National Health Insurance in South Africa
Costings and Evaluation of NHI
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The original costing for the post-Polokwane NHI proposals was prepared for COSATU by Sule Calikoglu and Patrick Bond and is dated August 2008.It was initially not in the public domain but can now be downloaded from:
http://www.amandlapublishers.co.za/special-features/the-nhi-debate/214-preliminary-costing-estimates-for-national-health-insurance
Commentary by Patrick Bond on the work by Servaas van der Berg and Heather Mcleod: http://www.ukzn.ac.za/ccs/default.asp?3,28,11,3512
A costing entitled “Brief overview of preliminary modelling of NHI resource implications” was produced as part of the SHIELD project by Di McIntyre, John Ataguba and Sue Cleary. All are from the Health Economics Unit, University of Cape Town. The report is not yet on the web-site.
The SHIELD project web-site is at: http://web.uct.ac.za/depts/heu/SHIELD/about/about.htm
Business Day published an opinion piece by Prof Servaas van der Berg and Prof Heather McLeod on the promises being made and the lack of hard numbers. They concluded “The NHI proposal can only be taken seriously once a proper analysis of its costs, fiscal consequences and affordability has been undertaken. The current proposal is beyond what the country can afford.”
Promises. Promises. Why the National Health Insurance plan needs hard numbers – by Prof Servaas van der Berg and Prof Heather McLeod.
http://www.health-e.org.za/news/article.php?uid=20032492
“ECONEX was established in 2005 due to the growing need for applied work in competition economics. Since then, the company has grown into a more diverse economics consultancy with not only extensive experience in competition cases, but also trade analysis and general applied economics.”
http://www.econex.co.za/
ECONEX has produced papers on healthcare issues and has begun a series of special research notes on aspects of the National Health Insurance plan. “... the concern at the moment is that little is known about the technical detail of the proposed scheme, that has promised to provide universal coverage for all SA citizens. The key question is whether South Africa can afford such a scheme at this stage. In order to contribute to this debate, ECONEX is engaged in a comprehensive costing exercise where we will estimate the total cost to the economy of the introduction of such a scheme.
This research project is undertaken with the aid of Prof. Servaas van der Berg and Dr. Ronelle Burger, both from the University of Stellenbosch, Economics Department.
The special series of NHI Notes will deal with some of the key issues in the current debate and will be sent out regularly in order to stimulate a more informed debate on this very important issue.”
Demand for Healthcare and Health Insurance in South Africa
http://www.econex.co.za/index.php?option=com_docman&task=doc_details&gid=26&Itemid=60
The Extent of Current Cross-Subsidisation in the SA Health System
http://www.econex.co.za/index.php?option=com_docman&task=doc_details&gid=40&Itemid=60
NHI Note 1: Key Features of the Current NHI Proposal
http://www.econex.co.za/index.php?option=com_docman&task=doc_details&gid=42&Itemid=60
NHI Note 2: South Africa's Burden of Disease
http://www.econex.co.za/index.php?option=com_docman&task=doc_details&gid=43&Itemid=60
Alex van den Heever provided estimates of the cost of NHI in an article dated 11 September 2009. [Download from IMSA web-site]
“Total annual expenditure required amounts to approximately R358 billion per annum or 15.7% of Gross Domestic product (GDP). This estimate incorporates efficiency improvements and the complete elimination of private medical scheme administrators, brokers, and managed care companies. Of this amount R127 billion includes health service providers that do not exist in South Africa”.
The article provides estimated costs on various parts of health reform and the administration of NHI. “Presently the South African Social Security Agency (SASSA) which has a similar configuration, but with more straightforward functions, has administration expenditure equivalent to 8% of turnover. Extrapolating this minimum administration cost onto the NHIA would result in an expense of R16 billion per annum (at the low estimate of R200 billion turnover per annum) which would have to be up and running before extending a single service.”
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