National Health Insurance in South Africa

Healthcare Financing Reform in Other Countries

During 2010 IMSA added the first country notes to a new section of the web-site. When confronted by reform and policy change, people often turn to look at other countries. This is no easy task. As Heather McLeod wrote in one of the first IMSA background briefs: “One of the first things people tend to do on being faced with reform is to look at how other countries have dealt with healthcare financing issues. A strong word of caution: it is seldom easy to understand another country in sufficient depth to be able to determine whether an element of their system could be successfully adopted in another country. There is not one “best” solution – the current state of any healthcare system is a product of the people, their culture and history, their value systems, changing political ideology over time, economic pressures, the supply of providers and the design and governance of the healthcare system – amongst other factors.”

“The Country Notes are a collation of material submitted by independent researchers in South Africa who are willing to place their research notes in the public domain. The collated notes, together with other studies found in the public domain are presented as a service to researchers, policy-makers and stakeholders who are considering health reforms around the world. The Country Notes are by no means final or definitive works on each country. While excellent material is easily available on developed countries and countries in Europe, researchers often struggle to find material on developing countries and particularly countries in South America, Asia and Africa. We hope these notes collated from other researchers will speed up the process for any other researchers heading down this route. The first five notes to be loaded cover Ghana, Indonesia, Taiwan, Thailand and Colombia. Points of access to the wealth of material available on Europe have also been loaded as a separate note.”

http://www.innovativemedicines.co.za/national_health_insurance_health_systems_in_other_countries.html

Other country papers notified during 2010
The Canadian health system is often held out to be something South Africa should emulate. A new paper from The Canadian Medical Association says “Canada’s health care system is valued by its citizens. However, not only is our Medicare system failing to meet the five principles — universality, accessibility, portability, comprehensiveness and public administration — originally laid out in the 1984 Canada Heath Act, but those five principles, while still relevant, need to be expanded in scope to serve the current and future health needs of Canadians ...” See http://bit.ly/cS1vsO  

An article in the September issue of the WHO bulletin deals with Brazil. “Brazil’s landmark reform in 1988 has brought health coverage to millions of people, but the system is underfunded ...”. See http://www.who.int/bulletin/volumes/88/9/10-020910/en/index.html  

 “The SHIELD (Strategies for Health Insurance for Equity in Less Developed Countries) project produced a set of information sheets on health care financing in SA, Ghana and Tanzania.” The South African reports are referenced in section 6.1.
 http://web.uct.ac.za/depts/heu/SHIELD/reports/reports.htm

SHIELD Reports

• A critical analysis of Ghana's health system with a focus on equity challenges and the national  health insurance.
• An assessment of the health financing system in Tanzania

SHIELD information sheets

• Who pays for health care in Tanzania?
• Who benefits from health care in Tanzania?
• Who pays for health care in Ghana?
• Who benefits from health care in Ghana?
• Access barriers to the use of health care in Ghana

All healthcare publications by ECONEX can be found at:
http://www.econex.co.za/index.php?option=com_content&view=article&id=55:health-economics&catid=35:sectors&Itemid=54
There is an Occasional Note on healthcare in Brazil:

• October 2010: The Brazilian Primary Healthcare Delivery Model

Health reform in the USA was much in the news in early 2010 and there are two useful places for authoritative summaries of those reforms:

• The Commonwealth Fund: http://www.commonwealthfund.org/Health-Reform.aspx    
• Policy briefs from Health Affairs: http://www.healthaffairs.org/healthpolicybriefs/   

The USA reforms are now being implemented and there is increasing commentary available on the reforms and progress.

