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This explanation appeared on the ANC’s website:
In the State of the Nation address, President Jacob Zuma clearly stated that:
“We will introduce a National Health Insurance Scheme (NHI) in a phased and incremental manner. In order to initiate the NHI, the urgent rehabilitation of public hospitals will be undertaken through Public-Private Partnerships”.
This is all in line with the ANC 52nd National Conference 2007 Polokwane resolution that: “reaffirmed the implementation of the National Health Insurance System by further strengthening the public health care system and ensuring adequate provision of funding.”
The voters have given the ruling party a clear mandate, and therefore to the current government to implement NHI. It must be said however that the debate in the media came ahead of the release of details.
In order to translate the policy statements on NHI into reality, as a transitional arrangement, a Task Team on NHI was established to prepare the necessary background materials that will form the basis of a plan for NHI to be handed to the Minister of Health. The chair of the Task Team led a team that comprised of individuals from inside and outside government with expertise from health economics, finance, tax collection, health planning, human rights, social security, labour issues, private hospital industry, medical aid and politics. These individuals came from Departments of Health, Social Development, Treasury, South African Revenue Service, science councils, universities, private hospitals, health care funders, private medical groups, labour movement-COSATU, SACP and ruling party, the ANC. The role of the committee is to make evidenced based proposals on both the design and the processes of implementing NHI in South Africa by the South African government.
WHAT IS NHI?
The idea of the NHI has been proposed to cure the ills of the health care system in the country. The public health system has suffered a degree of under funding which has resulted in deterioration in the conditions of the state facilities, decline in the quality of care and exodus of skilled personnel.
This must be put into its proper context. The formerly ‘white only’ hospitals were always better resourced and had lower bed occupancy while the overcrowded formerly ‘blacks only’ institutions were familiar with floor beds and long queues. The integration of facilities brought the reality of the situation to the fore. The increasing burden of disease exacerbated by the HIV and AIDS pandemic together with Tuberculosis, poverty, high unemployment and apartheid backlog in service delivery has put extreme pressure on the public facilities and its hard working and ever-dedicated health care staff.
The private health system has become less affordable. For many years the country’s expenditure in private health systems was equal to or more than the expenditure in the public health system. Whereas the private health system catered for 20 percent of the population in the past fifteen years, that number has decreased to about 15 percent Most of the funds are managed through medical aid schemes which had been increasing the premiums to less affordable levels. This accounts for the increasing percentage of the public (85 percent) relying on the public health service for service. In 2007/08 the expenditure in private health service catering for about 7 million people cost about R56 billion and a similar amount was spent by the provincial Health Departments to collectively cater for 41 million South Africans.
Many doctors in private practice are only too familiar with the situation of members of medical aids who get disqualified from seeing private practitioners because they exhausted their annual medical scheme allocation mid-year. They get dumped into the public health system as they cannot afford the fees in private hospitals.
All the medical aid schemes have the risk rating policy i.e. they recruit the younger and healthier members who are employed and need less medical attention, only to dump them or charge them more when they get sicker with age and cannot afford premiums after life-long contribution to the schemes.
With poor and overcrowded conditions many public institutions cannot compete with the private hospitals, even though they could use the additional revenue from private patients. The costing in the private health sector is not conducted under conditions of transparency raising the question of what drives the spiralling costs.
For the economic status and the total expenditure in both public and private health sectors South Africa has unacceptable health outcomes. The morbidity and mortality rates especially on preventable diseases remain worse than countries that spend less on health. This points to the inadequate internal distribution of resources available in the country. This means that rigid separation of the public and private sectors is not desirable, especially since government also contributes in the financing both the public and private health sectors.
The NHI has been proposed to create a mechanism to level the playing field and create equitable distribution of resources resulting in high quality of health services for all the people. Universal access to a basic package of services for both the rich and poor will be achieved by the NHI. With such a well developed private health sector South Africa needs to ensure a regulated coexistence of the two sectors to find a balance between the two extremities. This must include the increased funding for the public health sector and regulating the medical aids industry to pool the resources available for the whole country and create a common platform for improving health outcomes.
