KwaZulu Natal joins the NHI roll out wagon

NHI on cards for two areas in KwaZulu-Natal

KwaZulu-Natal would roll out the National Health Insurance (NHI) in two districts this year, Premier Zweli Mkhize said yesterday. “At long last, after so many years it fills me with joy to proclaim that the NHI is here. And it is here to stay,” he said. The two districts would be announced by Health MEC Sibongiseni Dhlomo.

The premier said the government was sorting out compliance matters from national, provincial and local government levels ahead of the roll out.KwaZulu-Natal will roll out the National Health Insurance (NHI) in two districts this year, premier Zweli Mkhize said on Tuesday.

“At long last, after so many years it fills me with joy to proclaim that the NHI is here. And it is here to stay,” he said in his state-of-the-province address.

The two districts would be announced by health MEC Sibongiseni Dhlomo.

The premier said the government was sorting out compliance matters from national, provincial and local government levels ahead of the rollout. The NHI would require sufficient staff, especially nurses.

“The vacancies of all nursing posts in hospitals and clinics must be filled and training of nurses fast-tracked. Without this the NHI will be doomed to fail.”

The health department describes the NHI as a financing system that will ensure all South Africans have access to healthcare, regardless of their employment status and ability to contribute to the NHI fund. - Sapa

Source : iol.co.za

Tags : nhi,nhi natal, nhi kwazulu natal, national health insurance, nhi roll out

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Department of Health on NHI issues in SA

Cape Town - The Department of Health has embarked on a massive audit of clinics and hospitals in preparation for the implementation of the National Health Insurance (NHI), the Minister of Health Aaron Motsoaledi said today.

Briefing media in Parliament on Thursday, Motsoaledi said so far the audit, which looks at cleanliness, safety and security, drug stock count, long queues, infection control and the attitude of staff at clinics, had addressed 3 336 of the department's 4 200 health facilities.

The attitude of staff and cleanliness were two of the biggest problems, he said, adding that the department this week had trained a team of 40 health experts to prepare them to provide assistance in improving health facilities.

Motsoaledi said the department would start with four districts and 214 facilities in KwaZulu-Natal, Gauteng, the Free State and the Northern Cape. These districts are: Zululand (KwaZulu-Natal), Sedibeng (Gauteng), Motheo Free State), and Pixley ka Seme (Northern Cape).

He said his department was also refurbishing nursing colleges and homes to increase the capacity of these colleges to produce more nurses.

In all, 122 colleges had been targeted and 49 colleges were already being refurbished.

Motsoaledi said his department was still tackling the problems of the Gauteng Provincial Health Department, particularly in its non-payment of service providers.

He said he had held conversations with the Minister of Finance Pravin Gordhan to ensure that provincial health departments had to fulfil certain non-negotiables when allocated funding from the Budget.

This could be for example to ensure that provincial health department's set aside allocations for such areas as immunisations of key infections, he said.

Turning to HIV and Aids, he said the mother-to child infection rate for HIV and Aids had dropped from 8 percent in 2008 to 3.5% last year, for children born to mothers infected with HIV.

This had helped to save 30 000 babies per year - most of these in KwaZulu-Natal, he said.

He also called on South Africans to get tested for HIV and Aids at least once a year.

The department would also be tackling non-communicable diseases, such as alcohol and tobacco abuse.

He said South African government's regulations against smoking had already resulted in a sharp drop in smoking over the last few years.

"We have to deal with the scourge of alcohol advertising where this is projected as product bringing success," said Motsoaledi, who pointed that adverts often depicted images of success and a depiction that drinking was "cool" for young people.

A more difficult issue, he confided, was how to get South Africans to exercise more and to mind their weight. -

Source : buanews.gov.za
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National health insurance funding debacle

After the South African Government released its long expected Policy Paper on National Health Insurance (Policy Paper) (NHI) funding on 11 August 2011, quite a few questions remained unanswered.


According to the Policy Paper, Government planned for an additional R145 billion funding requirement in real 2010 prices for the roll-out of NHI over the next 14 years. 

The expectation is that these additional funds will be sourced through increased tax revenues. An additional R15 billion is needed over and above the Medium Term Expenditure Framework (MTEF) estimated health budget for the implementation of NHI in the 2012/13 financial year. 


This represents an increase of 14% in the MTEF budget estimate and will bring the health budget from the original estimate of R110 billion to R125 billion in the 2012/13 financial year. Over the entire roll-out period, the estimate equates to an average of R10.4 billion in additional funding in real 2010 prices being required every year. 


