

National Health Insurance Download Full NHI Policy Brief 15 PDF Document The purpose of this series of policy briefs on National Health Insurance (NHI) and the related IMSA web-site is to put in the public domain material and evidence that will progress the technical work of developing a National Health Insurance system in South Africa. This includes tools for costing NHI and evidence on where savings could be achieved in moving to a future mandatory system with universal coverage. The proposals for NHI developed by the ANC task team since December 2007 have envisaged a single pool and single purchaser for healthcare. The September 2010 proposals, like the earlier drafts, seem to ignore the diversity of healthcare already provided in the workplace or negotiated by employers and unions in the workplace. This policy brief sets out what is known about workplace healthcare in South Africa and argues that this should be encouraged, developed and incorporated in a future NHI, rather than replaced by a monolithic single purchaser NHI. Overview of Workplace Healthcare in South Africa One of the flows in purchasing healthcare in South Africa is direct payments by firms. McIntyre and Thiede, using 2005 data, showed that this is a small amount relative to the total expenditure on health, but in Rand terms may still be significant. It is roughly of a similar order to the financing flowing through the National Department of Health, at less than 1% of the total of R108 billion. The financing intermediaries were found to be (in 2005 Rand terms): National Department of Health: R1 billion Local Departments of Health: R 1 billion Provincial Departments of Health: R45.5 billion Households out-of-pocket: R16.5 billion (although the authors think this is underestimated) Medical schemes: R54.2 billion Firms’ direct payments: under R1 billion. There is relatively little written about workplace provision of healthcare in South Africa. One of the few sources is a chapter written for the South African Health Review in 2007 (SAHR 2007) by Adams, Morar, Kolbe-Alexander and Jeebhay6. The authors said: ‘This chapter focuses on the health status of the South African workforce and health care provision in the workplace. ... Health care provision and financing aimed at the workforce is described in terms of the relevant legislative framework; models of employer-subsidisation and workplace-based models of health care service provision; and provision for social security and disability care.” “Despite the active role of the private sector in health care provision in the workplace, sourcing of data proved problematic as it was neither available nor accessible. Consequently, most of the data were sourced from government departments, policy documents, company reports or through personal communication.” This lack of visibility means that few people thinking of the structure of a future NHI have considered how these initiatives can be harnessed. This policy brief thus aims to open up this question and ensure that workplace health is logically incorporated in a future NHI. << Back to NHI Project List	Contact Details: Innovative Medicines SA Val Beaumont P.O. Box 2008 Houghton, 2041 Tel: +27 11 880-4644 Fax: +27 11 880-5987 Contact Us! IMSA: Published Profile of Member Companies and Position Statements Deloitte Final Report: Feb 2010

National Health Insurance

Download Full NHI Policy Brief 15 PDF Document

The purpose of this series of policy briefs on National Health Insurance (NHI) and the related IMSA web-site is to put in the public domain material and evidence that will progress the technical work of developing a National Health Insurance system in South Africa. This includes tools for costing NHI and evidence on where savings could be achieved in moving to a future mandatory system with universal coverage.

The proposals for NHI developed by the ANC task team since December 2007 have envisaged a single pool and single purchaser for healthcare. The September 2010 proposals, like the earlier drafts, seem to ignore the diversity of healthcare already provided in the workplace or negotiated by employers and unions in the workplace. This policy brief sets out what is known about workplace healthcare in South Africa and argues that this should be encouraged, developed and incorporated in a future NHI, rather than replaced by a monolithic single purchaser NHI.

Overview of Workplace Healthcare in South Africa

One of the flows in purchasing healthcare in South Africa is direct payments by firms. McIntyre and Thiede, using 2005 data, showed that this is a small amount relative to the total expenditure on health, but in Rand terms may still be significant. It is roughly of a similar order to the financing flowing through the National Department of Health, at less than 1% of the total of R108 billion. The financing intermediaries were found to be (in 2005 Rand terms):

National Department of Health: R1 billion
Local Departments of Health: R 1 billion
Provincial Departments of Health: R45.5 billion
Households out-of-pocket: R16.5 billion (although the authors think this is underestimated)
Medical schemes: R54.2 billion
Firms’ direct payments: under R1 billion.

There is relatively little written about workplace provision of healthcare in South Africa. One of the few sources is a chapter written for the South African Health Review in 2007 (SAHR 2007) by Adams, Morar, Kolbe-Alexander and Jeebhay6. The authors said: ‘This chapter focuses on the health status of the South African workforce and health care provision in the workplace. ... Health care provision and financing aimed at the workforce is described in terms of the relevant legislative framework; models of employer-subsidisation and workplace-based models of health care service provision; and provision for social security and disability care.”

“Despite the active role of the private sector in health care provision in the workplace, sourcing of data proved problematic as it was neither available nor accessible. Consequently, most of the data were sourced from government departments, policy documents, company reports or through personal communication.” This lack of visibility means that few people thinking of the structure of a future NHI have considered how these initiatives can be harnessed. This policy brief thus aims to open up this question and ensure that workplace health is logically incorporated in a future NHI.

<< Back to NHI Project List

Contact Details:

Innovative Medicines SA
Val Beaumont

P.O. Box 2008
Houghton, 2041

Tel: +27 11 880-4644

Fax: +27 11 880-5987

IMSA: Published Profile of Member Companies and Position Statements

Deloitte Final Report: Feb 2010