Posted on Sep 24, 2010 by Sergio Ulloa
South Africa's ruling party, the African National Congress (ANC) has released more information regarding their plan to mandate universal access to healthcare through a National Health Insurance Scheme.
The Ministerial Advisory Committee on the NHI has produced a document providing a rough outline of the ANC's National Health Insurance (NHI) scheme, which is ready to be submitted to the ANC National General Council (NGC) for debate. The ANC's National Health Insurance plan aims to ensure access to healthcare is based on need rather than the ability to pay, with the intention of doing this through a single payer health insurance system. The initiative will take a community-centric approach, with a focus on local primary care networks rather than large-sized hospitals.
South Africa currently spends slightly more than 8% of GDP on healthcare every year, although most of that money is being spent through the private healthcare system, despite the fact that nearly 64% of the South African population relies upon the public system.
The new national health insurance program is expected to cost at least ZAR 128 billion (USD 18.1 billion) in the first year, rising to ZAR 376 billion (USD 53.15 billion) by 2025. Although according to Di McIntyre, the Director of the Health Economics Unit of the University of Cape Town, this would roughly equal the total amount spent on healthcare in South Africa. McIntyre also said that even with the NHI scheme and associated increases in healthcare use, hospital staff and resources over the next 10 to 15 years, healthcare expenditures would still remain at roughly 8% of GDP.
The South African treasury and the Ministerial Advisory Committee on the NHI, which is chaired by Dr. Olive Shisana, the CEO of the Human Science Research Council, has put forward a provisional model for funding the scheme, while they explore potential options. While the main source of revenue would be from South Africa's general taxation, additional financing may be sought through a surcharge on taxable income, an increased value-added tax (VAT) dedicated to the NHI, payroll taxes for employers and employees, and removal of the presently existing tax credit for medical aids.
The first phase of the project will be rolled out in 2012, and will focus primarily on bringing services to areas with little or no access to quality healthcare. A number of other key areas of attention for the initial roll-out are being discussed in closed chambers by delegates at the NGC. These include investing and rebuilding the country's public health infrastructure, developing human resources programs to fill the national shortage of qualified health workers, and establishing a national health fund that would be ensconced in the Ministry of Health but operate autonomously, much like the South African Revenue Service in the National Treasury.
Officials are also looking at electronic medical records, such as the e-health system that Singapore has been developing, as a way to manage to reduce the associated management costs of the healthcare system. Members of the Ministerial Advisory Committee were also quick to point out that affluent South Africans would still be able to use private healthcare, through the purchase of private medical insurance and use of private hospitals.
As the Ministerial Advisory Committee has now submitted their proposed program to the ANC National General Council for debate, it will be interesting to see how the continuing process, as government officials are encouraging input from stakeholders in the debate, with ANC Spokesperson Jackson Mthembu saying "If there is one organisation that likes to have people involved in what it does, that's the ANC. We welcome your contributions on this matter."