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South African National Health Bills Outlined

The Department of Health has set a target of 2026 to have a new national health system rolled out in South Africa, in many ways akin to the UK’s NHS, with the goal being equal access to healthcare, regardless of socio-economic status.

The first set of enabling legislation paving the way for universal healthcare in South Africa has been gazetted by Cabinet, Health Minister Aaron Motsoaledi announced on Thursday.

Motsoaledi presented two bills to the media on Thursday that would lead to massive changes in the way public health and medical aid coverage are handled in the country: the National Health Insurance (NHI) Bill and the Medical Aid Schemes Amendment Bill.

The minister said that the essence of the NHI is that the “rich will subsidise the poor, the young will subsidise the old, and the healthy must subsidise the sick”.

“Currently, it’s the opposite. At present, the poor subsidise the rich, and we will attempt to show that.”

Only 10% of South Africans could afford what was being charged in private healthcare, he said.

Citizens, civil society and the private sector have three months in which to comment on the new bills, which can be found HERE.

Single purchaser

The NHI Bill seeks to establish a fund – the National Health Insurance Fund – to act as a public entity governed by the Public Finance Management Act.

The fund will be a single public purchaser and financier of health services in the country, to ensure “equitable and fair distribution” and will be a mandatory pre-payment health services system.

It will purchase health care services, medicines, health goods and health-related products from certified, accredited and contracted service providers on behalf of the public.

It will “pool funds to provide access to quality health services for all South Africans based on their health needs and irrespective of their socio-economic status”, the minister explained.

The aim is for everyone to have the same access to the same standard of healthcare regardless of income, what people can afford or how frequently they need the services.

‘Terrible twins’ of the current system

Motsoaledi said there couldn’t be one set of rules for the rich and another for the poor as both groups “have the same health needs”.

He acknowledged that the move would require a massive reorganisation of the current health system, both public and private.

The National Development Plan described the exorbitant costs of private healthcare and the poor quality of public healthcare as the “terrible twins” of the health system.

Many have argued the country needs an overhaul of its health service first before changing the way it is funded, he said.

Fixing public healthcare, however, won’t be a single event, but a continuous, ongoing process, and shouldn’t be a “big stick” with which to beat back the move to national healthcare, he said.

“We are very much alive to the problems of poor quality in the public health system,” he said.

Comparison to Europe

South Africa currently spends a total of 8.7% of its GDP on both public and private health, he said.

The private sector spends 4.5% of GDP on health but only provides care to 16% of the population.

The public sector spends 4.2% of GDP on health but provides care to other 84% of the population.

Motsoaledi noted similarities in terms of spending when comparing SA to European countries, but not when it comes to the provision of healthcare. “It looks like chalk and cheese. The reason is the way the money is divided”, he said.

On top of that, South Africa is an outlier when it comes to voluntary spending on private health insurance.

South Africa spends 42.2% of total health spending on private healthcare, the highest proportion in the world. The US meanwhile spends 32%. The world average is 4.1%.

School health the ‘heartbeat’ of the new system

The NHI Bill will seek to make amendments to 12 other existing acts of Parliament in order to pave the way for an effective national fund.

For the purposes of the briefing, Motsoaledi confined himself to two acts: the National Health Act of 2003 and the Mental Health Act of 2002.

The amendment to the National Health Act will essentially give the minister’s office more direct capability in intervening in ailing provincial health departments, as it did in the North West earlier this year.

The same would apply for mental health services.

School health has been identified as the “heartbeat” of the new system under the NHI, with 12 million children in school currently.

After screening 3.5 million school children, the department found that eyesight, hearing, oral health and speech were physical barriers to learning.

The NHI would intervene in the matter, allowing for free glasses, hearing aids, oral hygienists and speech therapists. Pilot projects will be launched this year.

“We cannot wait for kids to arrive in clinics already sick. We need to know what is going on with them because they are the future.”

Co-payments to be abolished

Motsoaledi also announced the new Medical Aid Schemes Amendment Bill that will change how private medical aids operate in South Africa.

The minister said changes were necessary to pave the way for the NHI.

“The first amendment is to abolish what has become known as co-payments.”

Citizens have paid in the last financial year a sum of R29bn in co-payments from “their own pockets”.

“The patient should not be burdened with the need to pay anything,” Motsoaledi said.

“Of course there are people who say this amendment is callous and aimed at destroying the medical aid system. I assure you this has been well thought through.”

No late joining fees

He also took exception to medical aid schemes holding in reserves close to R60bn.

There is a statutory requirement that the schemes hold 25% of income in reserves to cater for emergencies.

“Our bone of contention is that R60bn is equivalent to 33% of reserves and is unnecessary accumulation.”

The bill will also abolish penalty fees for late joiners. “Under the NHI, there will be no penalty for late joining.”

In most retirement cases, a spouse cannot continue with the scheme until they themselves register as the principal member.

To see the gazetted bill, click here.

