Green Paper on NHI
Health Minister Aaron Motsoaledi launched the Green Paper on the National Health Insurance (NHI) during a post-Cabinet media briefing in Pretoria on Thursday, 11 August 2011.He described these first steps towards establishing the national health insurance as “truly historic”. The minister made it clear that the NHI is seen as a 14-year project and that the first five years will consist of a process of building and preparation to give effect to NHI.

The cornerstone of the proposed system of NHI is universal coverage. NHI is a financing system that will ensure the provision of essential healthcare to all citizens of South Africa (and legal long-term residents) regardless of their employment status and ability to make a direct monetary contribution to the NHI Fund. This is the essence of NHI.

Key areas that the Green Paper covers:

•    Membership of NHI
•    Contributions to NHI
•    Healthcare benefits, services and exclusions
•    The role of medical schemes and private healthcare
•    Quality of healthcare
•    Resource management

What will happen in the first five years of NHI implementation?
The first five years of NHI will include pilot studies and strengthening the health system in the following areas:

•    Management of health facilities and health districts
•    Quality improvement
•    Infrastructure development
•    Medical devices, including equipment
•    Human Resources planning, development and management
•    Information management and systems support
•    Establishment of an NHI Fund

The purpose of the Green Paper is to outline the broad policy proposals for the implementation of NHI. The document is published for public comment and engagement on the broad principles. After the consultation process, the policy document (or White Paper) will be finalised. Thereafter, draft legislation will be developed and published for public engagement. After public engagement, the legislation will be finalised and submitted to Parliament for consideration. After Parliamentary approval, the Bill has to be approved by the President of the Republic.

Medical aid fees to guide NHI payments

The yardstick for how much people will pay for national health insurance (NHI) is their current contribution to medical funds.

Dr Yogan Pillay, deputy director general for health, told the parliamentary standing committee on budgets that the plan for the NHI system was to try to ensure that individuals do not exceed their current medical aid costs.

Pillay said that revenue sources for the NHI need to be as broad-based as possible, so that smaller contributions are required. He said that the cost of the NHI, at R255bn in real terms (what it would cost today), was merely an estimate.

NHI could be a tax squeeze

The small size of the tax base is the most difficult issue that will have to be addressed in finding a way to fund National Health Insurance (NHI) by way of a compulsory contribution, an actuarial science professor warns.

A large proportion of the country’s taxpayers is concentrated in the middle-income group with a taxable income of R150 000 to R300 000 a year, Professor Heather McLeod, Extraordinary Professor in the Department of Statistics and Actuarial Science at the University of Stellenbosch, says.

If a compulsory NHI contribution is introduced on a sliding scale at a rate of between one and eight percent of taxable income – the rate proposed by the African National Congress – middle-income earners may have to be taxed at the higher end of the sliding scale to raise sufficient revenue, she says.

Discovery strongly supports rollout of NHI

Health insurer Discovery Health said on Thursday it strongly supports the rollout of a National Health Insurance system as it believes that South Africa needs healthcare reform to ensure a comprehensive healthcare system for all South Africans.

Commenting on the recent release of the Department of Health’s Green Paper – the policy proposal for the implementation of comprehensive National Health Insurance (NHI) for all South Africans – Discovery group CEO Adrian Gore said the policy proposals set out were rational, appropriate and bold.

“Importantly, they seek to address human resource shortages in the healthcare system, raise additional revenue for healthcare delivery and recognise the role of both the public and private healthcare sectors,” Gore stated.

He added: “Discovery Health is confident that if properly executed, South Africa’s healthcare system will be strengthened. Discovery Health remains confident of its role in this emerging environment.”