National Health Insurance in South Africa
Stakeholder Perspectives on NHI to end 2008
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Shisana, O., Rehle, T., Louw, J., Zungu-Dirwayi, N., Dana, P., & Rispel, L. (2006). Public perceptions on national health insurance: moving towards universal health coverage in South Africa. S Afr Med J, 96(9), 814-818. URL: http://blues.sabinet.co.za/WebZ/Authorize?sessionid=0:autho=pubmed:password=pubmed2004&/AdvancedQuery?&format=F&next=images/ejour/m_samj/m_samj_v96_n9_a14.pdf
“This paper reports on the findings of a national probability household sample of the South African population, drawn as part of the 2005 HIV/AIDS national survey, to gauge public opinion on universal health care coverage.” “The majority support efforts to contain medicine costs and one-third are of the opinion that the country can provide everyone with all the needed health care and medical services. A large percentage of participants thought it more important to provide improved health care coverage even if it meant raising taxes, while a small percentage said it is better to hold down taxes despite lack of access to health care for some South Africans. Almost a quarter of participants were unable to comment on questions posed to them, indicating the need for improved public education and communication.”
COSATU/NEHAWU (2003) Submission to the Public Hearings on the Report of the Committee of Enquiry into Comprehensive Social Security System. Submitted to the Portfolio Committee on Social Development 09/10 June 2003. Available on http://www.cosatu.org.za
Slides on the COSATU position of July 2008 as presented to the Board of Healthcare Funders on 12 November 2008.
http://www.bhfglobal.com/bhf-policy-conference-12-november-2008
The perceptions of employers were canvassed by Old Mutual in their Healthcare Survey 2005: towards Social Health Insurance.
“All 100 employers surveyed say they want to play a part in the process of transformation and in the decisions taken that affect both employer and employees. This finding contrasts sharply with the 62% of respondents who say they do not understand the impact of SHI on the healthcare industry. There is significant opportunity for engagement so that employers understand the objectives of SHI.
“The analysis of the opinions of employers regarding the proposed Health Charter indicates that they believe the most important element is the necessity for greater collaboration between the private sector and government for the good of the South African healthcare industry. Employers are sceptical about the success of the practical implementation of transformation and would like more information on the roll-out of SHI and other initiatives aimed at transforming the healthcare industry.”
Old Mutual (2005) Old Mutual 2005 Healthcare Survey: towards Social Health Insurance. Previously available on http://www.oldmutual.co.za but no longer on that site. Document can be downloaded here (2.459 Mb) [Download here]
No policy documents available but comments or descriptions of conference proceedings found in:
South African Medical Journal: http://www.samj.org.za/index.php/samj
Medical Chronicle: http://www.wilbury.co.za/mc_archive.html
The BHF held a policy conference on 12 November 2008 on National Health Insurance. Speakers included COSATU, Alex van den Heever from the Council for Medical Schemes and Prof. Di McIntyre, the Research Chair: "Health & Wealth". The three presentations can be downloaded from
http://www.bhfglobal.com/bhf-policy-conference-12-november-2008
Financing South Africa's National Health System through National Health Insurance: Possibilities and Challenges (Colloquium Proceedings). Compiled by Claire Botha and Michael Hendricks for the HSRC Policy Analysis Unit. URL: http://www.hsrcpress.ac.za/product.php?productid=2240
“The provision of universal access to healthcare, a right enshrined in the South African Constitution, is the responsibility of government. Although much progress has been made towards the creation of a national health system which makes 'access to health for all' a reality, much remains to be done.”
“As a means to facilitate debate on the subject, the Policy Analysis Unit of the Human Sciences Research Council, hosted a colloquium on 'Health within a comprehensive system of social security', under the auspices of the South African National Liaison Committee of Unesco's Management of Social Transformation Programme. The main purpose of the colloquium was to initiate policy dialogue and critical discussion on how health services are accessed, provided and funded - and to formulate ideas, views and recommendations that could be presented to those involved in health policy development. This book contains the keynote addresses and a summary of deliberations emerging from the colloquium.”
“Section A of the book contains the opening address by Dr Olive Shisana, President and CEO of the HSRC, and the keynote address by the Minister of Health, Dr Manto Tshabalala-Msimang, followed by a discussion of the context for policy debates on health within a comprehensive system of social security.
Section B provides a synthesis of the colloquium proceedings, beginning with a brief summary of inputs and discussions under the four key themes: the reform path since 1994; critical options for health within the context of a comprehensive system of social security; local and international evidence on health system models; health systems reform and stakeholder engagement. The section concludes with a brief outline of key issues discussed in the areas of healthcare provision, healthcare funding and the purchasing of healthcare. Section C provides recommendations for improving implementation, and taking the process of policy development forward.”
http://www.dbsa.org/Pages/default.aspx
A document resulting from the “Roadmap for Reform” process was prepared but is not on the DBSA web-site. A near-final version that was handed out at a meeting of stakeholders in August 2008 is available [download from the IMSA web-site].
“The implementation of a NHI structure will not instantly eliminate tiering as South Africa is inhibited by its socioeconomic context, its level of development, and the weak public sector health administrations. However, the existence of the NHI structure will automate the evolution of a predominantly single-tier system as the economy enlarges and formal employment increases.
It is furthermore important to understand that the existence of health insurance within a developing country context is inevitable and desirable. South Africa has the advantage of a well regulated medical scheme system that can form an important component of the overall system of social security. Consistent with health systems internationally, the considered incorporation of regulated private health insurance into the overall system of social security is well accepted and essential to the achievement of health policy goals.
A necessary consideration for health systems reform is to avoid unravelling existing institutional arrangements and attempting to replace them with new ones. Successful reform of any complex system always builds on existing institutions whether in the private or public sector.
The framework and vision provided in this Roadmap therefore focuses on the priority areas for intervention, including structural reform. The challenge is however considerable, and strong leadership, extensive mobilisation and public participation will be needed to see significant change within a five-year period. Without this leadership the reforms will fail to achieve their goals irrespective of the quality of the plan.
”Produced for IMSA by
Professor Heather McLeod
24 October 2009
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