A year after the government launched its National Health Insurance (NHI) pilot project‚ a third of the districts involved in the experiment have spent barely half their allocated budgets‚ according to a government-commissioned review presented to Parliament on Tuesday (23 July).
The slow pace of expenditure highlights the patchy progress being made by the project‚ which is running in 11 health districts.
It was launched in April 2012 and was allocated a R150m conditional grant for the fiscal year 2012-13‚ with some provinces adding extra funds.
According to the Division of Revenue Act‚ the grant was intended to strengthen the health system in the selected districts‚ test innovations necessary for implementing NHI and strengthen revenue collection at central hospitals.
The review‚ presented to MPs by health director-general Precious Matsoso‚ shows four districts spent half or less of their budgets by 31 March. Amajuba in KwaZulu-Natal spent just 37% of the money earmarked for its high-profile project.
The biggest spenders were Pixley ka Seme in the Northern Cape‚ which overspent its budget by 14%‚ Thabo Mofutsanyane in the Free State‚ which spent 88% of its budget‚ and Eden in the Western Cape‚ which spent 86% of its budget.
Contracting services
Only a third of the 556 primary healthcare facilities assessed in the pilot districts were ready to start contracting services from private sector GPs‚ a key structural reform the projects were supposed to test‚ said Matsoso.
The review documents show the districts that have made the most progress in this area are Eden in the Western Cape and Umzinyathi and Umgungundlova in KwaZulu-Natal‚ where about four out of five facilities have the necessary equipment‚ medicines and space for a private sector GP to work. By contrast‚ only 2% of the facilities in OR Tambo district in the Eastern Cape were ready.
Matsoso said the NHI pilot project had been trying to improve revenue collection at four large hospitals‚ including Charlotte Maxeke.
Hospital administrators needed incentives to collect revenue from patients‚ she said‚ and her department was considering applying a model used in the Western Cape‚ which allowed hospitals to retain some of the revenue they collected provided they met specific targets.
