National Health Insurance in South Africa
ANC Policy on Proposed National Health Insurance
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.
An initial background brief covered NHI developments from the 1940s up to December 2008. This brief provides resources on the debate around mandatory insurance in South Africa during 2009. The major source material is the ANC proposals for National Health Insurance as articulated in party documents and presentations. By end October 2009 there was still no Government document on NHI in the public domain.
In December 2007 at the Polokwane conference of the African National Congress (ANC) (see http://www.anc.org.za/ancdocs/history/conf/conference52/index.html ), a number of resolutions were taken, (see http://www.anc.org.za/ancdocs/history/conf/conference52/resolutions.html ), including the following on NHI:
“ON HEALTH,
52. Education and health should be the two key priorities of the ANC for the next years.
53. Reaffirm the implementation of the National Health Insurance System by further strengthening the public health care system and ensuring adequate provision of funding.” ...
The ANC National Executive Committee (NEC) Sub-committee on Health and Education is chaired by Dr Zweli Mkhize. This Sub-committee set up an ANC Task Team led by Dr Olive Shisana in July 2008 to prepare a policy proposal for consideration by the subcommittee and later by the NEC. However none of the documents produced by that task team or considered or approved by the ANC NEC have been released in the public domain.
A short summary of the ANC proposals for NHI was included in the party’s election manifesto for the elections in April 2009 (see http://www.anc.org.za/elections/2009/manifesto/manifesto.pdf )
“In practical terms, the ANC government will: ... Introduce the National Health Insurance System (NHI) system, which will be phased in over the next five years. NHI will be publicly funded and publicly administered and will provide the right of all to access quality health care, which will be free at the point of service. People will have a choice of which service provider to use within a district. In the implementation of the NHI there will be an engagement with the private sector in general, including private doctors working in group practices and hospitals, to encourage them to participate in the NHI system.”
The first broad description of the ANC proposal for a National Health system was contained in an issue of ANC Today dated 23-29 January 2009.
African National Congress (2009). National Health Insurance: A revolution in health care, ANC Today (Vol. 9 No.3) Johannesburg: African National Congress.
URL: http://www.anc.org.za/ancdocs/anctoday/2009/at03.htm#art2
“The implementation of the national health insurance plan means transformation of the funding model for health as well as reorganisation of health care delivery. Universal access to health services can only be achieved through a simultaneous and two-pronged approach. First, significantly strengthen the public sector so that it becomes the provider of first choice. Second, design mechanisms for ensuring that scarce and critical health service resources in both public and private sector are shared and optimally used by all to maximise social value. ... “The establishment of National Health Insurance is predicated on two core principles:
“First, the right to health: the state must take reasonable legislative and other measures, within its resources, to achieve the progressive realisation of the right to access health care services. A key aspect of ensuring access to health care is that services must be free of any charges at the point of use.
“Second, social solidarity and universal coverage: The commitment to social solidarity in the South African health system means a mandatory contribution by South Africans to funding health care according to their ability to pay. Given the massive income inequalities, progressive funding mechanisms must be used (i.e. the rich should contribute a higher percentage of their income to funding health services than the poor) and the government contributes for the indigent.”
The most recent public release of information on the planned NHI is a four page summary in the “ANC Today” of 24-30 July. http://www.anc.org.za/ancdocs/anctoday/2009/at29.htm
“The broad objective of the NHI is to put into place the necessary funding and health service delivery mechanisms, which will enable the creation of an efficient, equitable and sustainable health system in South Africa. It will be based on the principles of the right to health, social solidarity and universal coverage.”
“NHI will be funded through a combination of current sources of government health spending, including the removal of tax subsidy for medical schemes and a modest mandatory or compulsory contribution by employer-employee contribution which will be split equally.” “Contribution will be less than what members and their employers currently pay to medical schemes. Certain categories of workers, due to their low-income status, will be exempted from the contribution. All these funds would be placed in a single pool that would be available to fund all health care in the public and private health sector under conditions that would apply to all health care service providers.”
The National Health Insurance Plan for South Africa document, dated 16 February 2009, was leaked to the Business Times and is available from:
http://www.thetimes.co.za/PrintEdition/PDFs/ANC-NHI-16Feb2009.PDF
An updated version of the National Health Insurance Policy Proposal, dated 22 June 2009, is available from:
http://wikileaks.org/wiki/African_National_Congress_National_Health_Insurance
_plan%2C_July_2009
There are considerable differences between the two versions. The February document does not use the phrase “medical scheme” once in the 200 pages of the report while the shorter June version of 64 pages uses the phrase extensively. Neither of the versions contains any financial costings or economic evaluations of the proposals.
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