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S. Africa Plans National Health Insurance

A woman suffering from tuberculosis covers her face at a clinic in the township of Khayelitsha, on the outskirts of Cape Town, South Africa, March 24, 2011

South Africa has announced plans to propose a National Health Insurance system (NHI) to bolster its ailing public health care sector. The government plans to phase it in over 14 years.

Health Minister Aaron Motsoaledi says the aim of the NHI is to ensure that everyone in South Africa has equal access to good quality health care.

"NHI is a financing system that will ensure provision of essential health care to all citizens of South Africa, and legal long-term residents, regardless of their employment status and ability to make a direct monetary contribution to NHI fund," said Motsoaledi.

The government will on Friday publish proposed legislation for the NHI for public comment over the coming three months. However, Motsoaledi said the plan is to begin implementation next year.

South Africa spends 8.5 percent of its national budget on public health care, which is in excess of the 5 percent recommended by the World Health Organization (WHO). However, the system is reeling from a range of problems including infrastructure decay, mismanagement, corruption, and over-burdened professionals who are often inadequately skilled. Motsoaledi says the government is aware of the problems.

"Yes it is true that the quality of health care in public health institutions is often totally unacceptable and that radical measures are needed to put the matters in order, but at the same time we need to appreciate the sheer scale of the service provided by the public health facilities in ensuring care for 84 percent of our people who are totally dependent on these facilities for their health needs," Motsoaledi added.

The NHI will cost some $18 billion in its first year, rising each year until 2025, the final year of implementation, when it is expected to cost double that amount. The government plans to fund it from existing funds, from contributions paid by employers and employees, surcharges, and private partnerships.

Motsoaledi says the government will begin with a massive investment in buildings and equipment; establishing core standards in every public health facility; and, improving management.

The health minister has also set his sights on costs in the private health sector, saying the costs are not justified.

"This is not only a burden to people using private health services, but a disservice to our country as a whole because it distorts pricing across the board, and there are clear signs that this might in the long term be simply unsustainable," Motsoaledi added.

South Africans will still be able to contribute to private health care funds, but those above as yet unspecified income levels, will also have to contribute to the NHI.