Currently principles of the NHI have been accepted by the ruling party. This allows for more detailed work to be completed and consultative processes be embarked upon. Even before the details are publicly debated, it has been generally accepted that revitalisation of all hospitals, improvement of the remuneration packages of the health care workers and transformation and capacity building of management is a pre-requisite for the NHI. This means that there is need for tremendous investment into the public health services. Hence the President announced that this revitalisation of public health institutions requires a public private partnership.
About 10 years ago, it would have cost R28 billion to revamp all hospitals in the country to a condition of new facilities. The figure may be higher today, but the rescheduling of debt that the PPP arrangements allow, would be affordable even within current financial constraints. This means this is the time for laying of the foundation of NHI and creating environment for better quality health.
The NHI Task Team has a responsibility to design a plan for implementation of National Health Insurance in line with the ruling party’s Polokwane policy resolution in December 2007. The initiative focuses on both National Health Insurance as a funding model and delivery models that seek to eliminate the impoverishing out-of-pocket payments and co-payments, redistribute human and material resources in a highly inequitable system, improve the quality of health services, enhance access to essential services and ultimately improve health outcomes for the majority of the people. The proposed initiative is aimed at providing both technical and consultative support to the Task Team on National Health Insurance, as well as research advice, evidence, expert inputs to the design and implementation of NHI plan. Changes to the funding model for health care in South Africa require robust engagements with empirical evidence and key stakeholders if it is to become successful.
We are aware of the debates in the media which are obviously not based on facts because no details of such plan have been officially announced by government. The debates are not only ill-informed but are also highly speculative. We are also aware that the debates are coming from a few individuals from specific sectors of the private sector, who have vested interests in maintaining the status quo in which the majority of our people continue to struggle in accessing quality health care – a Constitutional and a basic Human Right. Accusing the Task Team of pursuing an ideological agenda robs the country of a balanced debate in search of a lasting solution which a strictly market oriented approach cannot solve. We need to acknowledge the role of each of the sectors but seek a solution to correct the shortcomings. For that we require a sober and evidence-based debate, not an alarmist and confrontational discourse that currently characterises the debate in media.
The work of the National Task Team on NHI will be formally released to the public through appropriate channels when it is complete. We appeal to the public to be patient and wait for the release of the formal NHI plan in the near future. The plan will include processes of consultations with all key stakeholders to ensure that the voices of the public, private sector, labour, civil society and others are heard and considered in the finalisation of the plan.
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A very specious perception, held by our new ANC masters, is that castles can be built in the sky.
All these new plans are foundationless. The public health foundations are crumbling, and instead of propping up and rebuilding, the failing structure is just being shifted onto new foundations; – in this case the sturdy private health foundations. The burden will collapse it ALL, because this is all Africa knows.
Mr Goodfella,
Your premature judgements are always negative. This country needs a national health insurance scheme deperately. The private medical insurance companies which have increased their premiums to exhorbitant levels, all driven by corporate greed, need to be controlled. Even good ‘ol America, the land of the free and the brave, has proven to the rest of the world that a health sector primarily driven by the private sector does not work. I don’t see why South Africa cannot have a national health insurance scheme like Canada. Canada spends 10% of their GDP on a national health system. In South Africa roughly 10% goes only to the private sector – Their profit levels become obvious when they start offering discounted movie tickets and avoid paying out at any cost. I am not suggesting that that corruption will not happen and that the ANC execution will be flawless but the idea itself is a step in the right direction for South Africa.
We supposedly live in a democratic country that allows for freedom of choice. About 65.6% of the population may have voted for the ANC. However, it does not automatically follw that they agree with all of the principles mandated at Polokwane. It seems interesting that the majority party has left its official opposition and other smaller parties out of the debate up until now.
