The implementation phase of the National Health Insurance (NHI), set to target women, children, the elderly and people with disabilities, is set to cost just over R69 billion over a four year period, Health Minister Aaron Motsoaledi said on Thursday.
Addressing journalists in Pretoria and Cape Town, Motsoaledi said the NHI white paper — the policy document which outlines how government will attempt to pool resources to create a quality healthcare system that services all South Africans regardless of socio-economic status — is set to be published in the government gazette on Friday.
Motsoaledi broke down the cost of the implementation phase of NHI over a four year period for all targeted patients irrespective of socio-economic status:
— R22.8 billion (R5.6 bln in first year, R5.6 bln in second year, R5.7 billion in third year, and R5.7 billion in fourth year) to be spent on pre-natal care for pregnant women — eight pre-natal checks (including two CT scans);
— R24.6 bln (R4.8 bln in first year, R5.8 bln in second year, R6.8 bln in third year and R7bln in fourth year) to be spent on breast cancer treatment;
— R4.9 bln (R987.5 mln in first year, R1.2 bln in second year, R1.3 bln in third year and R1.4 bln in fourth year) to be spent on cervical cancer treatment;
— R5 bln (R658 mln in first year, R920 mln in second year, R1.7 bln in third year, and R1.7 bln in fourth year) to be spent on school health;
— R548.5 mln (R136.1 million in first year, R136.7 million in second year, R137.4 mln in third year, and R138.1 mln in fourth year) to be spent on hip and knee replacements for the elderly;
— R934.7 mln (R318.1 mln in first year, R198.8 mln in second year, R198.8 mln in third year, and RR218.8 mln in fourth year) to be spent on cataract surgery for the elderly;
— R5.5 bln (801.9 million in first year, R1.2 billion in second year, R1.6 bln in third year, and R1.9 bln in fourth year) to be spent on the screening, treatment and care of the mentally ill;
— R1 bln (R42 mln in first year, R105 mln in second year, R262.5 mln in the third year, and R656 mln in fourth year) to be spent on the treatment and rehabilitation of the disabled; and
— R3.6 bln (R778.7 mln in first year, R875.2 mln in second year, R945.2 mln in third year, and R1bln in fourth year) to be spent on childhood cancer.
Motsoaledi said it cost the private sector R24,000 to pay for one dose of herceptin, an effective treatment for some forms of breast cancer, with 17 doses being needed. Some medical aids don’t pay for this treatment.
“Even people on medical aid and have good employment are struggling,” he said.
The minister said by pooling resources and buying the herceptin in bulk would mean the drug would cost less.
Motsoaledi gave examples of how much the public and private sector were paying for vaccines. The Pneumo (pcv13) cost R266 in the public sector while the private sector cost stood at R794.
He emphasised that the NHI represented a policy shift which would require a “massive reorganisation of the current health system, both public and private”.
Currently, South Africa exceeds the World Health Organisation target of spending five percent of GDP (gross domestic product) on health. Motsoaledi said South Africa spends 8.5 percent of its GDP on healthcare.
However, he pointed out that South Africa’s outcomes were worse than other countries who spent less of their GDP on healthcare.
Motsoaledi said the problem was that 4.4 percent of SA’s GDP was spent by the private sector which only caters for 16 percent of the population, while the remaining 4.1 percent was spent by the public sector which services 84 percent of the population.
While its still not clear where the money will come from, the minister quoted his former colleague Pravin Gordhan during the February budget speech, repeating that various funding options will be explored, including “possible adjustments to the tax credit on medical scheme contributions”.
At the time, Gordhan said further detail would be provided in the medium term budget policy statement in October this year.
The implementation of NHI will first have to be preceded by legislative amendments and the introduction of a law governing the scheme.
The National Health Act, Mental Health Act, Occupational Diseases in Mines and Works Act, Health Professions Act, Traditional Health Practitioners Act, Allied Health Professions Act, Dental Technicians Act, Medical Schemes Act, Medicine and Related Substances Act, and the Nursing Act would be amended, said Motsoaledi. Several laws passed at provincial level relating to healthcare would also be targetted for amendment.
“It means all those must be tampered with completely,” the minister said.
“One of the things we going to demand is that teaching hospitals to removed out of provinces. They must be governed nationally.”
In addition, Motsoaledi said the face of emergency services would change under NHI.
He said a team of specialists, headed by a University of Cape Town medical school professor, travelled the world to do benchmarking when it came to emergency healthcare.
Something which would cause a negative response, said Motsoaledi, was a provision that “all ambulances must have the same colour” so the country doesn’t have “so many diverse services”. He said they’ve already received push back from companies saying their branding and business rights would be infringed.
“We do not accept that we are not allowed to do that,” said the minister adding that these provisions would give effect to Section 27 (3) of the Constitution which provides that no one can be refused emergency medical treatment.
He used the example of all taxi cabs in New York City being required to be yellow, saying this had not impacted the business interests of individual companies.
“An ambulance is an ambulance. Patients must be picked up and taken to the nearest hosptial and they must stabilise you whether you are rich or poor,” said Motsoaledi.
Changes to medical schemes would include the introduction of a Single Service Benefit Framework, which would reduce the number of options per scheme, by April next year. Prescribed Minimum Benefits (PMBs) would also be aligned to “NHI service benefits”.
Pricing regulation would also be established under NHI, to have “one standard price for services”.
Co-payments and balanced billing would also be eliminated by January 2019.
“The reform of PMBs has already started. The Council for Medical Schemes have started consulations. We will be working with them on that,” said health director-general Precious Matsoso.
Matsoso said several preparatory platforms would be set up in the next few months as the country moves towards the NHI implementation phase.
This includes a National Tertiary Health Services Technical Implementation Committee, a National Governing Body on Training and Development (to set clear guidelines on how accreditation happens), Ministerial Advisory Committee on Health Care Benefits for NHI (for the initial phase targeting women, children, the elderly and people with disabilities), a Ministerial Advisory Committee on Health Technology Assessment NHI, National Health Pricing Advisory Committee (to help with regulation of prices in healthcare), National Advisory Committee on Consolidation of Financing Arrangements (to reduce the current fragmentation of funding in health sector)
“This is not a big bang approach. This is a journey. We need skilled people that will help us,” said Matsoso.
The NHI white paper is to be published before 10 am on Friday.