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NHI: How is government going to solve the public-health puzzle?

Article that was published in Financial Mail on 24 August 2017 – Marie has highlighted some information for the hasty readers

Financial Mail 24 August 2017 – There is still uncertainty about just how government’s NHI plan will be implemented. Some proposals, such as getting private health-care workers involved in the public sector, have raised eyebrows.

The department of health finally has some sort of answer for where it will get the R256bn to fund National Health Insurance (NHI): from cutting staff in the department and slashing the number of medical schemes. However, the exact figure needed to fund the NHI is not yet certain. Health minister Aaron Motsoaledi has gone back on the R256bn figure outlined in the NHI white and green papers, saying it is too "linear" and "relies on too many variables". He says the department has heeded World Health Organisation advice against committing to specific costs of universal health coverage. Motsoaledi says that having each province run its own administration is not working because it duplicates services and raises costs unnecessarily. He says centralising and reshuffling the health department will streamline how all departments and budgets are run, and prepare the ground for NHI implementation. At the same time, the department wants to hire well-paid private health-care staff and bring them into public service under NHI. But not only are the pay scales in these sectors worlds apart, the public sector also offers few incentives to health-care professionals. One thing the minister is certain about is that implementing the first five programmes of the NHI — designed to cater for the disabled, children, the elderly and pregnant women, and provide mental health-care services — will cost about R69bn over the next four years. He says the money for this will come from the tax credit incentives currently enjoyed by medical schemes. Motsoaledi has calculated that, over the same four-year period, medical schemes will cost government R80bn. It’s not just public health that is going to be restructured; it’s the private sector, too. Motsoaledi says medical schemes are collapsing on their own, and they need to adopt the NHI single-buyer, single-payer model. "If all schemes use the public tender system, they could save R2bn," the minister says. In 2015, schemes incurred a combined deficit of R1.2bn, up from R456m in 2014. Bonitas, the Government Employees Medical Scheme (Gems) and Bankmed were identified as among those with the highest net health-care deficits. The proposal is that small schemes with fewer than 6,000 members, as well as Gems and other state medical schemes, be merged into a single structure, reducing the number of schemes and trimming the number of options available in medical schemes. Discovery Health CEO Jonathan Broomberg says while larger schemes tend to have larger, more stable risk pools than smaller schemes, many smaller schemes are stable, have strong reserves and provide excellent benefits for their members. "Any process of consolidation will therefore have to be carefully defined and implemented to ensure that it is in the best interests of all [affected] members, and also is fully compliant with applicable legislation," he says.