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SA pledges fiscal discipline in sweeping health reform

Government budgets around R2bn for NHI for the current fiscal year.

A proposed switch to universal health coverage in South Africa will be managed in a fiscally responsible way, a senior presidential aide told Reuters, forecasting the landmark reform would cost the state $2.2 billion (R30 billion) per year by 2025/26.

The National Health Insurance (NHI) programme, to be debated in parliament soon, is one of the country’s biggest policy changes since white minority rule ended in 1994, and a cornerstone of government plans to fix a crisis-ridden system in which deep racial disparities persist.

Against a backdrop of a struggling economy and a corruption-riddled corporate sector, some opposition politicians and analysts have however questioned its affordability.

Responding to that concern, Olive Shisana – a special advisor to President Cyril Ramaphosa – said the programme would be phased in over a number of years.

“This government is not going to do something that will collapse the economy,” she told Reuters in an interview.

“(The plan) is for gradual, incremental implementation in a fiscally responsible manner.”

Expenditure for NHI in the current fiscal year, which began on April 1, is budgeted at around R2 billion. 

Shisana said this would rise to around R33 billion ($2.2 billion) in the 2025/26 fiscal year.

NHI is designed to improve the quality of public health services and change the way private companies in the sector can operate.

Fewer than 20% of South Africa’s 58 million people can afford private healthcare, while a majority of poor black people queue at understaffed state hospitals short of equipment.

To keep costs within budget, Shisana said the government would initially focus on a set of targeted interventions. Those could include hiring more doctors and improving hospital infrastructure in the public system.

At a later stage, the government is considering extending a medicine distribution programme for chronic diseases and rolling out a payment system for general practitioners based on the number of patients they serve and the health conditions in which they operate.

When the programme is fully launched, at a date yet to be determined, private medical insurance schemes won’t be allowed to cover services reimbursed by a central NHI Fund. Private hospitals and clinics will accredit with the fund.

Alex van den Heever, a professor at the University of the Witwatersrand who specialises in health, suggested Shisana’s assumptions on spending would not stretch to universal coverage.

“NHI envisages a shift to centralised medical cover, R30 billion won’t buy you that,” van den Heever said.

He estimated a full-scale rollout of NHI would involve raising tax revenue upwards of 3% of gross domestic product, or well over R100 billion.

The government introduced NHI legislation to parliament this month, but lawmakers have yet to debate the proposals.

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Sure, government has a great track record of financial discipline…… NHI will be a bit like Eskom but people’s lives will be at stake????

Ask cancer patients in KZN about the ” fiscal discipline ” in that province, where those in authority could not even see to the maintenance of equipment.

“a special advisor to President Cyril Ramaphosa – said the programme would be phased in over a number of years. This government is not going to do something that will collapse the economy, she told Reuters in an interview.”

OK, so you are going to collapse the economy over a number of years instead of immediately. Nice to know, thanks.

I think the idea is that they will charge the full amount in taxes immediately but the person paying will only get use the system when fully implemented or more likely continue to pay be not ever get anything usable out of the system.

So if government is capable of running it with fiscal discipline, why haven’t they applied this skill anywhere else eg SAA, SABC, ESKOM etc etc?

This lot thinks “Fiscal Prudence” is a woman’s name.

Every bankrupt individual and business promises to act in a financially responsible manner if they can only receive this one last extension of the loan agreement.

This government has implemented the policies that drove us to the fiscal cliff. They brought us the Mining Charter, BEE, cadre-deployment, redistributive rates and taxes, they nationalised mineral rights, they implemented security of tenure laws that was a de facto nationalization of property, they oversaw the looting at SOE’s, they enabled the destruction of service delivery at municipalities and now they promise to act in a responsible manner.

I am sorry. Their track record is in tatters. Only a fool will believe any word they say.

Ramaphosa says that if we are anti NHI then we are anti transformation. This is fundamentally incorrect, if we are anti NHI, we are merely anti stupid. Show me exactly how much this is going to cost and who is going to pay for this. First prove that you can actually run the current govt healthcare system correctly. Here’s a suggestion for the ANC – make it compulsory for all cadres, commissars and comrades to make use of govt healthcare facilities right now. Here’s another suggestion – why not get unemployment down to under 10% and then consider NHI as there will be more taxpayers to fund the system. Their dogged socialist ideology will be the downfall of this great country.

No, they are first going to kill the Private Medical sector, losing billions in taxes, then pay all these new state employees from taxes. Makes perfect sense.

“The ANC’s first motivation is its ideological commitment – confirmed by its Nasrec resolutions – to impose equality through wealth redistribution – rather than by evolving equality through decent education, sustained economic growth and job creation”

No doubt there will be enough money to roll out the NHI……but surprise surprise there will not/can’t be enough medical personnel ( not to mention specialists ) to service the patients. One can see one patient at a time not 11….so logic tells me nothing will change, only queues will be longer.

Long queues are the hallmark of a socialist system. Queue to get bread, water, electricity(loadshedding), medicine, etc.

In my speciality the average age was 64yrs old 4 yrs ago . They are not training near enough doctors and nurses. And now the newly qualified and younger qualified are leaving in large numbers. Another grandiose illusion of the ANC. A useless corrupt bunch as we see and hear at the different commissions at present.

More anc lies, deception and twaddle!

Your so called “government” and your salivating cadres couldn’t be trusted with a armoured piggy bank!

You need integrity before pledges will be taken seriously.

R33 bn a year is R570 a head. One GP consultation each ? or maybe the oral hygienist. We won’t be needing specialists then, or hospitals. Probably just as well.

Even the 100bn looks way too low. What happened to the 250bn that was being bandied about a couple of weeks ago ?

and we all know what an ANC promise is worth.

Its plain daft. The ANC is complaining about the money spent on 16% of the population. The 16% are paying for themselves and via their taxes they are also paying for the remaining 84%

This process will chase away people like me at the end of middle age, in the top few percent of the population that pay most of the taxes. Last time I checked 0.80% of the population (8% of all taxpayers) paid 54.25% of all income tax.

If I cannot have private health care I will have to leave. Its not anti transformation its anti dying. You cannot make the weak strong by making the strong weak. Fact of life.

There exist a specific song lyrics concerning politicians and the NHI…and it eerily relates:

(if you grew up in the late 80’s / early 90’s you might recognise):

“The handshake seals the (NHI) contract
From the contract, there’s no turning back
The turning point of a (doctor’s) career”
“The grabbing hands grab all they can
All for themselves, after all
It’s a competitive world
EVERYTHING COUNTS in large amounts”
The graph on the wall
Tells the story of it all”


So you still believe the ANC Government lies I can only conclude you must be ANC educated!

The ANC promising fiscal discipline is like a prostitute promising virginity.

The UK NHS costs the equivalent of R2.1 trillion when adjusted for the small difference in our population size. These clowns reckon they can do it for R30 billion, what a sick joke!

Exactly Expat and that is what I think gives away the scam. I reckon you will see budget allocations creeping from R2bn now, to R5bn then R10bn, all without any results, the loot siphoned into cadre pockets; same as the nuclear deal “consultants”. Ramaphosa learnt from Zuma.

A medical expert I heard on SAFM rubbished the numbers and destroyed an argumentative ANC lackeys comments in a number of areas but the key one I thought was that countries where and NHI type system sort of worked had per capita GDP’s eight times higher than SA and unemployment well under 10%.

Take a BROKE country and then BLEED the electorate by ANOTHER R 2 BILLION. This is ideocracy on parade. They need the votes of the poor to stay in power and this is their strategy. Very sad !!

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