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2020/02/03 08:03 AM

Chief executive officer of the Council for Medical Schemes (CMS), Dr Sipho Kabane, says that the medical regulator made the controversial decision to scrap Low-Cost Benefit Options to protect consumers and make way for the incoming National Health Insurance (NHI).

In an opinion column for News24, Kabane said that the move will promote the NHI which will address the ever-widening disparities in access to healthcare and not ‘aggravate unfairness’.
2020/02/272020/02/03 08:05 AM

The enrolment of membership to schemes has been stagnant, and the proportion of the population that enjoys medical scheme cover has decreased during past decade.
So why is the regulator discontinuing the Low-Cost Benefit Option (LCBO) intended to increase the affordability of medical schemes?

Having seen a modest growth of 6.7% – from 8.32 million to 8.8 million – between 2010 and 2017, with the proportion of the population that enjoys medical scheme cover having decreased from 16% to 15.9% over the same period, it has now become clear that we need change.
2020/02/272020/02/03 09:01 AM

More than 600 qualified nurses, trained through the Health Department and who have completed their community service learning are sitting at home doing nothing, while public hospitals and clinics struggle with staff shortages.

This is according to nursing unions, who say the nurses had signed contracts with the department for a guaranteed four years of work upon completion of the course. They said the latest batch of nurses, who completed their studies last month, added to the backlog of nurses that the department had failed to absorb into the system, apparently due to a lack of funds.
2020/02/212020/02/24 09:09 AM

South Africa’s largest open medical scheme says its prescribed minimum benefits policy remains centered around funding treatments where there is strong clinical evidence showing their effectiveness, even if they are more expensive than alternatives.

This comes after the Council for Medical Schemes (CMS) ruled recently that Discovery
Health Medical Scheme (DHMS) must fund alternative surgical treatment for glaucoma which Discovery argued did not meet “PMB level of care” treatment prerequisites.
2020/02/24 09:11 AM

Health and Other Service Personnel Trade Union of South Africa (Hospera) is disappointed at the lack of focus shown on the embattled public health sector during the State of the Nation (Sona) last week.

The union is disappointed the president made no mention of plans to rescue a depleted healthcare system, characterised by poor infrastructure, maladministration, public health facilities operating on skeleton staff, as well as the high prevalence of violent attacks on healthcare workers.
2020/02/212020/02/24 09:14 AM

South Africa’s largest open medical scheme says its Prescribed Minimum Benefits policy remains centered around funding treatments where there is strong clinical evidence showing their effectiveness, even if they are more expensive than alternatives.

This comes after the regulator, the Council for Medical Schemes (CMS), ruled recently that Discovery Health Medical Scheme (DHMS) must fund alternative surgical treatment for glaucoma which Discovery argued did not meet "PMB level of care" treatment prerequisites.
2020/02/202020/02/24 09:13 AM

Portfolio committee on health chairperson Dr Sibongiseni Dhlomo says the National Health Insurance (NHI) Bill will come into effect in 2026.

On Friday, the portfolio committee on health will host a public hearing on the NHI Bill in Soshanguve, Pretoria.
2020/02/24 09:05 AM

In a scathing and precedent - setting ruling against Discovery Health Medical Scheme, the industry regulator has opened the door for consumers to force the industry to pay for treatment not available in state hospitals.

The Council for Medical Schemes’s (CMS’s) ruling follows a case by a glaucoma patient, who took the scheme on after it refused to pay for an implant of a medicated device called a Xen stent to lower eye pressure as recommended by a specialist.

The scheme, which would have paid for a treatment more than two times what the device would have cost, argued that clinical evidence on the effectiveness of the stent was weak, and that it was legally entitled to refuse payment for it as it was not offered in state hospitals.

Judge Bernard Ngoepe, head of the CMS final appeals board, said in a ruling that it was mind-boggling that Discovery would be willing to fund the inappropriate treatment for R20 000 and refuse to fund an effective, affordable and cost-effective treatment for R9 000.

He said this kind of decision-making is viewed as irrational.

The ruling opens the door for patients to force the industry to fund any drug or medical care deemed necessary by their doctors to treat any disease that falls under the prescribed minimum benefits.

