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Possible value-added tax to fund National Health Insurance

BUNDLE OF JOY: Minister Aaron Motsoaledi holds baby Refilwe Aronica Mashitisa whom he helped to deliver at Mankweng Hospital in Limpopo. PHOTO: ELIJAR MUSHIANA
BUNDLE OF JOY: Minister Aaron Motsoaledi holds baby Refilwe Aronica Mashitisa whom he helped to deliver at Mankweng Hospital in Limpopo. PHOTO: ELIJAR MUSHIANA

Ways to find the billions needed for the National Health Insurance (NHI) scheme could include an increase in the VAT rate, a payroll tax on employers, and a surcharge on the taxable income of individuals

The new system would require funding over and above current budget allocations to public health, Finance Minister Pravin Gordhan told MPs, tabling his 2012/13 Budget in the National Assembly.

"Funding options include an increase in the VAT rate, a payroll tax on employers, a surcharge on the taxable income of individuals, or some combination of the above."

It was expected that an extra R6 billion would be needed for the NHI in 2014/15.

An additional R1 billion conditional grant had been allocated over the next three years to cover the cost of NHI pilot projects, which would be established in "selected districts" during this year and 2013.

The grant will serve as an interim funding mechanism. It is likely to last about five years, until a permanent funding stream for the new system -- which is to be phased in over 14 years -- is established.

"Achieving an appropriate balance in the funding of national health insurance is necessary to ensure that the tax structure remains supportive of economic growth, job creation and savings," Gordhan said.

The new system would provide "equitable health coverage for all South Africans".

According to the Budget Review document, tabled by Gordhan on Wednesday, the aim of the pilot sites is to start laying a foundation for the scheme, including skilled managers and a re-engineering of primary health care.

"Integrated teams of specialists -- obstetricians, gynaecologists, family physicians, anaesthetists, midwives and nurses -- will provide clinical services at this level.

"In particular, pregnant women and women who have recently given birth, as well as children, are expected to benefit from the greater involvement of specialists at primary level."

Strengthening public hospitals is a key component of national health insurance.

Five hospitals will be prioritised in the first phase of a public-private partnership programme for improving health facilities: These are Chris Hani Baragwanath, George Mukhari Hospital, Limpopo Academic Hospital, King Edward VIII Hospital and Nelson Mandela Academic Hospital.

Implementation will begin once feasibility studies have been completed and plans approved.

As national health insurance progresses, the public sector will need to recruit more doctors and nurses, and expand contracting with selected general practitioners, the Budget Review says.

Similar arrangements, for example with private pharmacies or for trauma services, will be phased in over time.

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