NHI Gets Cash, But Detail Vague

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Kerry Cullinan

BUDGET: R4,2-billion has been allocated the National Health Insurance (NHI) scheme to be spent over the three years – but exactly how the NHI will work remains vague

Photo – Masutane Modjadji, Health-e News.T

The National Health Insurance aims to make a package of essential healthcare free to all citizens and legal residents of South Africa through compulsory employee contributions to a national NHI Fund – a noble cause with a hefty price tag.

But the health department’s attempt to introduce the scheme has floundered over the past five years, – partly dogged by huge management weaknesses in the public health sector.

According to yesterday’s Budget Review, the NHI will get R4,2-billion made up of allocations of R700 million, R1.4 billion and R2.1 billion over the next three years. This money will come from “an amendment to the medical tax credit”.

Tax credits reduced

It will be used to contract general practitioners to work in the public sector, increase schools’ eye and ear testing, for “community mental health” and “expanding the Chronic Disease Medicine Distribution Programme to enable three million patients to collect chronic medicines at their collection point of choice instead of at a clinic”.

It is plain wrong to increase VAT to pay for public health as it means that the people who are using public health will be the ones who are paying for this.”

Medical tax credits are given to taxpayers who opt for private medical aid. By offering below-inflation increases in medical tax credits (ranging from 2,2 to 2,5%), government estimates that it will save R700-million this year – the sum total of this year’s NHI allocation.

But Professor Alex van den Heever from Wits University’s School of Governance, says this reduction in tax breaks is unlikely to save much money, as it is likely to drive some of those who are already battling to pay private medical aid back into the state sector.

“The medical tax credit is an entitlement to compensate people who are paying for medical cover themselves rather than depending on the public sector. As most medical schemes have higher-than-inflation annual increases, the reduction in the medical tax credit will mean that people will be out of pocket and some will drop out of cover,” said Van den Heever.

VAT increase ‘wrong’

To Van den Heever, “it makes no sense to take the subsidy away from people but offer no substitute for what is lost. What the R4,2-billion NHI allocation is for is unknown. It is likely to go to institutions and consultants that will not improve healthcare.”

Van den Heever also decried the increase in VAT as “the wrong thing to do as it taxes the poor more than the rich”. Instead, government could have introduced an extra tax bracket for the super-rich, gone after pension tax subsidies for very high end earners and increased corporate taxes, which are “the lowest in 20 years”, said Van den Heever.

“It is plain wrong to increase VAT to pay for public health as it means that the people who are using public health will be the ones who are paying for this,” he said.

The Rural Health Advocacy Project’s (RHAP) Russell Rensburg was also against the VAT increase, arguing that it would affect poor communities more and “deepen inequality of access”.

Rensburg also warned that money alone would not create a viable universal healthcare system: “Adding additional resources to an increasingly inefficient system does not increase efficiency.”

The “on-going freezing of critical health posts, under-investment in the maintenance of key infrastructure, including medical equipment”, and “the under-allocation of resources” to rural areas were undermining the health system, he said.

Last week, The Davis Tax Committee said that the uncertaintly around how the NHI would be funded was a cause for concern. Government itself has estimated that it will need R256-billion (2010 prices) a year for the scheme. The Davis committee said that, if the economy only grew by 2%, there would be a shortfall of R108-billion by 2025.

Sugary drinks tax on 1 April

“The proposed NHI, in its current format, is unlikely to be sustainable unless there is sustained economic growth,” said committee, which urged more realistic costing and a detailed framework for implementation.

The Department of Health says that an NHI Bill is passing through the last stages of a Cabinet review process on its way to Parliament, and this is likely to also set out the creation of an “NHI Fund” to pay for the scheme.

Meanwhile, the tax on sugary drinks – referred to as the Health Promotion Levy – will be introduced on 1 April, according to the Budget Review. Government expects that this tax – approximately 11% on a can of Coca Cola – will net it around R1,93-billion.

The aim of the levy is to reduce consumption of sugary drinks, a leading cause of obesity – which drives a number of health problems including diabetes, strokes and cancer.

But Wits School of Public Health Professor Karen Hofman said that the tax “has been significantly watered down and needs to be around 20% in order to have a serious impact on reducing obesity”.

“It also exempts fruit juices, which sends the wrong message as fruit juice is also very high in sugar content,” added Hofman, who heads Priority Cost Effective Lessons for System Strengthening South Africa (Priceless SA).

Health-e News – World Heart Day: learning to survive heart attacks

Heart and Stroke Foundation
World Heart Day, which happens every year on 29 September, will see iconic landmarks turned red in honour of the occasion with Table Mountain and the Wheel at the V&A Waterfront in Cape Town being lit up on Friday night.

