by Blum Khan

A healthy nation

National Health Insurance realities

The road to healthcare.
Better healthcare for all

National Treasury has previously indicated that they are considering various funding options, from a payroll tax to higher value-added tax to a surcharge on income tax. At this point, it still appears that mandatory employee and employer contributions will be a necessary feature of a successful NHI. This clearly has implications for employees and employers alike.

According to the green paper, private providers will be allowed to choose whether or not they become an accredited NHI supplier, while medical schemes will be able to continue to exist as long as there is demand for their products. The NHI green paper also highlights the importance of primary healthcare as an essential foundation for sustainable NHI. 

Implementation of NHI has been somewhat slower than anticipated in the green paper. The white paper has not been finalised and we still await the discussion document on funding options. The latest indication from Treasury is that they expect to publish the delayed discussion document on funding options for NHI before the next budget. Despite delays, progress towards NHI implementation has been made in a number of areas.

NHI pilots

Following the 2012 budget allocation of a conditional grant of R1-billion for NHI pilot projects and increasing primary healthcare visits, NHI pilots launched in 11 districts. The NHI pilot projects focus on improving district health systems and testing their ability to assume the greater responsibilities that will be required under NHI. 

The ‘service packages’ of primary health will be delivered by teams of specialists as well as contracted private healthcare practitioners who will focus on improving service delivery and referral mechanisms. School-based primary care services are also a key component of primary healthcare restructuring. The Integrated School Health Programme (ISHP) was recently launched in Tshwane, one of the 11 pilot districts. 

Changes in tax relief for medical scheme contributions

As part of the process for achieving greater equality in the treatment of medical expenses across income groups, the first phase of the tax credit system came into effect 1 March 2012. The shift to tax credits is expected to facilitate the transition to a NHI framework in which the contribution from the tax system is equitable, limited and likely to be less than, or in line with, the insurance costs per person under NHI. 

Looking ahead

There is broad consensus that medical schemes need to remain viable well into the future.  Even post full NHI implementation, a well-regulated medical scheme and health insurance market is likely to be one of the essential building blocks for creating universal coverage. 

The green paper indicates that individuals will be free to choose whether they 'top-up' the NHI package through medical scheme membership that provides access to benefits – and providers – not funded through NHI. The extent to which this choice will be exercised will depend on affordability constraints and perceptions of the quality of service within a revamped public sector. 

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Issue 16


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