NHI budget comments confuse health researchers
The controversial National Health Insurance (NHI) scheme got more than a token mention in this year’s budget, but Finance Minister Pravin Gordhan still left everyone in the dark about what implementing the system will mean in real terms.
On Wednesday he announced that R1-billion would be allocated to the “National Health Insurance pilot projects and increasing primary healthcare visits”. According to the Budget Review, the money will be a conditional grant and the pilot sites will focus on upskilling managers and improving facilities and the quality of primary healthcare.
But healthcare researchers are perplexed.
“We’re not entirely clear on what the R1-billion is going to be used for and we really need more details,” said Daygan Eagar, researcher for Section27, a public interest law centre, and co-ordinator of the Budget Expenditure Monitoring Forum.
He asked the treasury to release a clearly articulated budget plan that would outline precisely how these grants would be used and said it was still unclear how the government would fund the scheme, or even what it meant by national health insurance.
The scheme will be phased in over 14 years, starting this year, and is expected to require about R6-billion in additional funding in 2014-2015.
According to the Budget Review, its full implementation by 2025 could require public health financing to increase from the current 4% of gross domestic product to 6%. Gordhan said this could be raised by increasing value-added tax, a payroll tax on employers, a surcharge on the taxable income of individuals, or a combination of these.
But Nhlanhla Ndlovu, programme manager at the Centre for Economic Governance and Aids in South Africa, said he doubted the viability of these proposals. “I’m not sure these options will give them the funds they need,” he said, adding that they would have serious implications for taxpayers and be resisted by organised labour and trade unions.
Economist Alex van den Heever, chairperson of social security at the Wits Graduate School of Public and Development Management, said the concept of national health insurance had been politicised and this had fed into the budget.
Although a chapter of the Budget Review was dedicated to the scheme and despite Gordhan having raised the issue in his speech, the details described strategies to provide general health services at the district level of the health system and not a move towards a national health insurance scheme.
“It’s disappointing. People are misrepresenting what they’re doing,” he said.
This had been brought about by political pressure from the alliance partners. There was nothing in the budget documents to suggest a turnaround strategy for the way the public health system was run.
Patricia Kopane, the Democratic Alliance spokesperson on health, concurred. She said although the DA welcomed the concept of national health insurance, it would not solve the country’s healthcare problems. “We need to ask ourselves if we have competent people to implement these pilot projects.”