Commonwealth Fund president Karen Davis discusses the provisions of the Affordable Care Act that place a new emphasis on preventive and primary care and reward health care quality. She says these features will ultimately push the health care system to deliver more patient-centered, accessible, and coordinated care”.
http://www.commonwealthfund.org/Content/Blog/How-Will-the-Health-Care-System-Change.aspx  

An example of the changes in practice at the “Hudson Valley Initiative website to share health care transformation lessons learned, research results, team expertise” at:
http://www.hudsonvalleyinitiative.com/main.html  

A White Paper on the reform of the National Health Service in the UK was released for public comment. The reforms have been described as “radical” by the BBC. “The NHS in England is to undergo a major restructuring in one of the biggest shake-ups in its history.... Hospitals are to be moved out of the NHS to create a ‘vibrant’ industry of social enterprises under the proposals. And ... GPs are to take charge of much of the budget.

The move will lead to the abolition of all 10 strategic health authorities and the 152 management bodies known as primary care trusts.”

The British Secretary of State for Health, Andrew Lansley, said in parliament on 12 July: “This Government will always adhere to the core principles of the NHS; a comprehensive service for all, free at the point of use, based on need not ability to pay. This principle of equity will be maintained, but we need the NHS also consistently to provide excellent care. ... So today, I am publishing this White Paper, Equity and Excellence: Liberating the NHS:

• so that we can put patients right at the heart of decisions made about their care;
• to put clinicians in the driving seat on decisions about services; and
• to focus the NHS on delivering health outcomes that are comparable with, or even better than, those of our international neighbours.

“For too long, processes have come before outcomes, as NHS staff have had to contend with 100 targets and over 260,000 separate data returns to the Department each year. We will remove unjustified targets and the bureaucracy which sustains them. In their place, we will introduce an Outcomes Framework to set out what the service should achieve, leaving the professionals to develop how.” He went on to say that “With this White Paper we are shifting power decisively towards patients and clinicians. We will seek out and support clinical leadership. That means simplifying the NHS landscape and taking a further, radical look at the whole range of public bodies. We will reduce the Department of Health's NHS functions, delivering efficiency savings in administration costs. We will rebalance the NHS, reducing management costs by 45% over the next four years ... As we empower the front-line, so we must disempower the bureaucracy.”
The range of documents provided for consultation is extensive and instructive. They include the White Paper itself, a document on the analytical strategy or purpose, and an initial equity impact analysis. See
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_117353  
The healthcare reform proposed in the UK continues to receive a lot of attention from analysts. The King’s Fund in the UK has links to analysis and comments by various stakeholders on the reforms. See http://www.kingsfund.org.uk/current_projects/the_nhs_white_paper/index.html 

Commonwealth Fund International Health Policy Center

“The Commonwealth Fund's International Program in Health Policy and Innovation promotes cross-national learning by:

• sparking high-level creative thinking about health policy among industrialized countries;
• encouraging comparative research and collaboration among industrialized nations;
• building an international network of health care researchers devoted to policy; and
• showcasing international innovations in policy and practice that can inform U.S. health reform.

http://www.commonwealthfund.org/Topics/International-Health-Policy.aspx
See the 2010 Commonwealth Fund International Health Policy Survey, covering Australia, Canada, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.

http://www.commonwealthfund.org/Content/Surveys/2010/Nov/2010-International-Survey.aspx
The “International Health News Briefing” is a monthly newsletter with summaries of health policy news in select countries, as well as updates on related Fund publications and events.

The annual report of the World Health Organisation is always devoted to a specific topic. The 2010 report was released in late November 2010 and is entitled “Health systems financing: the path to universal coverage”

“Good health is essential to human welfare and to sustained economic and social development. WHO's Member States have set themselves the target of developing their health financing systems to ensure that all people can use health services, while being protected against financial hardship associated with paying for them.”

“In this report, the World Health Organization maps out what countries can do to modify their financing systems so they can move more quickly towards this goal - universal coverage - and sustain the gains that have been achieved The report builds on new research and lessons learnt from country experience. It provides an action agenda for countries at all stages of development and proposes ways that the international community can better support efforts in low income countries to achieve universal coverage and improve health outcomes.”

http://www.who.int/whr/2010/en/index.html 

Produced for IMSA by
Professor Heather McLeod

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