I don’t have a problem with the idea of NHI in principle. Its how they intend financing said scheme that concerns me. There is talk that a compulsory medical tax (comes off salary as per normal tax and uif) will be levied on all taxpayers which will be then cover those lesser fortunate individuals who cannot afford medical insurance. It is not clear whether the tax will be linked to income i.e. the more you earn the more you contribute. UIF works on the basis that you pay 1% of your salary up to a maximum of R 124.78. If they were to calculate the medical tax on the same basis, I suspect that people wouldn’t object too much. All working people would then contribute a basic nominal amount to the national health insurance, but would still be free to pay into their own private health insurance. If it is a case that high income earners pay medical tax as a direct percentage of their gross income, then I believe that it would be grossly unfair if working people with families of their own to support are now forced to support the masses. Where is freedom of choice in this? The reality is that plans will be made behind closed doors and then presented as fait accompli.
Presently, if you are a state medical patient, you have to go to the hospital / clinic that the govt. dictates. There is no freedom of choice. With private medical aids, there is a certain amount of choice given, obviously linked to the particular plan you are on.
If the nhi is compulsory, does this mean that the govt. is now going to dictate to people who have been on a private medical aid up till now, what hospital they have to go to for treatment. Is it their intention to force private patients into having procedures at govt. hospitals so that these hospitals can start generating funds and pay for themselves?
I will try to keep an open mind and wait until more detailed information is made available, but the questions listed above are those that I’ve heard expressed among our local community and the general feeling is not a happy one at this stage.
Mr Monty
Accomplished and experienced businessmen can see a bullsh.it business plan from its opening sentence. This NHI deal is not workable, because this is not Canada. We do not have 8% unemployment, we have 38% unemployment. We do not have 80% upper middle-class, we have 80% below bread-line.
Most importantly, we do not have a competent government public health administration comparable to the first world Canada, New Zealand or Australia, no matter what the health budget. We have an incompetent health management that will faak up anything that they are allowed to take control of.
Negative judgement, you say. Where do you live?
Larry,
I can see you view yourself as an expert in this area but yet you sources are flawed.
First off the Unemployment figure in SA is 23.50% and not your grossly overblown 38%.
http://www.statssa.gov.za/publ.....8;SCH=4379
Canada has a much lower GINI Coefficient than South Africa, which just reaffirms why we need universal health care. Health care (and education) is a basis for so many other benefits to this country as a whole.
Everyone is quick to critisize the health care system but the moment they have to actually pay some more taxes for a possible improvement they throw their arms up in the air and accuse the idea of a NHI as a nefarious plot against them.
We all know the previous health administration was grossly incompetent. Hopefully, the new administration will improve on their predecessors. Even so, should we just stop any step in the right direction due to corruption and incompetence? By implication then why do we not just halt any step in the right direction by any government department due to fear of mismanagement?
Only a complete idiot or prize ANC apologist will believe that we actually have an unemployment figure as low as 23.5%. Pigs can also fly and our crime rates are coming down year after year. The fact that senior police leaders have been advocating non-reporting of crime for years to massage the numbers downwards is just an inconvenient truth.
ANC denialism is prevalent across most ministries and black-ruled board rooms. I guess it is also a cultural thing not to own up to your flaws.
Larry,
what you have not mentioned among the many things that we are not, is the fact that south africa is the only country in that group where the indegenous people have not been wiped out, except only for the Khoi peoples.
larry, you have forgotten to mention thaty Cuba, much poorer than south africa has a vibrant NHIS system.
larry, i would like to copy and paste something for you.
Mon, 22/06/2009 – 20:21 — AK The National Health Insurance debate
My friends and comrades, this is my second article just on the heels of that introductory letter of mine. Today it is business, and I would like to express my innermost feelings on this subject with neither fear or favour. It is indeed most unfortunate that the people that we all claim to be representing or talking on behalf of-the poor- hardly get a chance not only to participate, but indeed to hear what is being said by many of us, supposedly on their behalf.
It is a sorry state of affairs when people will stand on the tables and if possible even on the mountains, holding on straws ,seducing the world with figures thumb sucked , devoid of scientific evidence at all, telling us doing the right thing for the poor will collapse the economy. How sad that the fewer they are the louder their noise becomes.
Ladies and gentlemen, some of you may just be astounded by this sudden burst of anger from the very man who , only yesterday was knocking at your doors begging of your friendship. It is very difficult to keep your cool when people uphold that which is satanic as holy and reject the virtuous as demonic.
