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The allocation will serve as an interim funding mechanism. It is likely to last about five years, until a permanent funding stream for the new system — which is to be phased in over 14 years — is established.
“We have to lay down the basics and do the preparatory work. Without that the NHI won’t make any sense,” Health Minister Aaron Motsoaledi said alongside Finance Minister Pravin Gordhan at a media briefing at Parliament ahead of the budget speech.
Ten districts have been selected as pilot projects.
On Tuesday Premier Dr Zweli Mkhize said two of the districts would be in KZN, although he left the details for his Health MEC Sibongiseni Dhlomo to announce.
In budget documents released yesterday, the Treasury indicated that the NHI would be rolled out in three ways:
• Integrated teams of specialists — obstetricians, gynaecologists, family doctors, anaesthetists, midwives and nurses — will provide clinical services at the sites. Because of the high infant mortality rate in the country, pregnant women and women who have recently given birth will be given priority.
• Professional nurses will be employed at every school in the 10 districts. They’ll immunise children, promote health and help with ailments.
• Municipal ward-based primary healthcare will be set up. Community health workers and doctors will be brought in to help with disease prevention.
Motsoaledi said GPs in private practice would be contracted to run prefab health centres.
All GPs in the 10 areas would also be contracted to have sessions in clinics. “We will pay the doctors. But this is not going to be their price. It’s going to be our price,” he said.
All hospitals and clinics in the 10 districts would be refurbished, re-equipped and have full maintenance plans.
The health sector had been hoping for more details on how exactly NHI would be funded, but these weren’t released. Gordhan repeated that funding options could include a payroll tax, payable by both employers and employees, a higher VAT rate, a surcharge on taxable income or a combination of these.
National Health Insurance is to be phased in over 14 years and is projected to cost R225 billion.
“The quality of healthcare needs to be overhauled and we need to make it affordable to everyone in the country, because at the moment it’s definitely not,” said Motsoaledi.
He criticised the private medical sector for its “exhorbitant” pricing, which was “unjustifiable”.
“What is being charged should not be charged by any normal country. We’re even worse than the U.S.”
Gordhan called on all players to make the NHI work. “It’s going to take us a long time to turn the public sector around to reach equilibrium. This can’t be done by government alone.”
According to the Green Paper on NHI, every working person will contribute to NHI while everyone will be entitled to a “comprehensive package of care” — from primary healthcare to specialised hospitals.
The Treasury said a discussion paper on revenue options would be released later this year, together with a review of associated transition issues, including the role of medical schemes.
It was expected that an extra R6 billion would be needed for the NHI in 2014/15.
The Budget Review said five hospitals would be prioritised in the first phase of a public-private partnership programme for improving health facilities.
These were King Edward VIII Hospital in Durban, Chris Hani-Baragwanath in Johannesburg, George Mukhari Hospital near Pretoria, the Limpopo Academic Hospital and the Nelson Mandela Academic Hospital in Mthatha.
Implementation would begin once feasibility studies had been completed and plans approved.
Motsoaledi announced that the department would hire senior staff to improve management at public hospitals without delay.
“This weekend we will be announcing 92 positions for CEOs that include all the 10 central hospitals, because we need to start putting in managers who are competent, who are at a very senior level in the public service.”
He said he planned to deploy “some of the best management you can ever get” in the districts where NHI would be piloted.
— Moneyweb, Sapa
and Witness Reporter.