It could lead to an increase in patients demanding access to expensive drugs, such as lung cancer prescription medication called Yervoy, which can cost up to R1- million a year and is usually not provided in state hospitals and refused by many medical schemes.

Ngoepe said that the state did not solely rely on affordability and effectiveness when deciding whether to introduce a new treatment.

He said state hospitals can be affected by budgetary constraints, delayed bureaucratic tendering and procurement processes, skills shortages, training priorities, administrative challenges.

The medical aid industry relies on a regulation that it only has to fund procedures available in state hospitals.

Health economist Alex van den Heever said no reasonable person could accept the prevailing care offered in the state sector as a benchmark.

However, Discovery Health also contended that there was limited evidence about the efficacy of the stent, with its CEO Ryan Noach saying the type of approval from the US regulators was for products that “have not undergone a rigorous clinical assessment”.

He added that it is not unusual in this type of approval for retractions to follow after evidence matures.

In 2018, Swiss-based pharmaceutical company Novartis withdrew its surgical stent for glaucoma patients after clinical data showed it might damage the eye.

The drug was approved by the US Food and Drug Administration (FDA) in 2016.

Xen stent was given FDA clearance in 2016.

It is manufactured by Irish-based Allergan, which declined to comment.

The CMS’s ruling also puts the spotlight on the interpretation of regulations under prescribed minimum benefits, which requires medical aids to pay in full the treatment of a long list of diseases but has not been updated in 20 years.

The list, which includes pregnancy, 270 diseases and 26 chronic conditions, was supposed to be evaluated by the regulator every two years from 2000, taking into account new treatments and costs, but the regulator is undertaking its first review of the list.

It has been a source of disputes as there is no limit on how much medical aids must spend.
2020/02/182020/02/24 09:07 AM

As recently as March 2019 the Council for Medical Schemes released a discussion document seeking industry inputs on how best to go about implementing Low Cost Benefit Options, with the intention of introducing measures to provide the protection of healthcare cover on medical schemes for low-income households.

The project to introduce minimum benefits specially tailored for LCBOs was meant to be implemented as a measure to replace risk based health insurance products, which were until recently subject to an Exemption Framework. Just nine months later in December, as the holiday mood began to settle over our nation, the CMS announced that no further exemptions to the insurance products would be granted and the replacement LCBOs too would no longer be developed and rolled out – no exemptions, no exceptions, finished and klaar.
2020/02/182020/02/24 09:08 AM

The medical schemes industry is fighting back against the regulator’s shock move last year to scrap primary health insurance and low-cost benefit packages, with its two biggest associations lodging formal appeals.

According to industry sources several health insurers have also lodged appeals.
2020/02/24 09:12 AM

The public has been given its last platform t make comments on the National Health Insurance issue as hearings move to Gauteng.

The Health portfolio committee will this week visit that province on the NHI, following a series of hearings in other provinces in the past few months.

The committee said it would take into account the views of the public when it started crafting the NHI Bill.

The bill was tabled by Health Minister Zweli Mkhize last year.

However, the government has not given detailed plans on the cost of the NHI, and some opposition parties have warned it would not work because the infrastructure in public hospitals and other facilities was not working.

They also said the government would not have the money required to fully implement it.
2020/02/24 09:10 AM

The wildfire spread of the coronavirus from China’s Hubei province to 28 other countries suggests it is just a matter of time before it arrives in SA.

Scientists are racing to model the likely effect of the new pathogen, with a leading epidemiologist at the University of Hong Kong warning last week that Covid-19 could infect up to 60 percent of the world’s population.

Even if most cases are mild and the mortality rate is less than 2 percent, as now appears to be the case, such extensive spread would be devastating.

The big question confronting SA whether health authorities will be able to detect and isolate patients fast enough to contain the virus, or whether the worst-case scenario will unfold, with extensive transmission within communities.

Official communication has focused on the measures being put in place to screen for the coronavirus, with little acknowledgment of the effect that a sudden surge of critically ill patients would have on SA’s overburdened public health system.

