HEALTH: NHI still somewhere on the distant horizon
SA’s ailing health system will get 13.9% of the national budget in order to increase awareness and access to services, establish a regulatory body and fund universal healthcare. But the elusive National Health Insurance (NHI) remains a vague concept.
Finance minister Malusi Gigaba revealed on Wednesday that R191.6bn had been set aside for health in 2017/2018 and R205bn in 2018/2019. This is set to grow to R240bn by 2020/2021.
About R126bn is earmarked for tertiary hospital services and R66.4bn will support HIV/Aids prevention and treatment. SA has the largest HIV/Aids treatment programme in the world, for 3.9m people.
The health budget is the second-largest after education.
The NHI fund was back on the cards after its maiden appearance in the budget last year. In 2017, then finance minister Pravin Gordhan allocated R5.2bn to set up the NHI fund. But Gigaba gave little detail about it during the medium-term budget policy statement in October.
On Wednesday Gigaba said an additional R4.2bn has been earmarked for amendments to the medical tax subsidy over the next three years. But the nature and expenditure of funds remains unclear.
Government will increase the medical tax credit from R303 to R310/month for the first two beneficiaries, and from R204 to R209/month for the remaining beneficiaries. The medical tax credit will be reviewed after the Davis tax committee presents its recommendations.
Prof Alex van den Heever, chair of social security systems administration & management studies at the Wits School of Governance, says it is concerning that treasury has substituted one service, which serves middle-income workers by subsidising medical aid, to fund another, which is still under construction.
Van den Heever points out that the intervention targets taxpayers, while the corporate and financial services sectors remain untouched.
Gigaba said health remains a key priority of government and the 2018 health budget expenditure points to a "prevention is cheaper than cure" stance.
Government strengthened tobacco laws and introduced health-conscious tax proposals designed to increase revenue collection.
The health promotion levy, which taxes sugary beverages, will be implemented from the beginning of April 2018 in a bid to encourage healthier choices.
Sugar is a high-risk ingredient that leads to a number of noncommunicable diseases such as hypertension and diabetes. Noncommunicable diseases are linked to risk factors such as tobacco use, unhealthy diet and alcohol abuse.
StatsSA data shows these diseases caused more than half of SA’s 460,236 registered deaths in 2015. They were responsible for 62.5% of the top 10 leading causes of death among females aged 65 and above.
The sugar levy is set to be coupled with the launch of a public-awareness campaign that has been allocated R368m to establish a health technology assessment unit. Part of the unit’s work will be to analyse the cost-effectiveness of various health interventions.
Prof Laetitia Rispel, National Research Foundation research chair at the Wits School of Public Health, says the health interventions are encouraging in that they will result in less pressure on the country’s public health-care system.
Rispel says health complications associated with co-morbidity requires specialists — and SA had a dire shortage of these.
The scarcity of doctors will be compounded by the decrease in top-ups to infrastructure spending.
Gigaba said over the medium-term expenditure framework period, the health facility revitalisation grant and indirect health facility revitalisation grant, which fund infrastructure programmes, would be cut by R820m.
Treasury says the SA health products regulatory authority will be launched as a public entity in 2018/2019. The authority will receive R396.9m in transfers to oversee registration, licensing, manufacturing and importing of active pharmaceutical ingredients, medicines and medical devices. It will also regulate clinical trials in line with national policy.
Treasury says the body will generate fees from the pharmaceutical and health products industry.