Yesterday, being Sunday one participated in a debate that has come to be called the Big Debate. I was the last addition to the audience after my comrades could not get enough members to come and support them. My invitation was conditional upon my not say anything so radical as to scare the investors away. Secondly, I was specifically informed not to use my characteristic forceful speaking. From my writings, you will soon learn that I belong to the Hitler, emotional group of speakers- and yet yesterday I was told to cast such habits away or I would never be invited again.
It is fruitless to regurgitate what you will hear for yourselves, without my poor adulteration of so eloquent a speaker as there was yesterday. Mine is to continue with the debate and say all those things which my comrades had barred from saying. If only all of us had second chances in life to say that which we did not, to redo that which you had messed up and to say sorry, when you had offended somebody. All these are second chances which should not be squandered away.
Now here I am , in the quietness of my room; how good would I have felt if I was allowed to say the following.
“ Yes gentlemen, I understand you all , I sympathize with you. I feel what you feel, not because you are correct, but because you are so engrossed in your selfishness, you hardly have a room in your hearts for anybody less privileged than yourselves. I have been sitting hear listening to you trying to justify the unjustifiable. You are telling us that this universal health system cannot be achieved because productivity in this country is so low. What you are not telling us is that it is the same low productivity which has earned you so many millions; which millions, today you see as the result of your productivity. What you are not telling us is that your millions are standing on the shoulders of the poor who are languishing under your heavy yoke of productivity”
I am not sure whether any of you have ever felt so empty in their souls; for my natural reaction was just to tell the people who were arguing against us; yes I wanted to tell them how selfish they were; to try and hold on to this privilege of private health while the masses that they love to speak on behalf of, are dying of Aids and TB
I somehow imagine myself looking at that Mr. So and So, I cannot remember what his name was, who must have been very embarrassed by this time. I would care less for his sorry state, I need to choose whether to please him and the investors or my conscience.
“ It is a great lie, that you are able to afford medical aid purely as a credit to your hard work.” I would have proceeded , were it not for my crew who had warned me not to embarrass them.” You forget to tell us that you would not be so wealthy with very posh medical aids, were it not for the labourers whose blood you suck everyday. “
“ I care less which political party you belong to; you have all been telling the poor that you want to liberate them. It does not matter whether you are ANC, for I know there are people who claim to be ANC, and yet oppose the party on this noble principle- I would care less if you are DA, for the very same DA has told the people, they want to deliver to the poor.”
“Now is the time to deliver. Stop pontificating from the towers telling the world you support the poor, only to turn against them long before the **** has crowed. Not so long ago you told us not everybody could vote as some people were of such low mental faculties as to be given this privilege. No sooner did we vote than you cringed away in your corners afraid to apologize. Even this Mandela whom, today you hero worship was once labeled a terrorist by your good selves.”
I would pause here and look at them in the eyes. I would fold my piece of paper on which I would have scribbled my notes. I somehow see the program conductor sighing with relief as he sees me sitting down.
“No sir, do not be happy, I am not about to sit down, you must hear me through. The voices of the voiceless are crying to me asking me to tell you that which they hardly have the ability no the means to say to you. Oh, my good , sir, the voices are crying to you. They tell me they died because your medical aid refused to pay for their mothers in the ICU. Yes gentlemen, these babies are telling me you refused to pay even though their parents were still contributing to the medical Aid.”
By this time the program director would have silenced me down. Today, I regret I did not say all these beautiful words; I am happy though I have told you what I would have sad.
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Comments
Kabelo, I’m assuming you are referring to the recent reports in which economists argued that “informal” employment should not be included in the employment figures. Why not may I ask? Their argument was that we are not conforming to european definitions of employment. I can assure that if Europe had an informal employment sector that was on South Africa’s level they too would have included informal employment. In my opinion the 23.50% unemployment figure accurately represents the situation in SA. How about you base your comments on some facts next time, instead of you conspiratorial, defeatist opinions.
AK, Good point about Cuba – It is a country with a working NHIS but which still suffers from corruption. A good example that it is possible. I don’t however know on what you base your view that the countries mentioned above have “wiped” out their indigenous population. Cuba, also, is not poorer than South Africa in term of GDP per Capita. You, too, should rather base you opinions on some facts.
