Plans for new dispensation speeded up

Deputy Health Minister Dr Molefi Sefularo has surprised the private healthcare sector by revealing that the government intends speeding up the policy-making process to establish a National Health Insurance (NHI) plan in South Africa by the end of this year, with legislation to give effect by April next year. Industry stakeholders fear that the sped-up policy process will sacrifice adequate industry consultation, leaving private sector stakeholders out in the cold.

The proposed NHI plan will be complex and has already led to much debate and controversy. However, to date the government has not yet begun the process and no Green Paper has been produced. But Sefularo says the green-to-white-paper policy process will be completed by the end of the year.

The deputy minister also rejected industry fears about the consultation process and assured a conference of the Board of Healthcare Funders (BHF), representing 95% of southern Africa’s medical schemes, that the NHI plan would be implemented in a phased manner allowing for adequate consultation, policy-making and review of legislation.
A policy submission is being prepared by the Health ministry in consultation with other members of the Cabinet and relevant government departments, and will be submitted to the full Cabinet for approval, before being released as a Green Paper for public debate and stakeholder consultation.

However, effectively there are only 11 weeks left in which to complete this entire process, as Parliament goes into recess on 20 November, reopening only in February, when all activities are focused on the State of the Nation address and the Budget, allowing only March thereafter for further policy and legislative processing of the NHI plan.
A key issue that still awaits clarification by the government is the affordability and sustainability of such a plan, which will be immensely costly. To date, the only available document providing some insight into what the government is planning, is a policy discussion document drafted by a task team of the African National Congress.
That document outlines in broad terms the policy aim of providing all citizens with access to public and private healthcare facilities without paying fees. It envisages funding to come from two primary sources, namely a personal income tax contribution of 3% to 5% and tax revenue.

Critics of the NHI plan and the sudden short time frame for its completion point out that nothing has come so far of the government’s proposed compulsory social security scheme. That is despite it having been announced with time frames and all in the February presidential State of the Nation address, and despite extensive work done on it by government departments and despite wide consultation having taken place.

Sefularo also urged private sector healthcare stakeholders to visit the website of the South African Government Communication and Information System (GCIS) to access the Program of Action of the Human Development Cluster, which provide the details of the 2009 Health POA.

However, that document merely states under the heading of “Better healthcare”, that: “To improve public healthcare provision, government’s main aims are to boost human resource capacity, revitalise hospitals and clinics and step up the fight against the scourge of HIV, Aids, TB and other diseases. Working together with communities, government plans to improve the implementation of the Comprehensive Plan for the Treatment, Management and Care of HIV and Aids to reduce the rate of new HIV infections by 50% by the year 2011. Government wants to reach 80% of those in need of antiretrovirals by 2011. Government will introduce a National Health Insurance (NHI) scheme in a phased manner. To initiate the NHI, the urgent rehabilitation of public hospitals will be undertaken through public-private partnerships. The remuneration of health professionals at public hospitals is also being looked at urgently.”

Relevant Documents:
To read the ANC’s resolution on health adopted at the ANC’s national conference, Polokwane, December 2007, go to:
http://www.anc.org.za/ancdocs/history/conf/conference52/index.html
In June this year, the ANC published an article in its online newsletter, ANC Today, about its envisaged NHI plan, which is available at:
http://www.anc.org.za/ancdocs/anctoday/2009/at24.htm#art2
Another article on the NHI plan was published by the ANC in July and is available at: http://www.anc.org.za/ancdocs/anctoday/2009/pdf/at29.pdf