The wildfire spread of the coronavirus from China’s Hubei province to 28 other countries suggests it is just a matter of time before it arrives in SA.

In the barely two months since it first emerged, Covid-19 has sickened more than 68 500 people and killed at least 1 669 in mainland China, with a spike in cases late last week after authorities changed the way they are reporting the numbers.

The demands Covid-19 is placing on China’s hospital services are staggering, according to figures provided last week by the World Health Organisation’s (WHO) head of emergencies, Michael Ryan.

About 15 percent of the people in China who were infected with the virus required hospitalisation.

Virtually all the hospital patients’ required supplemental oxygen, 20 percent-25 percent of those patients required intensive care, and up to 10 percent needed mechanical ventilation.

Until Friday, Africa appeared to have been spared, despite the continent’s extensive trade, aid and travel links with China, but that may have been more due to weak surveillance capacity in some nations rather than a delay in the arrival of the virus.

Egypt announced its first confirmed case on Friday.

In SA, the Health Department has been scaling up its capacity to detect and manage Covid-19, including increasing personnel at ports of entry, screening incoming travellers and designating public hospitals in each province for potential cases.

Officials are talking to the private hospital sector about how they will co-operate should the need arise, as private hospitals have lower bed occupancy rates than those in the state sector.

The National Health Laboratory Service is conducting all testing for suspected Covid-19 cases, but provincial laboratories were asked last week to submit their requirements to take on some of the load, and private laboratories are stocking up on test kits.

By Saturday the National Institute of Communicable Diseases said 82 people had been tested in SA, and all the results were negative.

Those are all reassuring moves, but they do not address fundamental weaknesses in SA’s health system highlighted by the global health security index, which scores countries out of 100 based on their capacity to cope with a health emergency such as Covid-19.

The index, compiled by the Nuclear Threat Initiative and the Johns Hopkins Centre for Health, found no country was fully prepared to deal with such an event and gave SA a score of 55, placing it 34th out of the 195 countries assessed.

China scored 48, the US ranked first at 84, and the average score was 40. While SA is ranked top in Africa, with high marks for its ability to detect disease outbreaks, its Achilles heel lay in its health system, with particularly low scores for infection control practices and equipment.

That should come as no surprise: while the country’s leading public hospitals, such as Tygerberg and Steve Biko Academic, have the capacity to isolate and manage patients with serious illness, many parts of the state system are dysfunctional.

Smaller public health facilities regularly hit the headlines over crises ranging from in-hospital transmission of deadly diseases to a lack of running water.

Facilities such as these simply will not cope with a sudden influx of contagious and critically ill patients.

SA’s experience with the novel H1N1 influenza in 2009 offers a hint of the kinds of problems that could accompany a coronavirus outbreak.

The surge in patients admitted to Tygerberg Hospital with H1N1 created such demand for intensive care and respiratory support that all elective surgery was temporarily suspended.

While it reflects well on the provincial health system’s capacity to manage H1N1 at the time, it illustrates the knock-on effect for other patients.
2020/02/142020/02/17 09:45 AM

The Democratic Alliance (DA) claims the people of the Western Cape have rejected government's National Health Insurance (NHI) plan.

On Wednesday, the party said there were still too many unanswered questions around NHI.

Last week, Parliament’s health committee conducted public hearings across Cape Town.

It wants the inputs of citizens before making recommendations on the way forward for NHI. But the DA is not impressed.

The party’s Western Cape spokesperson on health Wendy Philander said NHI would collapse healthcare.

“We see even in poorer areas such as Khayelitsha, that residents have no faith in the NHI bill. Residents want access to universal public healthcare of high quality without the government revoking their right to raising taxes.”

Health Minister Zweli Mkhize has stated NHI could be implemented by 2026.
2020/02/132020/02/17 09:50 AM

A myriad of questions rained down on a panel of parliamentarians during a public meeting on the National Health Insurance Bill last Friday.

Members of the National Portfolio Committee on Health spent the best part of Friday evening at the George Civic Centre, surrounded by 265 individuals who wanted to know more about the controversial bill.

