NHI needs longer phase-in period, says report
October 27, 2009 Edition 1
SLINDILE KHANYILE
THE PROPOSED National Health Insurance (NHI) will not achieve its objective of providing quality health care to all citizens unless the current resources are improved to cater for an increased demand for services associated with a free health care system.
This is according to research on the NHI released on Friday by Econex, a research company that offers economic analysis, including competition economics, international trade and regulatory work.
The Econex research on the NHI said that usage of health care services generally surged if there were no co-payments or costs attached to receiving the service.
The proposed NHI seeks to provide universal health cover for every South African. The scheme will be funded through general taxes and mandatory contributions from employers and employees.
Nicola Theron, a director at Econex, said that there was already a lot of demand for medical care that was not met and it would increase substantially with the introduction of the NHI.
"The way it is promised at the moment, the system will not be able to deliver," she said. "The positive thing arising from this study is that it helps to analyse the data in order to understand what the optimal design of an NHI should be.
"It does not mean one can't have an NHI at all, but it means we need much more resources and gradual implementation over a longer period than what currently is promised."
The health policy reform is proposed to be phased in over five years. It will offer a basic comprehensive package, but citizens will be allowed to take additional cover with private medical aid companies after making the mandatory contribution to the NHI.
The Econex study says that utilisation increases when services are free, and if no co-payments are assumed.
Econex makes reference to research conducted in the US a few decades ago, which compared utilisation between insured and uninsured families.
Theron said this study was still relevant today.
People who were insured and had no co-payments consulted a health care worker 4.55 times a year, while those people who had to make 95 percent co-payments only went 2.73 times.
This meant that the cost per capita was higher for the group that had no co-payments, compared with the groups with higher co-payments.
Theron added that this was not because there was a difference in price, but it was driven by the higher frequency of visits by the groups that had lower co-payments.
"This again drives cost under a model of universal coverage with a basic comprehensive benefit package," the research company said.
Econex's other recent projects include research on behalf of the National Recyclers Organisation on the impact of a proposed export tax on scrap metal. The results of this study are scheduled to be presented to the Department of Trade and Industry soon.
The Department of Health said at present there were 3 916 public hospitals and clinics. In the private sector there are 31 550 beds and the available capacity could accommodate another 2 million patients.
The South African Medical Association said there were 33 000 registered doctors and just more than 20 000 who were practising across the country.
The number of nurses stands at 140 000.
Fidel Hadebe, the spokesman for the Department of Health, said that it was not appropriate for people to pass judgment on how wrong or right the NHI was because it had not been implemented yet. "There is a process under way to work out the cost."
The ANC policy unit on the NHI declined to comment.
