NHI still a priority despite finance plan delays

NHI still a priority despite finance plan delays

The Treasury on Wednesday insisted National Health Insurance (NHI) remained a government priority, despite the delay in publishing policies outlining its shape and cost.

The government published its green paper on NHI in August 2011, and has since repeatedly promised that publication of a follow-up white paper is imminent.

In February, then finance minister Pravin Gordhan said the white paper on NHI and a discussion document outlining possible financing mechanisms would be released for public comment before the May 7 national election.

On Wednesday, Treasury director-general Lungisa Fuzile would not be drawn on why this target had not been met, insisting the government was pressing ahead with its plans.

“We said we would implement NHI over a 14-year period and that is under way,” he said in an interview with Business Day.

“We are taking steps to strengthen the public healthcare system — infrastructure, human resources, and procurement — and those are things that really matter.

“The conversation between us and the Department of Health is continuing. What we would like to avoid (are) gaps or contradictions in what health sets out and how the financing would work,” Mr Fuzile said.

The Treasury on Wednesday signalled possible changes to how public health sector funding is allocated.

Finance Minister Nhlanhla Nene said in his policy statement on Wednesday: “The future introduction of National Health Insurance could imply a significant restructuring of intergovernmental fiscal relations in the health sector. These considerations will be examined by a high-level working group that will make recommendations to the minister’s committee on the budget.”

The Department of Health sets policy and the provinces are responsible for its implementation. The department oversees several large conditional grants, which are funds that are ring-fenced for a specific programme, such as HIV/AIDS, but the rest of the health budget is allocated directly to the provinces.

In line with the Treasury’s commitment to protect the poor, spending on social services such as health, education and welfare grants has been protected. Consolidated health expenditure over the medium term remains largely unchanged, rising from R145.5bn in 2014-15 to R154.6bn in 2015-16 and R163.8bn in 2016-17.

A large part of the growth in planned expenditure is intended to cover the provision of antiretroviral drugs, which the Treasury says are now provided to 2.7-million people.

Mr Nene said the Treasury had allocated an extra R32.6m to the Department of Health for combating the Ebola virus. The funds were for domestic control measures and support to countries in West Africa.

“We are not an island,” said Mr Nene, and it was important for countries to help West African nations contain Ebola.

The Treasury has warned that spending on compensation for health sector employees — which has grown about 10% a year over the past three years — needed to be managed “to ensure continued funding for other essential inputs”.

Social grants, expected to reach 17.3-million people by 2017-18, are expected to account for nearly 85% of the R500bn allocated to social protection in the next three years.

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