Some voiced their utter frustration with the current public health care system and asked for the fast-tracking of the implementation processes, while the majority voiced their grave concern - especially on how the bill will affect the current private healthcare system.
2020/02/092020/02/17 09:47 AM

The Public hearings into the National Health Insurance are reaching the last leg, with more work to be dealt with later.

The NHI is expected to receive some funding when the budget is tabled later this month.
2020/02/092020/02/17 09:48 AM
Committee chairperson Dr Sibongiseni Dhlomo says while they have attended several public hearings, a decision will be made to benefit of the country.

Parliament’s health committee chairperson Dr Sibongiseni Dhlomo says there’s no need for the hysteria around the national health insurance (NHI) Bill.
2020/02/072020/02/10 02:32 PM

If these public hearings on the National Health Insurance (NHI) Bill is democracy in action – we are in trouble.

This week Parliament’s Portfolio Committee on Health is in the Western Cape for the second last leg of the public hearings that started last year.

After the Western Cape, Gauteng residents will have an opportunity to have their say on the Bill.
2020/02/10 02:28 PM

The first tranche of funding for the National Health Insurance (NHI) should be focused on fixing South Africa’s ailing health sector.

This was the position taken by health activist in Khayelitsha before the public hearings conducted in the area by the National Assembly committee on health yesterday evening.
2020/02/062020/02/10 02:29 PM

The Western Cape government often prides itself on its public healthcare infrastructure and system being the best in the country — but its users have painted a different picture at the National Health Insurance (NHI) Bill public hearings.

This week, parliament’s portfolio committee on health listens to the views of Western Cape residents on the draft National Health Insurance Bill.
2020/02/062020/02/10 02:33 PM

In a failure that could intensify concerns about the administration of the proposed National Health Insurance (NHI), a multi-billion-rand government fund that compensates doctors and therapists for treating injured workers has not settled most of its bills since October 2019.

Business Day reports that this is because the Compensation Fund’s new website to record accidents and lodge claims has been dysfunctional since then.

Health professionals say this is putting “workers’ lives at risk”.

The fund was set up to cover the medical expenses of workers injured on duty and pays thousands of orthopaedic surgeons, doctors, radiologists and physiotherapists to provide medical care at a cost of almost R5.4bn a year, according to its 2019 annual report.

The report says the Compensation Fund is the legal model for the NHI fund, which aims to pay for the health care of all South Africans like a state-run medical aid.
Health minister Zweli Mkhize said recently the NHI would be run like other government schemes such as the Compensation Fund that “had set a precedent of good governance and accountability”.
2020/02/062020/02/10 02:34 PM

The Council for Medical Schemes (CMS) has reinstated one of the six senior officials it suspended for alleged corruption and maladministration last year, after an internal investigation found no evidence of wrongdoing.

While the CMS’s head of legal services, Craig Burton-Durham, has been exonerated by its internal probe into his conduct, he returns to work for a mere two months, as he is among a group of long-serving senior staff who were notified late in 2019 that their contracts will not be renewed after March 31.

Burton-Durham was notified last week that his suspension had been lifted after the internal probe, which was triggered by a complaint via an anonymous tip-off line, found no grounds to conclude he had breached the regulator’s processes and procedures.

On-going SIU investigation

CMS registrar and CEO Sipho Kabane declined to comment on the nature of the investigation or its outcome, saying the Special Investigating Unit was still looking into alleged maladministration and corruption at the CMS.

Burton-Durham declined to comment as he is challenging the non-renewal of his contract at the Commission for Conciliation, Mediation and Arbitration (CCMA).

In December, it emerged that the CMS was effectively terminating the services of six of the 11 managers reporting to Kabane. Kabane was at pains to emphasise that the CMS’s council had not decided to not renew the contracts of its top managers but instead to allow those that were coming to an end in March to “run their course”.

None of the other staff suspensions have been lifted at this stage, according to Kabane.

The lifestyle audits of senior staff that he announced in September had been postponed until April 1, he said.
2020/02/10 02:24 PM

Public hearings on the National Health Insurance (NHI) Bill will be conducted in the province and the DA has urged the public “to use this opportunity to understand exactly what the bill means for health service delivery and their ability to choose their health service provider”.