Some of the funding mechanisms currently being discussed include a potential increase in the VAT rate, a surcharge on individuals' taxable income and the phasing in of a payroll tax (payable by the employee). 


When governments consider increasing tax rates to fund a new policy decision, it is not a straightforward decision. Factors such as equity, efficiency, flexibility, ease of administration and collection and potential revenue should be taken into account. 


Questions around equity will centre on whether or not the tax promotes an equitable or fair distribution of income. This would typically speak to the regressive or progressive nature of taxes. The debate round VAT, and those opposed to it, is that it is regressive in nature, meaning it affects the poor relatively more than the rich. 


On the other hand, proponents of VAT as a source of funding feels the tax base is broadened and that everybody can contribute. By zero-rating certain necessary items, the regressive nature of VAT is also reduced and it is relatively cheap and easy to administer if compared to income tax. 


Due to the broader nature of the tax base, research conducted by KPMG on the nature of a tax increase to fund NHI through VAT or through personal income tax, also indicated that increasing VAT might have a slightly less distorted nature. However, due to the socio-economic make-up of South Africa, changes in the VAT rate can and should be carefully considered. 


There is another, less common alternative. Many people believe that increasing the tax on cigarettes and alcohol could and would discourage harmful behaviour and, in turn, improve the population's health. From that perspective, it makes sense to use sin taxes as a potential source of funding for public health policy initiatives. In addition, sin taxes also serve as a source of revenue and are considered by some analysts to have less distortionary effects than other types of taxes. 


On the downside, research indicates that sin taxes might be regressive in nature and if the consumption of taxed products actually reduces on the back of the introduction of sin taxes, it might have a negative impact on the estimated revenue. Increasing sin taxes, on the face of it a potentially reasonable alternative, might therefore have other, unintended consequences that the Fiscus might like to avoid. 


Finally, it is important to consider that tax revenue in South Africa goes into one pool and are normally not ring fenced. The policy stance is unlikely to change with the introduction of NHI. Therefore, no matter the tax revenue source considered, the funds will be paid from the same pool of tax revenue. 


The question remains - who will contribute and how much? 


* Lullu Krugel is an Associate Director and Senior Economist at KPMG 

Source : businesslive.co.za
Tags : health insurance , insurance South Africa,national health insurance,NHI, insurance news, gr8insurance

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Huge price tag to run NHI in SA

Plans to roll out national health insurance should not be seen as a declaration of war on the private health sector, but an attempt to design a system that works, using existing resources, to provide affordable care for all.



Announcing Friday’s release for public comment of the green paper that spells out broad policy proposals for the scheme, Health Minister Aaron Motsoaledi said: “The NHI is not a war between the public and private health care sectors – it’s not even a competition between these two health care delivery systems.

National Health

“If we view matters in this light, and try to tear each other apart, the people will be the real losers.”


Pilot projects would be launched in 10 districts in April, the start of what Motsoaledi calls a crucial five years in which the management, staffing, infrastructure and equipment at public facilities would be overhauled and an NHI fund set up. The entire roll-out would be phased in over 14 years. Motsoaledi said the first five years would be the “most complex”.


Establishing a NHI service was agreed on at the ANC’s 2007 Polokwane congress, and President Jacob Zuma’s administration is under pressure to deliver amid mounting public dissatisfaction with the ailing public system.


Questions about the NHI’s costs were referred to Finance Minister Pravin Gordhan.


He said the R125 billion price tag mooted for the first year – and cited in the green paper – was only “indicative” as “a linear projection of what it will cost once the pilot projects are under way”.


“There’s money in the system at the moment,” Gordhan said. The details would have to be “worked out” during the pilot period.


There were many ways of rationalising costs, he said.


Infrastructure projects would include six new referral hospitals, Motsoaledi said, and would cost “more than the 2010 World Cup stadiums”.


Putting “the right people in the right places” would be crucial.


Motsoaledi said he would soon announce the country’s first health human development strategy “that will show clearly who needs to be where and how they are going to be trained” – including doctors, nurses, pharmacists and allied health professionals.


Hospitals would be redesignated as district, regional, tertiary, central or special – for treating tuberculosis, for example – in a uniform system, with the employment of managers who had the correct qualifications, for appropriate pay.


Motsoaledi said one of the reasons for the poor quality of public health care was that “anyone can wake up and think they want to run a hospital”.


“That’s one of the things we have to change if we want a good health care system,” he said.