The transition is expected to take approximately 15 years in three phases. Phase two began in 2017 and will end in 2022. In theory, the system should finally be ready by 2026, Motsoaledi said.

 

Sources: News24 via AllAfrica [1]. Image sources: [1].

For information as to how Relocation Africa can help you with your Mobility, Immigration, Research, and Remuneration needs, email marketing@relocationafrica.com, or call us on +27 21 763 4240.

South Africa Tightening its Tobacco Legislation

South Africa’s Health Minister Aaron Motsoaledi has published a new tobacco control bill which, if passed into law, will tighten the grip on how cigarettes and other tobacco products are sold, marketed and regulated in the country.

Health and Medicine Editor Candice Bailey asked Catherine Egbe about what it means for tobacco control.

What’s significant about South Africa’s pending tobacco control legislation?

There are five key areas of tobacco control that the new bill seeks to address:

  • A smoke-free policy,
  • Plain or standardised cigarette packaging,
  • Regulating e-cigarettes,
  • Points of sale marketing, and
  • Removing cigarette vending machines.

Some are addressed in South Africa’s current tobacco control law. But the country still doesn’t fully comply with the standards set by the World Health Organisation’s Framework Convention on Tobacco Control. South Africa signed the convention in 2005.

Smoke-free public places is one example. The current law bans smoking in public places but allows for designated smoking areas in places like bars, taverns and restaurants provided that they do not take up more than 25% of the venue.

The WHO’s convention calls for 100% smoke-free public places to protect non-smokers fully.

In line with this, the new bill calls for a 100% ban on smoking in public places. It will also ban the advertising of cigarettes and other products at tills or selling them in vending machines.

The health warnings on cigarette boxes and other tobacco product packages is another example. The current law allows for text health warning on 20% of the package. But the convention calls for a minimum of 30% and encourages countries to have the more effective plain or standardised packaging with graphic and textual warnings in place.

So the new law mandates standardised packaging with graphic health warnings to make tobacco packages less attractive to new smokers and to discourage old smokers from continuing to smoke.

The bill is also significant because it attempts to regulate e-cigarettes for the first time in South Africa. To date e-cigarettes have been freely marketed and sold anywhere to anyone, including children.

Is there evidence that the planned interventions will work?

There’s a great deal of evidence from the rest of the world.

Let’s start with smoke-free policies. In countries like South Korea and the US where they are in place, research shows that they led to an overall improvement in health, particularly children’s health.

Incidents of smoking-related cancers went down and there was a reduction in childhood smoking. There was also an increase in the number of smokers saying they want to quit.

When it comes to packaging, studies show that it encourages smokers to quit and discourages young people from wanting to start smoking. Plain packaging was first introduced in Australia in 2012.

E-cigarettes are still a relatively new factor. But research is already casting doubts on various claims made about them. First introduced in China in 2004 they were initially mooted as an aid to quit smoking. But research shows that they in fact encourage young people to start smoking cigarettes. And 18 studies have shown that e-cigarettes do not reduce quit rates. Instead, the latest research shows that they do the reverse – they reduce the quit rates of smokers intending to quit by about 66%.

There are 83 countries that regulate e-cigarettes and about 27 that have completely banned their sale. These include Brazil, Singapore, Uruguay, Seychelles and Uganda.

The advertising, promotion and sponsorship of e-cigarettes are regulated or prohibited in 62 countries.

Why is it important to have a legislation like this?

Tobacco smoking is the single most preventable cause of death in the world. Smoking also worsens TB and HIV treatment outcomes. Yet 37% of South African men and 6.8% of South African women aged 15 years and older use tobacco.

Before the WHO Framework Convention on Tobacco Control, South Africa was a leader in tobacco control in Africa and across the world because of strong tobacco control legislation it had put in place. But the laws weren’t updated according to current WHO’s standards and the country now lags behind some other African countries.

The new legislation will place South Africa on the right path. Apart from saving millions of lives, it will ensure that South Africa fulfils its obligation as a party to the WHO convention.

There are several benefits to having strong legislation.

Firstly, it will protect millions of South Africans who don’t smoke but take in secondhand smoke from those who do. They face the same health risks as active smokers.

Secondly, it will also help encourage people to quit and live healthier lives and discourage young people from starting.

And thirdly, the tobacco industry views young people as replacement smokers. Strong legislation will prevent young people from being manipulated by the tobacco industry.

What are the next steps?

Once the bill becomes law, the health minister will have to draw up several regulations to guide its implementation. These will ensure that the law is interpreted correctly and not manipulated by the tobacco industry and that the potential gains of the legislation are not watered down.

Catherine O. Egbe is a PhD specialist scientist, Alcohol Tobacco and Other Drug Research Unit, South African Medical Research Council.

 

For information as to how Relocation Africa can help you with your Mobility, Immigration, Research, and Remuneration needs, email marketing@relocationafrica.com, or call us on +27 21 763 4240.

Sources: The Conversation via EWN [1]. Image sources: [1].