The National Portfolio Committee on Health will be conducting four public hearings on the West Coast, in the Central Karoo and on the Garden Route.
2020/02/032020/02/10 02:23 PM

Many residents of Mangaung in the Free State came out in support of the National Health Insurance (NHI) Bill during the public hearings last week but asked that existing problems in the healthcare sector be fixed.

The dire state of healthcare services and facilities in the Free State is the main reason some residents in Mangaung are sceptical that the implementation of the NHI Bill will have a positive impact on their lives.

This was among a variety of views aired by residents at a public hearing on the NHI Bill in Bloemfontein last Monday, 27 January.

The Free State is the sixth province in which the Portfolio Committee on Health had its public hearings on the NHI Bill.

In October 2019 the provincial Health Department in the Free State also held preliminary hearings across the province to make people aware of the bill.

Close to 300 residents joined MPs at the Kagisanong Community Hall to give and hear input on the bill.

Many residents told the MPs there’s a need to first fix the ailing public health sector before NHI is implemented.

One resident, Sean Lakey, was among those who voiced their opposition to the bill and who said NHI must be properly managed:

“The current situation, unfortunately, is one of the most degrading circumstances and sadly the staff isn’t doing their job properly.”

Lovely bill on paper

“We’ve got a lovely bill on paper but the comprehensive needs of healthcare should be thoroughly addressed. We need to change the government’s formula in terms of who’s appointed and making the decisions. We can’t be putting all the power into one person or a group. The people in charge are not going to run the NHI properly.”

Two healthcare workers present at the hearing said they believe some of the challenges they’re facing at their healthcare facilities will be resolved once NHI is implemented.

Thato Litsesane, a staff nurse at the Nelson Mandela Clinic in Edenburg outside Bloemfontein, said she was at the hearing to get a clear understanding of the bill.

“What I know about NHI is that it’s the government’s structure to bring quality healthcare services to everybody.”

Ntebaleng Mohapi, a nurse at Albert Nzula District Hospital based in Trompsburg, believes the bill will not only assist health workers but the community as well.

“I don’t think the government is delaying implementing it,” she said. “I think people must first understand the bill very well before the government can implement it.”

Mohapi also questioned how the government will be funding the bill.

However, DA ward councillor David McKay believes the hearings do not reach everyone and not all people are able to participate.

McKay said there should be public participation in every town in SA. Citing the country’s already dire financial state, McKay said the government does not have funding for the bill.

“The proposed changes in the bill put all the power under one minister. He will then decide how everything is distributed, under a system that they currently can’t even control. The bill should totally be scrapped. It doesn’t make sense,” he said.

“You cannot take a system from another country and copy and paste it. It’s not feasible. As it is, the current system isn’t working. They can’t possibly maintain the level of service that they’re giving now. It’s absolutely pathetic – people are dying in our hospitals. You’re not improving the system, you’re making it worse. They should focus on improving the current system and making sure that it works well.”

Funding of the bill remains one of the main concerns raised by many who gave their input.

Some predict the bill could end up like other financially crippled state-owned entities (SOEs).

DA member of the Free State Legislature, Mariette Pittaway, also raised her reservations.

“They are still not saying who will be funding the rollout of the NHI. During the medium-term budget [speech] Finance Minister Tito Mboweni said the state didn’t have funds, so where will the money come from? NHI will not bring better healthcare services, it will only cripple the private healthcare sector and the economy. This is such a good opportunity for corruption, just look at how they’ve handled the SOEs.”

Support from trade unions

Meanwhile, representatives from Cosatu and the National Education, Health and Allied Workers’ Union (Nehawu) came out in support of the bill.

Cosatu’s provincial secretary Monyatso Mahlatsi, however, raised concern that the province has a fragmented healthcare system.

“In our view, NHI is going to assist everybody to have access to quality healthcare. NHI is a healthcare system that is going to be centrally funded by government and private sector,” he said.

“One of the issues we raised is about the current management in the healthcare sector. Managers can’t manage properly. They need to be properly empowered. Many managers can’t handle the little power and responsibility that they have and if that power is going to be increased, then there will be a problem. There is also a need for regulation of the pricing of medicines and pharmaceutical companies,” Mahlatsi added.

