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Heading Clearer On State Medical Insurance

July 29, 2009

Portfolio Committee on Health

With the lapsing of Bill no 58 of 2008, the Medical Schemes Amendment Bill, the route now being followed by the state in substitution of previous national health scheme proposals is becoming clearer as a result of a recent ANC policy statement on the subject.

Some sort of national health welfare or medical aid system has been the subject of considerable press speculation in recent months, culminating in a number of broad statements by ministers on medical insurance schemes for the poor in portfolio committee budget vote speeches, with President Zuma touching on the subject in his Opening of Parliament address this year.

That there will be some sort of equitable and integrated national health insurance coverage is therefore not in doubt; in fact government’s Council for Medical Schemes told the parliamentary portfolio committee on health in June 2007 that they planned to have a social insurance scheme ready for cabinet approval in July of that year, a budget then of R46m being presented to Parliament, with Bill no 58 being the result.

In the most recent portfolio committee meeting on 17 June this year, Thami Mseleku, acting director general of health, under questioning on the subject, indicated that by March 2010, policy proposals as the basis for new legislation will have been completed.

He added that “as legislation in general took some eighteen months to pass through Parliament including periods for comment” he saw some sort of document in place by mid-2011; a draft, subsequently indicated by health officials as a White Paper, being available to stakeholders at the very end of 2009.

In the meanwhile, currently before national treasury is the proposal to remove the tax subsidy for medical schemes in order to part-pay for any national health insurance (NHI) proposals, as indicated by Trevor Manuel in his exit 2009/10 budget speech.

In addition to such funding mechanisms, from the latest ANC statement, is also added the proposal to include “a modest mandatory or compulsory contribution by employer-employee contribution(s) to be split equally”.

The latest ANC statement gives a long history for the reasons for failure of previous ideas and proposals but says that, whatever happens, the new coverage will be “based upon need rather than the ability to pay.” Says the statement, “Coverage by the new NHI will not be interrupted and will be equal for everyone, thus ending the dependency on health on access upon employment status. “

The objective, concludes the statement, is to implement ” a publicly administered and publicly funded NHI fund that will be a single-player that receives funds, pools resources and purchases services on behalf of the whole nation”.