A leaked letter sent from National Treasury to the Department of Health reportedly shows rifts between the two over the National Health Insurance plans – including legal worries and sidelining public concerns.
The four page letter, seen by the Daily Maverick, reportedly highlighted major concerns from Treasury, including instances where provisions in the NHI Bill were changed without consultation or permission – or changes that were agreed to were not implemented.
Treasury said that the bill in its current form was different to the one approved by the minister of finance, which was problematic and raised legal concerns – particularly as it appeared that the new draft widely ignored input from the public and other stakeholders.
These are the “major concerns” identified:
- The bill is different – changes have been made without permission, and changes agreed upon haven’t been implemented;
- Public comment and stakeholder input appears to have been ignored;
- It removes health functionality and budget from the provinces – so they will be less equipped to run their own healthcare systems;
- Legal opinion needs to be secured on shifting provincial functions to avoid court challenges;
- There is a provision that says that medical aid schemes are complementary to NHI, thus can’t offer services the NHI covers – this is unnecessary, premature and threatening;
- Some proposals for governance are unclear or confusing;
- The bill tries to superscede other functions of government like the Public Finance Management Act and Division Of Revenue Act;
- The financial implications of the scheme have not been costed.
The health department in the past has admitted that it has no real idea how much the NHI will cost, with the R259 billion figure published in the NHI white paper a guess, at best.
Calculation by other groups have put the figure in excess of R350 billion, not counting losses that will be experienced by the medial aid and private healthcare sector as a result of the scheme.
Earlier in November, health minister Aaron Motsoaledi said that the National Health Insurance scheme had taken a back seat as government departments shifted budgets around to fund South Africa’s stimulus plan.
According to the minister, the health budget had to be reworked to make room for new initiatives to boost the economy, and as such the NHI was put on ice, and spending plans would have to go back to the drawing board.