Nehawu representatives from the Free State warned they will not be distracted by those who intend to take the matter to the Constitutional Court.

The DA has already indicated the party will fight the bill “all the way to the Constitutional Court”.

“NHI has humanity in it. Those who can, must assist those who can’t. I came to voice my support and ensure it goes through. In fact, our view is that this is long overdue,” said Nehawu’s provincial head of organising Jabu Makhubo.

“We call on the government to firstly deal with a transitional period of fixing all challenges within the health sector. NHI can’t be introduced under the current state of affairs, it isn’t conducive. We’re also aware of those opposing the bill and intending to go to the Constitutional Court. [To them] we are saying, whether or not the court rules otherwise, we want NHI and that’s the bottom line.”

Mixed feelings

Meanwhile, the head of the Free State Health Department, Dr David Motau, said he had mixed feelings about the public hearing.

He said they know about most issues raised by residents and a situational analysis has been conducted to assess all challenges.

He claimed there is a plan to deal with all issues at health facilities across the province.

“We have embraced the NHI Bill and it is our responsibility to deal with all the issues that were raised at this meeting. There’s a bit of uncertainty on whether this will work or not and it’s up to us to tackle all the challenges and restore everyone’s faith. We’re busy ensuring that we’ll be ready once the system is being implemented,” said Motau.

Dhlomo notes concerns

Portfolio Committee chair Dr Sibongiseni Dhlomo said he was satisfied with the hearings in Mangaung.

“While they [residents] expressed support for NHI, they highlighted that the government must first fix the current issues in healthcare.”

Dhlomo said the government can also not ignore the views of those who fear that NHI might follow the same path as that of SOEs.

“It is [the] health [department] that must indicate that the anti-corruption forum launched by the president is going to assist getting these issues out of the way. It’s not like we don’t have money. We must find the money. If we’re going to have this social solidarity plan to have all South Africans taken care of, then the government must look for money.”

Dhlomo said he expects the bill to be compiled into a report by May or June this year and then be submitted to the speaker of Parliament.

The next public hearings on the NHI were scheduled for the North West province from 30 January until 1 February.
2020/02/10 02:27 PM

As the National Health Insurance (NHI) Public Hearings begin in the Western Cape tomorrow, some of those who have made their submissions have lamented the lack of clarity around how public health care will work under the new system.

During the hearings in Klerksdorp in the North West recently, a resident sought to establish how pharmacies would be impacted, for example.
2020/01/312020/02/03 08:58 AM

On Wednesday evening, Harry Gwala Multi-Purpose Centre Sasolburg was filled up with hundreds of Free State residents who stood before Parliament’s portfolio committee of health to submit their thoughts on the National Health Insurance (NHI) draft bill.

As a standard procedure of these gatherings, a representative from the mayor’s office welcomes members of Parliament. The representative then tells citizens that the NHI is here for the poor.
2020/01/312020/02/03 09:10 AM

There has been no confirmed case of the coronavirus in South Africa, according to Health Minister Zweli Mkhize.

Mkhize and health officials from the World Health Organisation (WHO) and the National Institute for Communicable Diseases (NICD) addressed the media in Johannesburg on Friday morning.

At least 213 people have died in China and almost 10 000 cases of the virus have been reported.

The minister welcomed the WHO's declaration of a global emergency.

Mkhize added that 55 international travellers were screened at points of entry into South Africa and were found to have a fever.

However, none of them tested positive for the coronavirus.

He also said that there was no evidence to support repatriation or emergency evacuations of South African citizens in China.

"We have remained vigilant on the development regarding the movement and behaviour of the viral infection across the world and we continue to engage with the international academic fraternity to better understand how this virus behaves," Mkhize said.

The minister reiterated that South Africa was adequately prepared for active surveillance, early detection, isolation, case management, contact tracing and prevention of the infection.

Emergency centre operational

"An emergency operations centre was activated on Thursday night and is currently operational," Mkhize said.

"This means we have dedicated staff working exclusively on the coronavirus, monitoring and responding to all reports that they will proactively detect and follow up."

