NHI an African health road map

There seem to be a new wave in Africa health as South Africa follow the likes of Rwanda  to put in place  robust health insurance for her citizens.  South Africa government has launched a new policy to restructure the current national health insurance policy which has been heavily criticised by its citizens. 

The current NHI is two-tiered, with a relatively large proportion of funding allocated through medical schemes, various hospital care  plans and out of pocket payments. This current funding arrangement provides cover to private patients who have purchased a benefit option with a scheme of their choice or as a result of their employment conditions. It only benefits those who are employed and are subsidised by their employers – both the State and the private sector. 

The other portion is funded through the fiscus and is mainly for public sector users. This means that those with medical scheme cover have a choice of providers operating in the private sector which is not extended to the rest of the population. This arrangement is deemed to be inequitable, with the privileged few having disproportionate access to health services.

The new NHI entails major changes in the service delivery structures, administrative and management systems. It is aimed at introducing an innovative system of healthcare financing with far reaching consequences on the health of South Africans. It will ensure that everyone has access to appropriate, efficient and quality health services. It will be phased-in over a period of 14 years.

If the NHI policy is well implemented it is believed that it will usher a new era in South Africa healthcare addressing some injustices of the past.  Recently, the hospitals and specialists were targeted to be driving up  cost of healthcare because the hospital groups seem to have  formed “an oligarchy and wielded market power”. In addition, there was no price structure for healthcare services, allowing providers to charge at any rate they pleased.

Source : africahealthitnews.com
Tags : NHI, national health, africa health, health road map

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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
Tags : HIV, Aids,health insurance , insurance South Africa,national health insurance,NHI, insurance news, gr8insurance

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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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New plan for SA doctors in public sector

Health Minister Aaron Motsoaledi on Tuesday announced a healthy R1.24-billion would be spent to "revitalise nursing colleges" and improve infrastructure to train more nurses, as part of the department's new human resource policy. 


Motsoaledi unveiled the health department's first human resource strategy to deal with the country's severe shortages of doctors and nurses, at the University of Witwatersrand's medical school in Johannesburg.


He had promised to address staff shortages in the public healthcare sector, when he unveiled the national health insurance green paper in August. 


Department spokesperson Fidel Hadebe said nursing colleges standing empty would have to be fixed up so that they were fit for use.


"For the current financial year we will spend in R220-million, and R510-million each in subsequent years," Motsoaledi said. "Even if Wits University takes an extra 1000 [medical] students it would not meet our needs."


He said the shortage of healthcare professionals extended beyond South Africa and there are currently four million vacancies globally.


South African universities currently train 1200 doctors each year. 


Training more staff


The plan proposed an increase in the number of medical students trained every year; investing more money in training facilities and nursing colleges; and building a new medical school in Limpopo. It also suggested a focus on primary health care by increasing nurses in schools and municipalities to prevent people from going straight to hospital. 

Doctors

Earlier this year Motsoaledi asked the deans of South Africa's medical schools to train 40 more students per year. He said Wits University was the first to do so by taking in an extra 40 at the beginning of the year at the cost of R8-million.


The Wits' medical faculty dean, Professor Ahmed Wadee, said the country was short of every type of medical specialist and it would take a long time to fix because it took "six to eight years to train specialists after they had qualified as doctors".


South African Medical Association president Dr Norman Mabaso previously told the Mail & Guardian the country had 24 000 doctors in 1990, while in 2008 this had only increased to about 34 000. It took 18 years to produce 10 000 doctors, which he said was unacceptable.


A short-term solution from the health department included employing 400 retired nurses willing to work. Motsoaledi said they told him "they are retired but not yet tired".


Private vs Public


Motsoaledi echoed this sentiment and said bad planning was to blame for the predicament South Africa finds itself in. 


"Some problems are self-made," he said. "Further evidence indicates that the training and production of certain key health worker categories have stagnated or reversed over the years. The weak management skills in the public service aggravate the situation even further."


Motsoaledi said that staff did not like to work in the public sector and more had to be done to make sure management of hospitals were up to scratch.


"Studies have demonstrated that it is not only financial incentives that make them leave but sometimes how they are managed or mismanaged. The public health sector has to ensure that environment in which health workers operate is conducive," he said. 


Motsoaledi said in order for national health insurance (NHI) to work, there had to be enough staff distributed equitably around the country.


