South Africa has published its draft National Health Insurance (NHI) Bill on 8 August, with one senior official estimating universal healthcare for millions of poor citizens would cost about ZAR256bn ($16.89bn) to implement by 2022, reported Reuters.
The Bill creating an NHI Fund paves the way for a comprehensive overhaul of South Africa’s health system that would be one of the biggest policy changes since the ruling African National Congress ended white minority rule in 1994.
Less than 20% of South Africa’s population of 58m can afford private healthcare, while a majority of poor blacks queue at understaffed state hospitals short of equipment.
Dr Anban Pillay, deputy director general at the health department, told reporters an initial Treasury estimate of ZAR206bn costs by 2022 was more likely to be ZAR256bn by the time final numbers had been reviewed.
The Bill proposes that the NHI Fund, with a board and CEO, be funded from additional taxes.
Dr Pillay said, “The main source of funding (for the NHI) is appropriations which are from Parliament into the Fund and the chief sources of income for the appropriations are general tax revenue; funds that may be shifted from the provincial equitable share and conditional grants into the fund; a reduction of the medical scheme tax credits over time; the possible consideration of a payroll tax as well as a surcharge on personal income tax.”
According to the NHI Bill, the idea is to “create a single framework throughout the country for the public funding and public purchasing of healthcare services, medicines, health goods and health related products, and to eliminate the fragmentation of healthcare funding in the country”.
Medical aid schemes or private health insurance will only be allowed to provide “complementary cover” for health services, limited to the cover of services not provided by the NHI Fund.
The new Bill is to be debated in Parliament with public input. It is unclear how long the legislative process will take.