Mkhize also said there were dedicated centres in all nine provinces for the isolation and treatment of suspected coronavirus cases.

All travellers will be screened at 36 points of entry into South Africa, Mkhize said.

"We are on high alert."

Special measures have also been put in place at OR Tambo International Airport, which is the country's busiest airport.

"Workers have commenced to develop a vaccine as soon as possible," Mkhize said.

He added that South African citizens in China were "in safe hands".

"We maintain that there is no evidence to support repatriation or emergency evacuations of SA citizens in China."
2020/01/312020/02/03 09:10 AM

World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus said Thursday that the novel coronavirus outbreak has become a Public Health Emergency of International Concern (PHEIC).

Speaking at a press conference after a closed-door meeting of the Emergency Committee, he stressed that the WHO disfavours or even opposes imposing travel or trade restrictions on China. Under the International Health Regulations (IHR), the WHO director-general has the authority to determine that an outbreak constitutes a PHEIC when certain conditions are met.
2020/01/302020/02/03 09:00 AM

South Africa has a severe nursing shortage, yet hundreds of qualified nurses are sitting at home unable to help in clinics and hospitals.

Nursing unions said they are unable to be absorbed into the system because of an apparent lack of funds.

Democratic Nursing Organisation of South Africa President Simon Hlungwani credits poor planning for the shortage.

He said nurses have completed their qualifications and are placed in hospitals for community service but provincial health departments have not negotiated for funds from National Treasury in time to retain staff who have been employed for community service.

The North West and Gauteng are the most affected provinces.

Hlungwani encouraged nurses who do not have a placement to seek positions anywhere they can find them, including privately owned hospitals and clinics.
2020/01/302020/02/03 09:07 AM

In a failure that could intensify concerns about the administration of the proposed National Health Insurance (NHI), a multi-billion-rand government fund that compensates doctors and therapists for treating injured workers has not settled most of its bills since October 2019.

This is because the Compensation Fund’s new website to record accidents and lodge claims has been dysfunctional since then. Health professionals say this is putting "workers’ lives at risk".
2020/02/03 09:08 AM

South Africa is expected to spend significantly more on healthcare in the coming decade as the country prepares for the introduction of the National Health Insurance (NHI).

Writing in the latest South African Health Review journal, analysts – including Treasury, World Bank, and legal officials – state that this fund-raising will include a combination of increased government spend and taxes.

They add that this could include the possible earmarking of existing ‘sin taxes’, with cigarettes and alcohol some of the primary contributors to the chronic diseases impacting South Africans.

“Given that chronic diseases have become the largest national burden of disease, consideration may also be given to increasing excise taxes on unhealthy goods (‘sin-taxes’), such as alcohol, tobacco and the recently introduced sugary beverage tax.

“Although a hard earmarking of this revenue is unlikely to be implemented, some international experience shows that public support for such taxes is stronger when a portion of the revenue is allocated to health interventions,” the analysts said.

The pros of sin-taxes include reduced consumption of harmful substances, whereas cons include that they often do not raise large enough sums of revenue.

Other long-term options

The analysts believe that other longer-term options might include ultimately raising the tax-to-GDP ratio above 26% of GDP on the main budget or introducing new mandatory social security contributions.

Although the tax-to-GDP ratio in South Africa is already slightly above the average for upper-middle-income countries, it falls below that of high-income countries, and South Africa has a relatively poorly developed mandatory contributory social security system.

“Gradual introduction of a payroll tax may (also) be palatable if it accompanies improved quality and benefits, while the private sector fails to contain costs and therefore loses members.”

“Such a tax can be a part of total revenue and need not be ring-fenced for health.”

The NHI White Paper projects that public health financing would increase from around 4% of gross domestic product (GDP) to 6.2% of GDP by 2025/26.

Although this will require additional funding, total health expenditure may not grow to the same extent as a result of beneficiaries voluntarily leaving medical schemes and instead using publicly funded services as the NHI matures.

As a result, the White Paper estimates a funding shortfall of R72 billion for NHI by 2025/26, based on an assumption of 3.5% annual economic growth.
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