The NHI green paper policy document, released in August this year, mentions that there is a disparity between numbers of staff in the public sector and those in the private but does not address how to change it.


Despite his frequent complaints about the over-commercialisation of medicine, Motsoaledi dodged a question about how the ministry planned to attract health care workers from the private sector back to the government sector. 


The minister was critical of the costs of private health care and said many people told him he was mad about wanting to fix the public health care sector. "I will not stop this madness of mine," he told audience.


"People tell me the health care sector is not going to work but it has to work -- 84% of our population rely on the public health care sector."


The NHI policy document that the minister launched was also critical of private health care and suggested prices on private industry needed to be regulated.


The document noted that private hospital costs have increased by 121% and specialist costs by 120% over the past decade. It targets those increases as unacceptable and "out of proportion" to the services provided, suggesting that pricing in private healthcare needed to be "radically transformed".


Source : http://www.mg.co.za
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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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Douglas Ramaphosa assisting NHI plan success

DOUGLAS RAMAPHOSA: Working together to make the NHI succeed

THE African National Congress (ANC) has announced plans to take its National Health Insurance (NHI) scheme forward and has given us a hint of what the health industry will look like from 2012.

THE African National Congress (ANC) has announced plans to take its National Health Insurance (NHI) scheme forward and has given us a hint of what the health industry will look like from 2012. Responses to the scheme range from guarded optimism to outright rejection.

In the spirit of Lead SA (pioneered by Radio 702,) and the ANC’s Batho Pele (People First) campaign, we have a responsibility to make the plan work, identify areas of concern and put workable proposals on the table.

Whether we like it or not, there will be an NHI in one form or an other. Now that we know the ANC’s intentions, we need to prepare proposals and engage with each other as businesses serving the healthcare sector and take our joint considered views to the ministerial task team for consideration. The ANC has committed itself to wide-ranging engagement and consultation on the issue.

One of the areas the ANC will focus on is the improvement and expansion of public healthcare infrastructure and services. This area, according to the ANC, is critical to realising the principle of universal access to quality care and reducing inequality of access. The quality of service, efficiencies, information technology (IT) infrastructure, project management and processes in a number of public healthcare facilities leave a lot to be desired.

The private healthcare sector has, over the years, invested a lot of resources and deployed world-class expertise in perfecting their systems and processes in a number of privately run clinics and hospitals. The government would be remiss not to enlist such expertise.

SA’s private health sector has arguably the best developed IT and administration systems, skills and capabilities in the world, and a successful track record. This includes the management of doctors’ debtor systems, electronic switching, price- file updates and the integration of the World Health Organisation’s International Statistical Classification of Diseases and Related Health Problems into doctors’ work routines, and so on. There is no need for the NHI to reinvent the wheel.

If it is true that we may see some medical scheme members opt out and rely on state services (Prof Di McIntyre of the University of Cape Town predicts as many as 40%), then the current patient-management administration systems in public medical facilities will not cope with the volumes.

Apart from just refurbishing or building new clinics and hospitals, the expertise of the private healthcare industry will have to be enlisted by the government to ensure these are world- class public facilities and the IT support infrastructure required to operate these effectively is in place. Not only will the management and administration of the new generation of public hospitals require this infrastructure, but the medical staff will need to use secure and proven technology to transfer patient records within and beyond hospitals, as well as clinical data and images, among other records.

It is in the interests of the private sector that public facilities are improved so that there are minimal adverse effects on productivity in the workplace. A number of employees, who currently belong to medical schemes and will in future also belong to the NHI and will be contributing towards it, will certainly visit public facilities to get their money’s worth. If the systems and processes are not improved in such places, this will elongate the already long queues and result in repeat visits, which will affect the ability to provide universal access to affordable, quality healthcare — the main aim of the NHI.

From a private sector point of view, the government will have to establish workable public-private partnerships.

It will be prudent to establish a few facilities run by public-private partnerships as pilot projects before attempting a huge roll-out.

Pilot facilities will give the government time to refine processes and systems and learn from mistakes. Believe me, there will be mistakes.

We are in this together and once there is better clarity on a number of issues, we should all get down to establishing one of the best public healthcare systems in the world, one that we can be proud of.

- Ramaphosa is CEO of Bytes Healthcare Solutions.

Source - Businessday.co.za

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