipment. They cannot fill vital clinical posts, and have had to contend with crippling public sector strikes.

The Democratic Alliance’s Jack Bloom’s regular press releases detailing the litany of woes confronting patients using Gauteng’s public health system may give the impression of the boy who cried wolf, but the problems he flags are grounded in grim reality.

Despite assistance from the Treasury to improve its budgeting, it still over-ran its budget last year by R104m.

Against this backdrop, Dr Motsoaledi is introducing a new office of standards compliance, which will accredit public and private-sector facilities. He plans to change the way primary healthcare is structured, introducing teams of specialists dedicated to each of the 53 health districts. He has persuaded medical schools to increase the number of students they train, and has taken steps to reopen the nursing colleges closed in the late 1990s. He is also intent on finding a way to put a cap on rising prices.

There is so much political pressure to implement NHI that the Cabinet is unlikely to scotch the latest proposals from Dr Motsoaledi . But in some ways it hardly matters if it does. The minister’s initiatives to improve the public health system and control costs in the private sector are so desperately needed that, if they are successfully implemented, they may in fact turn out to be NHI by stealth.

kahnt@bdfm.co.za

Funding for medical training flawed - Pandor Tamar Kahn Science and Health

Education Minister Naledi Pandor said yesterday that the current funding model for the training of doctors, dentists and pharmacists was fundamentally flawed, and urged Health Minister Manto Tshabalala-Msimang to help develop a co-ordinated system.

Marburg death toll in Angola reaches 280

The death toll from the outbreak of the Ebola-like Marburg virus in Angola has reached 280, most of whom succumbed to the disease in the northern Uige province, the health ministry and the World Health Organisation (WHO) said late on Monday.