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 The National Health Insurance (NHI) program, to be debated in
parliament soon, is one of the country's biggest policy changes
since white minority rule ended in 1994, and a cornerstone of
government plans to fix a crisis-ridden system in which deep racial
disparities persist.
Against a backdrop of a struggling economy and a corruption-riddled
corporate sector, some opposition politicians and analysts have
however questioned its affordability.
Responding to that concern, Olive Shisana - a special advisor to
President Cyril Ramaphosa - said the program would be phased in over
a number of years.
"This government is not going to do something that will collapse the
economy," she told Reuters in an interview.
"(The plan) is for gradual, incremental implementation in a fiscally
responsible manner."
Expenditure for NHI in the current fiscal year, which began on April
1, is budgeted at around 2 billion rand.
Shisana said this would rise to around 33 billion rand ($2.2
billion) in the 2025/26 fiscal year.
NHI is designed to improve the quality of public health services and
change the way private companies in the sector can operate.
Fewer than 20% of South Africa's 58 million people can afford
private healthcare, while a majority of poor black people queue at
understaffed state hospitals short of equipment.
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To keep costs within budget, Shisana said the government would
initially focus on a set of targeted interventions. Those could
include hiring more doctors and improving hospital infrastructure in
the public system.
At a later stage, the government is considering extending a medicine
distribution program for chronic diseases and rolling out a payment
system for general practitioners based on the number of patients
they serve and the health conditions in which they operate.
When the program is fully launched, at a date yet to be determined,
private medical insurance schemes won't be allowed to cover services
reimbursed by a central NHI Fund. Private hospitals and clinics will
accredit with the fund.
Alex van den Heever, a professor at the University of the
Witwatersrand who specializes in health, suggested Shisana's
assumptions on spending would not stretch to universal coverage.
"NHI envisages a shift to centralized medical cover, 30 billion rand
won't buy you that," van den Heever said.
He estimated a full-scale rollout of NHI would involve raising tax
revenue upwards of 3% of gross domestic product, or well over 100
billion rand.
The government introduced NHI legislation to parliament this month,
but lawmakers have yet to debate the proposals.
(Reporting by Alexander Winning; editing by John Stonestreet)
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