Shout out To all the ANC crony-boys in the room.
@monty python
@Ak-***-onthepen
your stupidity amazes me, that you can have hope in the anc to implement a national health insurance effectively.
lets look at the facts my boytjies:
1. Lotto is in a shambles.
2. Eskom is in a shambles.
3. Arms deal still not resolved.
4. land redistribution is not wekking.
5. education is a mess, eish!
6. still no jobs
7. corrupt ministers kept on by msholozi
8. approx. 1000 ppl die of aids each day in SA
yet you stooooooopid, stooooooopid okes still believe that the anc can make an nhi scheme work.
i hope that you slip on a banana peel, maybe then your thick cro-magnum skulls will be fixed by the fall.
if you believe the anc can pull this off, then you are clearly a product of the anc education system.
that is all.
p.s you are stupid. a dog has more brains than you.
AK, I will not read such a rambling waste of words. There is a program that you can download which removes all unneccesary wordage. “Ladies and gentlemen” should be reserved for addressing wedding guests, and so on.
Cuba may have basic healthcare, but they have this at the expense of basic technological products such as computors and cellphones. Imagine that.
Monty, it is only you who see me as an expert. I was generalising, and the point I made is sufficient for the intended context.
The government or party that plans to rob Peter to pay Paul, can always rely upon the support of Paul. This NHI is just long-term pre-election spin. In this Zuma is right, The ANC will rule until Jesus returns; – or at least until the looting and destruction is complete.
Larry and Company,,
We are not going to allow pressure groups and selfish individuals to derail us.You must either come in as positive participants or hold your peace. Should you fail to do any of the above, please go to your prefgerred countries.
This government will not be run by unseen hands anymore.
Power to the people. All these selfich greedy easons you put forward why it cannot be done are very stupid
If you are uninsured and does not have insurance, you should check out the website http://UninsuredAmerica.blogspot.com -California
Ray Looks like your blogspam is not really up to the ejob hey.
I guess to say that you agree with something that the ANC plan on this blog is akin to saying you are agnostic in a church. I am not an ANC crony or apologetic or any of the other names. Agreeing with something they say does not automatically make me a fanboy.
I just wonder wether this plan would have been accepted if it were presented by one of the opposition parties.
@Monty
yes you are a fanboy. you are a george michael fanboy, you are lower than a dogs A$$.
That is all.
Wow George that is a really good reply. That must have really got you excited to hit that enter button. You just discredited any sense you might have commented earlier.
And what does it matter that Kabelo is white or black – I thought we were past that stage
@Ak
you are not my baas. i will derail you as much as i please.
power to the poephol more likely. the R5 destroyed your AK on the border.
the fact that you support the anc politburo NHI scheme despite:
Massive Failiure in service delivery
tells me many things about you, and @Monty also..
You are a staban.
you have infections in the brain.
you are high on the krak
you are afflicted with downs and other mental handicaps.
@monty
my post was good eh? i am suprised that a boy-loving staban like you agrees with me.
George First off “staban” is not a word.
Further if you think you are humorous like the actual George Burns you are sorely mistaken. I imagine you will probably leave another comment after this but I will refrain from even bothering as you are obviously incapable of any meaningful dialogue.
@monty
you are a festering mthondo. u think because you talk ama-upper class that i will have respect for you wena?
i am happy you are refraining from me. i was getting scared ppl would think i am a staban like you, i do not want to be seen as a bunny, so please V0etsek wena, or i may have to skop your h0l wena, we do not like you here, so V03TSEK!
you are a scared little B!TCH, now go away little B!TCH, or i will tell your mommy!
Hi,
We have just added your latest post “ANC explains National Health Insurance – full text” to our Directory of Science . You can check the inclusion of the post here . We are delighted to invite you to submit all your future posts to the directory and get a huge base of visitors to your website.
Warm Regards
Scienz.info Team
I am Ray Hartley, the editor of The Sunday Times in South Africa.
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Monty
June 23, 2009 at 8:23 amA plan that this country surely needs. I hope it works!