SLINDILE KHANYILE

Durban - Fourteen years after it was first mooted, the national health insurance scheme appears to be moving towards implementation. Some of the policy documents formulated over the past decade will be tabled before the cabinet tomorrow.

Health minister Manto Tshabalala-Msimang said yesterday that once the process was completed in the cabinet, costing would follow and the matter would be referred for public comment.

She told delegates at the opening of the Board of Healthcare Funders annual conference that the process had not moved as quickly as the department would have liked.

"We had to consult [with the] treasury," she said. "There were always other considerations, like unemployment, that delayed the process. But we are quite excited that … we are on track with regards to the national health insurance."

National health insurance became a priority again following the ANC's announcement that the government had taken steps to urgently finalise its implementation.

The national health insurance plan seeks to introduce universal cover for every citizen, to counter inequality in the distribution of healthcare, improve access and affordability, and reduce the burden faced by the state facilities.

At least 40 million people rely on the government for healthcare, while more than 7 million belong to medical schemes that give them access to private healthcare.

Tshabalala-Msimang has long criticised the fact that such a small fraction of the population is covered by schemes that spent at least R60 billion a year.

Since the national health insurance discussion was revived, there has been a lot of speculation about what role private health insurers would play.

Moremi Nkosi, the director for health insurance in the health department, said the scheme could play three roles - as substitute, complementary or supplementary cover - but the details were still being discussed.

Nkosi said there were no deadlines yet because the department did not want to rush and make mistakes. Another issue that was still being debated was how the scheme would be funded.

"Everyone has to be covered," said Nkosi. "Those that are employed will make a contribution, so it will be payroll-based, but we don't know just how much yet. The state will also make a contribution."

This funding meant that there would be two national insurance systems funded by the working population to benefit the poor. The new social security and retirement system was also under discussion.

Di McIntyre, a health economist at the University of Cape Town, said the contributions towards the national health insurance would have to be shared between employers and employees to avoid impoverishing the low-income earners.

"The important thing is that it must be phased in," said McIntyre. "You can't undermine the existing health system, but rather build on it. [The scheme] means different things to different people, but it's not just about money, it's about systems change."

Nkosi said another issue that had to be considered was the responsibility for collecting the funds. He said a single-payer system would mean that the government would be responsible for pooling the funds, while the schemes played a significant role.

By contrast, the multipayer system would put the bulk of the job into the private sector's hands.