Carol Paton Editor at Large

The Budget Council — a statutory body composed of the national government and the nine provincial finance MECs — has flagged the complexity of implementing the National Health Insurance (NHI) scheme because of the implications for provincial health departments.

Provinces have concurrent powers with national government over health and receive R150bn from the Treasury to run provincial health services. The NHI proposes an entirely new health-system architecture, which involves a centralised fund and hundreds of contracting units overseen by district management offices, which report to the national government.

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