The Minister of Health has published a series of policies for comment which relate to the transformation of the health care system in South Africa, transformation that will be underpinned by a national health insurance (NHI) scheme. The policy paper states that “NHI is an innovative system of healthcare financing with far-reaching consequences for the health of South Africa [which] will ensure that everyone has access to appropriate, efficient and quality health services.”

Comments must be submitted by 12 October 2011 and be addressed to the Director-General: Health, Private Bag X828, Pretoria, 0001.

It will be phased in over a period of 14 years, and will be piloted in 10 districts in the short-term. It will be accompanied by major changes in service delivery structures, administrative and management systems. The first five years of NHI will focus on strengthening health facilities and health districts, quality improvement, infrastructure development, medical devices, HR planning, development and managements, information management systems and establishing the NHI fund.

The problem statement: We have a two tiered health system – public and private – based on socio-economic status and it continues to perpetuate inequalities. Evidence shows that at present those not covered by any form of health insurance (which funds private health care) include women, children and low-income groups.

Rationale for NHI: The current tiered system results in those with the greatest need for quality health services having the least access and poorest health outcomes. NHI will improve access to quality health care services and provide financial risk protection against health-related expenditures for the whole population.

Funding contributions will be linked to an individual’s ability to pay and benefits from health services will be in line with an individual’s need for care.

Everyone will have access to a defined comprehensive package of healthcare services, including prevention, health promotion, treatment and rehabilitation. This will be provided through various service delivery vehicles, including public and private providers, as well as community and household service providers which will be responsible in a large part for health promotion and prevention services.

A re-engineered primary health care system

The public health care system will be strengthened through a focused Primary Health Care (PHC) approach which will dwell mainly on community outreach services to ensure access to the comprehensive package of services beyond health care facilities and district hospitals. PHC services will be delivered through three streams at a district level: district-based clinical specialist support teams; school-based PHC services; municipal ward-based agents.

Management of the health care system

As part of the overhaul of the health system and improvement of its management, hospitals will be re-designated into one of five categories with correspondingly appropriate levels of care. (See the article on the Policy on the Management of Public Hospitals in this issue.) An Office of Health Standards Compliance will be established which will be responsible for health norms and standards and monitoring compliance.

Funding the NHI

The principle funding mechanism for the NHI will be a pre-payment health financing mechanism sourced from a combination of the fiscus, employees and individuals. The latter two groups will make monthly NHI contributions. It is estimated that it will cost R125-billion in 2012, R214-billion in 2020 and R255-billion in 2025.

WEB LINKS FOR THIS ARTICLE

Click here to view the NHI policy paper.