Finance minister Tito Mboweni revealed on Wednesday a national budget that includes changes intended to improve the public health system and address funding for initiatives such as national health insurance (NHI).
The only reference to the issue of funding for NHI was the flatlining of medical tax credits – a move that is expected to generate additional revenue of R1 billion in 2019/20. Spending in the NHI programme is set to increase at an average annual rate of 36.6%, from R1.2 billion in 2018/19 to R3 billion in 2021/22.
While Mboweni made it clear that NHI remains on government’s priority list, R2.8 billion from the NHI indirect grant will now be redirected to address staff shortages and other problems in public healthcare facilities. The money will help to fill critical posts at provincial level, including intern and community service posts. A further R1 billion in 2021/22 will fund the permanent appointment of medical interns.
In his budget speech, Mboweni said: “In health, we need simple, effective interventions. We need more doctors and nurses.”
In addition to the funds above, R1 billion will be allocated to raise the wages of community healthcare workers to R3 500 a month.
Rising medico-legal claims to be paid in periodic settlements
The move to address staff shortages and improve service delivery in the public healthcare sector ties in with government’s response to rising medical negligence claims as outlined in the budget review this year.
Claims against health departments rocketed from R28.6 billion in March 2015 to R80.4 billion in March 2018. Payments for claims in this three-year period escalated from R498.7 million to R2.8 billion.
The increase in medico-legal claims is attributed to inadequate quality of care, poor patient record management and poor legal capacity. To address this, government plans to recruit more medical specialist personnel, inspect public healthcare facilities more regularly, and recruit national teams of legal experts. The budget review also refers to the possibility of legislative amendments to allow for periodic settlement payments to claimants rather than lump-sum payments. This would assist in terms of budgeting for these claims.
Focus on digitisation and roll-out of chronic medication
A further R2.4 billion from the NHI indirect grant will, over the next three years, go towards improving public health information systems as well as centralising the dispensing and distribution of chronic medicines. Government intends to have 50 million patients registered on the NHI patient beneficiary registry, and to have 3 850 health facilities reporting availability of chronic medicines to a national distribution centre. This centre will service 3.8 million chronic medicine patients by March 2022.
Sugar tax fizzes up
The health promotion levy, implemented for the first time last year, will go up from 2.1c per gram after the first four grams of sugar to 2.21c per gram with effect from April 1 this year. This means that on a 330ml can of juice with 37.9g of sugar, you will pay 74.91c in sugar tax compared to 71.19c last year.