The day was created and led by the World Heart Federation (WHF) as an event designed to raise awareness of cardiovascular disease (CVD), the world’s biggest killer.

It is seen as a time to promote a heart-healthy lifestyle and improve health globally by encouraging people to make lifestyle changes and be good to their hearts.

The event has the backing of several high-level experts, who are keen to lend their voices to the cause.

Professor Karen Sliwa, Director of the Hatter Institute for Cardiovascular Research in Africa and President-Elect of the World Heart Federation, said “World Heart Day is our chance to shine a light on the world’s biggest killer and work together to improve heart health. This includes highlighting the need for better care of patients with rheumatic heart disease and cardiac disease associated with pregnancy.”

Professor Pamela Naidoo, CEO of the Heart and Stroke Foundation South Africa, said “Around the world 1 in 10 people die prematurely from cardiovascular disease but the power to change this is in our hands. Making small lifestyle changes such as eating more fruit and vegetables, keeping active, reducing alcohol consumption and stopping smoking can save lives.”

President of the South African Heart Association, Professor Liesl Zuhlke – who is also Director of the Children’s Heart Disease Research Unit and a paediatric cardiologist, said “We are urging people to ‘share the power’ this World Heart Day by sharing healthy heart tips with friends and family and inspire people everywhere to be healthier. Our focus is on families and communities as children can have heart disease too and a healthy heart starts in childhood.”

Cardiovascular disease is a major cause of death in South Africa. Heart disease, in particular, features prominently among the conditions that contributed to a significant rise in deaths from non-communicable diseases in 2015, according to Statistics South Africa.

All of them agree that neither heart attacks nor death as the result of a heart attack are inevitable and can be avoided by understanding and managing the risk factors involved.

It is possible for a person who suffers a heart attack to regain good health by getting the right treatment fast.

Medical organisations are using World Heart Day to raise awareness and highlight the seriousness of heart disease for all sections of South Africa’s population and help people take heart health into their own hands.

“We want every South African to understand the link between lifestyle and cardiovascular disease,” said Dr Shanil Naidoo, Medical Director of Boehringer Ingelheim. “Healthy lifestyle choices significantly decrease the risk of heart attacks and strokes and have the further benefit of improving an individual’s quality of life.”

Spot the risks and neutralise them

A heart attack occurs when an artery carrying oxygen to the heart becomes blocked. The likelihood of a blockage increases when arteries are narrowed by fatty cholesterol deposits or plaque – a condition referred to as coronary artery disease.

Risk factors for the condition include smoking, an unhealthy diet, obesity, physical inactivity, diabetes, high blood pressure (hypertension), high cholesterol or a family history of heart disease.

Giving up smoking, modifying poor diets and increased exercise are all good solutions along with the critical management of diabetes, blood pressure and high cholesterol under medical supervision.

“Many South Africans have uncontrolled or undiagnosed hypertension, diabetes and high cholesterol,” said Dr Naidoo.

A 2014 study showed that 78% of South Africans over 50 years had hypertension, with less than half of them being diagnosed and less than 7% having it under control.

“These individuals are placing themselves at an even higher risk of having heart attacks or strokes,” cautioned Naidoo.

“While we cannot change our genetics or age, it is important to understand that we need to be disciplined about lifestyles choices which include regular medical check-ups.”


Recognising a heart attack:

Speed of reaction is absolutely critical to surviving a heart attack and regaining good health. In some cases, a heart attack causes virtually instant death. But in many cases survival and recovery are perfectly possible – provided you know what to do and get to work instantly.

What does a heart attack feel like?

  • There is heavy pressure, tightness, unusual discomfort or crushing pain in the centre of the chest.
  • This may spread to the shoulders, arms, neck or jaw.
  • It may last more than 15 minutes and could stop or weaken and then return.
  • This may be accompanied by sweating, nausea, faintness or shortness of breath.
  • The pulse could be rapid or weak.

Important things to note

  • Women may have different symptoms to men, with more pronounced nausea, dizziness and anxiety.
  • A heart attack can be silent and produce no signs or symptoms.
  • A sharp stabbing pain in the left side of the chest is usually not heart pain.

What to do if you experience or witness a heart attack

  • If unexplained chest pain lasts for more than a few minutes, move quickly. Do not try and figure out the cause, rather call an ambulance and state that you are dealing with a suspected heart attack.
  • If the ambulance is delayed, access private transport to get to the emergency department of the nearest hospital. On arrival, advise the staff this is a suspected heart attack.
  • If you have been trained and you are near a person who loses consciousness due to these symptoms, perform chest compressions at a rate of about 100 per minute.