South Africa spent 8.6 percent of its gross domestic product on health – far beyond the 5 percent recommended by the World Health Organisation – an average of R2 700 a person a year.


That health outcomes were so poor showed there was something very wrong with the system.


The quality of care in public health facilities was “often totally unacceptable”, and “radical measures” were needed to correct this.


“But we need to appreciate the sheer scale of the service provided by public health facilities in ensuring care for 84 percent of our people who totally depend on these facilities.


“In many cases this involves a heroic effort day in and day out by men and women in our hospitals under very trying conditions.”


While the private sector was held up as an example of good service and quality care, the price tag that came with this was “not only a burden to people using private health services, but a disservice to our country as a whole because it distorts pricing across the board”. There were clear signs that this might, in the long term, be unsustainable, Motsoaledi said.


The challenge was to get the best out of both systems. “(With) this green paper on NHI we’re making a real effort to design a system that works with the resources we have and build on these.” Even if it was affordable, extending the current model of private care to all citizens would overwhelm the sector.


“The bulk of South Africa’s health infrastructure resides in the public sector and our task is to overhaul it so that people will choose to go to public facilities once they have options.”


While this might sound impossible, it could be done, Motsoaledi said. Not too long ago, public hospitals were an automatic choice for people who could afford private care.


Achieving NHI would be a “long journey” and “at times things will be tough”, Motsoaledi cautioned.


For the scheme to be viable, the quality of service at public sector facilities had to be improved. Private health care pricing had to be tackled equally seriously. - Political Bureau


Source -http://iol.co.za
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Raising South African taxes for NHI - not good

Raising taxes to pay for NHI ‘premature’

Before the government considers raising taxes to pay for national health insurance (NHI), it should meet its own promise to allocate 15% of its budget to health.

CAPE TOWN — Before the government considers raising taxes to pay for national health insurance (NHI), it should meet its own promise to allocate 15% of its budget to health in line with the Abuja target, according to University of Cape Town health economist Prof Di McIntyre.

The government also needed to improve public health facilities and win the trust of the public before increasing the tax burden, she said ahead of today’s publication of a European Union- funded study on the financial implications of alternative scenarios for health sector reform.

The study concludes that an NHI-style model was the most affordable.

“I don’t believe people should be asked to pay the tax until they see tangible benefits,” said Prof McIntyre, who is also a member of the ministerial advisory committee on the NHI, set up by Health Minister Aaron Motsoaledi last year.

The Abuja target was set by African heads of state in 2001 and reaffirmed this year in August in Kampala. SA still has a considerable way to go to meet this goal, as health got just 11,5% (R104bn) of the R907bn budget for the 2011- 12 fiscal year .

Prof McIntyre’s comments follow the release last month by the African National Congress (ANC) of a discussion paper on NHI, and add to the debate about health sector reform.

The ANC is proposing the introduction of a central fund to pay for public health services, financed by increased government spending of up to 14,5% of the national budget, a mandatory NHI contribution of up to 8% (split between worker and employer), and possibly increasing value added tax. The party is proposing to phase in NHI over 14 years, starting in 2012, and projects costs will rise from R128bn to R376bn by 2025.

The Strategies for Equity in Less Developed Countries study examined health inequalities in Ghana, SA and Tanzania and investigated how these gaps could be closed by reforms.

In the South African component, Prof McIntyre and her team modelled the costs of phasing in three different scenarios over 15 years: leaving the status quo unchanged (with about 16% of the population belonging to medical schemes), introducing mandatory medical scheme membership for everyone in formal employment, and an NHI-style “universal coverage” model which would have more people relying on state- funded healthcare.

It concluded that the most affordable option for SA would be the “universal coverage” model.

This would require public spending on health of between 5% and 24% of gross domestic product (GDP) by 2025, with the “best guess” being 6,4%, said Prof McIntyre. The wide cost variation was largely due to different estimates of the unit costs of services. If the “best guess” scenario was introduced today it would cost R196bn (with R102bn coming from the public purse) and rise to R394bn (with R295bn from public funds) by 2025 in current terms. In this scenario, administration costs would be tightly controlled, and unit costs for services would be lower than current private sector rates.

Under this scenario, medical schemes would continue to exist but with a smaller membership base, and so they would account for spending equivalent to 2,2% of GDP by 2025. About 40% of medical scheme members would be likely to drop out. About 8% of SA’s GDP is spent on health at present, said Prof McIntyre.

