CAPE TOWN — The Cabinet is expected to approve the government’s policy document on National Health Insurance (NHI) at its meeting next month, government spokesman Jimmy Manyi said yesterday.
It is potentially the most expensive policy change advocated by the African National Congress since it came to power.
The policy has been anxiously awaited by business, consumers and health practitioners as it is expected to reform the way state health services are provided for and financed. The private sector will be looking for signals about its future role, while consumers and employers are anxious to know if they will pay more taxes.
The government is under political pressure from its allies in the tripartite alliance to deliver on its promise to introduce the NHI to provide universal access to quality healthcare.
Health Minister Aaron Motsoaledi has made it clear that he is intent on regulating private sector prices to contain costs and provide certainty to funders — including medical schemes and the state.
In February, Dr Motsoaledi said an inter-ministerial committee had approved an NHI policy document and it was poised for endorsement by the Cabinet .
Mr Manyi said yesterday that the Cabinet had raised questions about the contents of Dr Motsoaledi’s February report, and this input had now been accommodated by the health department.
"It’s ready," he said . "At the next Cabinet (meeting) it will be tabled for final endorsement. The only delay has been caused by the various travels by the minister."
Ministerial spokesman Fidel Hadebe said yesterday that Dr Motsoaledi had taken personal charge of all communication on NHI . Dr Motsoaledi was travelling back from China yesterday.
Three independent sources on the ministerial advisory committee on NHI said yesterday that they had been kept in the dark about the document’s contents.
Independent health economist Alex van den Heever said all that had been proposed on NHI was a "crude tax-and-spend approach" equivalent to 5% of gross domestic product, mixed in with the introduction of a centralised "fund".
"This is miraculously supposed to compensate for the myriad of performance weaknesses in the generally corrupt and dysfunctional public health system, which lacks a coherent governance and accountability framework.
"The technical rationale for these proposals has been extremely weak and has relied almost exclusively on differences in per capita spending between privately funded medical scheme beneficiaries and the general tax-funded public sector," he said.
"Somehow the South African population is expected to accept the reasoning that the institutional failures of the public system are due to high private spending on medical schemes.
"Hopefully, this absurd reasoning, prevalent within all public utterances and documentation on NHI to date, will have been excised from any publicly released government document."
Mariné Erasmus, an economist at Econex, said she hoped to see details on service delivery models and financing, but was unsure this information would be included at this stage. "Since the NHI will be phased in over the next 14 years, we do not expect the entire system to be finalised," she said.
Mark Heywood, director of the health advocacy group Section 27, said the underlying issues that drove the government to propose an NHI — how to finance and provide universal access to healthcare — were becoming "graver with each passing month".