The range of services offered by the state under this scenario would have to be limited, she said. “There is going to be rationing,” she said, implying that those who could afford to would continue to buy from the private sector the services not provided by the state. “There is rationing in the (UK) National Health Service, there is rationing everywhere.”

Source - Businessday.co.za

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Momentum Health to increase premiums

Momentum CEO Anthon Swart said: "Research shows that all over the world where NHIs are put into place there is always a certain percentage that will opt for private healthcare."

Swart said that in South Africa the percentage of private medical aid members had risen above that figure: "In South Africa, it's gone up in the past two years to between 16% and 17%."

But University of Cape Town health economics professor Di McIntyre said NHI would affect the medical schemes. "How it impacts our medical schemes depends on the changes. If really good services are provided under a universal system it's quite likely that some of the current medical scheme members will decide to opt out."

However she said the number of people who would opt out of private healthcare depended on the level of service provided. "If bad health services are provided people will stay in private medical schemes."

But Swart said it was too soon to tell how many could opt out because "official policy documents still need to be circulated".

Speaking at a briefing in Johannesburg yesterday, Swart also predicted that mergers in the South African medical scheme environment would continue.

"There is pretty much consensus that we'll see much consolidation in the medical scheme environment," he said, adding that there had been a 40% reduction in the industry of registered schemes.

Ingwe Health Plan (15219 principal members) merged recently with Momentum Health (75508 principal members) whose holding company Momentum joined with Metropolitan.

The Government Employees Medical Scheme has been one of the contributing factors to the challenges pressurising the industry, said Swart.

Gems has grown significantly from only 91800 beneficiaries in 2006 to the third-largest medical scheme in South Africa.

Gems said on its website that the firm's fast growth is "due to cannibalism from other medical schemes, but more than half the government scheme's growth so far has been from people who were not on a medical aid before."

I-Net Bridge reports that the Competition Tribunal will rule tomorrow on the proposed merger between Metropolitan and Momentum.

Metropolitan intends to acquire 100% of the issued share capital of Momentum and has applied to the competition authorities for approval of this merger.

The transaction will affect the long-term insurance, medical insurance, retirement fund administration, asset management and property investment markets.

The proposed transaction has a significant public interest component, given that a large number of jobs might be made redundant as a result of the merger.

The majority of the employees of the merging parties are represented by employee representatives. Nehawu represents about 6% of the employees of Momentum.

The merging parties, however, have made certain undertakings in an attempt to lessen job losses. The Competition Commission has recommended to the tribunal that the merger be approved subject to employment-related conditions.

The tribunal was not satisfied with the limited employment-related information submitted to the commission and has, in a pre-hearing of September 15, requested a more information relating to potential employment effects from the merging parties. The anticipated employment effects and proposed conditions will be further addressed at the hearing. 

Source - timeslive.co.za

- Additional reporting - I-Net Bridge

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NHI plan to be presented to British advisers

UK to give advice on NHI

Health officials will meet former NHS chief

Oct 3, 2010 11:26 PM | By HARRIET MCLEA 

---

Implementation of National Health Insurance (NHI) will "get a step closer" this week after more than a decade of planning.

Health ministry officials are expected to meet British advisers on Wednesday to learn from their experience of the National Health System.

This follows a decision by the ANC at its national general council meeting that the health department would need an additional R11-billion in 2012, the first year of the NHI's implementation. It is to be implemented in phases from 2012 over a 14-year period.

Director General of the National Department of Health Precious Matsoso said the UK was "a good example of a country that has dealt successfully with problems of quality in the health care system".

Former chief executive of the NHS, Lord Nigel Crisp and the British High Commissioner to South Africa, Dr Nicola Brewer will attend the meeting described as an "international consultative workshop on quality improvement." Matsoso said it was an opportunity "to learn . how health services can be delivered based on principles of honesty and respect, and how to promote a culture of safety, quality, openness, accountability and collaborative teamwork ...

"We can also learn . how they introduced appropriate standards, enhanced safety of patients, and promoted public participation..."

The meeting will look at creating benchmarks for standards in six "priority areas":

• Patient safety;

• Infection prevention and control;

• Availability of medicines;

• Reduction of waiting times;

• Cleanliness;

• Healthcare worker attitudes;

• Values and motivation;

Speaking at a Gauteng Health Department forum last week, head of community health at the University of Pretoria, Professor John Matjila said he hoped the NHI would mean a change in attitude to caring for patients. ''Hopefully it will not just provide resources but also improve [service to patients]."

Source -iol.co.za

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