Innovative Medicines > National Health Insurance Library

National Health Insurance

Title	Chapter	Click to Download Document	Click to Download Executive Summary

Policy Brief 1: The Population for Universal Coverage	0. Executive Summary of Policy Brief 1
	1. Estimates of the Population
	2. The Price of Healthcare by Age and Gender
	3. Provincial Differences in the Amount Needed for Healthcare
	4.Aging of the Population
	5.Conclusions and Implications for NHI
	6. Policy Brief 1: Resources

Policy Brief 2: Expanding Health Insurance Coverage	0. Executive Summary of Policy Brief 2
	1. Public-Private Mix of Healthcare Coverage
	2. Beneficiaries Covered by Medical Schemes
	3. Provincial Medical Scheme Coverage
	4. Phased Introduction of NHI based on Income
	5. Anti-selection in Voluntary Medical Schemes
	6. Impact of Mandatory Insurance on the Price of Minimum Benifits
	7. Conclusions and Implications for NHI
	8. Policy Brief 2: Resources

Policy Brief 3: The Impact of Chronic Disease on a Future NHI	0. Executive Summary of Policy Brief 3
	1. Evidence of the Prevalence of Chronic Disease in Medical Schemes
	2. Evidence of the Prevalence of Chronic Disease in South Africa
	3. Estimate of Future Prevalence of Chronic Disease in South Africa
	4. The Burden of Disease on the Health System
	5. Multiple Chronic Disease and Disease Management Programmes
	6. Conclusions and Implications for National Health Insurance
	7. Policy Brief 3: Resources

Policy Brief 4: The Impact of HIV on a Future NHI	0. Executive Summary of Policy Brief 4
	1. The HIV Epidemic in South Africa
	2. Modelling of the Epidemic
	3. The HIV Epidemic by Province
	4. Prevalence of HIV/AIDS in Medical Schemes
	5. Estimates of the Cost of Treatment in the Public Sector
	6. Disease Management in the Private Sector
	7. Minimum Benefits for HIV, AIDS and TB.
	8. The Interaction between HIV and Other Diseases
	9. The Impact of HIV, TB and Related Diseases on a Future NHI
	10. Policy Brief 4: Resources

Policy Brief 5 : The Impact of Cancer on a future NHI	0. Executive Summary of Policy Brief 5
	1. Cancer in South Africa
	2. Sources of Data on Cancer in South Africa for NHI Modelling
	3. Cancer in Medical Schemes in South Africa
	4.The Effect of Poverty on Site of Cancer
	5.The Impact of Cancer on a Future NHI
	6.Provider Initiative for Making Treatment more Affordable
	7. Research and Further Resources on Cancer in South Africa
	8.Planning a Cancer Service for a National Health System
	9. Policy Brief 5 : Resources

Policy Brief 6: Costing and Long-term Modelling of NHI	0. Executive Summary of Policy Brief 6 (Long Term Modelling of NHI		Long Term Modelling of NHI Costing of NHI
	0. Executive Summary of Policy Brief 6 (Costing of NHI)
	1. Basics of Costing and Pricing Healthcare
	2. Estimates of Cost Curves in South Africa
	3. Uncertainty in Long-term Demographic Projections
	4. Demographic, Epidemiological and Health Transitions
	5. The Quadruple Burden of Diseases in South Africa
	6. Theories of Future Changes in Mortality and Morbidity
	7. Conclusions and Implications for a Future NHI
	8. Policy Brief 6 : Resources

Policy Brief 7: The Future Role of Private Health Insurance	0. Executive Summary of Policy Brief 7
	1. ANC Policy Proposals on PHI under NHI
	2. Universal Coverage
	3. Private Spend and Public Spend
	4. Public Subsidy of Private Insurance in South Africa
	5. Single Tier vs. Multi-Tier Systems
	6. Conceptual Framework for the Role of PHI
	7. Public and Private as Technical Issues
	8. Conclusions, Some History and Implications
	9. Policy Brief 7 : Resources

Policy Brief 8: Reducing Fragmented Risk Pools	0. Executive Summary of Policy Brief 8
	1. The Function of Pooling
	2. Risk Pool Size
	3. Risk Pooling in Medical Schemes
	4. Regulations and Risk Adjustment to Improve Pooling
	5. The Proposed Risk Equalisation Fund between Medical Schemes
	6. Risk Pooling in the Public Sector
	7. Need for Risk Adjustment in the Public Sector in South Africa
	8. Possible Risk Pooling between Public and Private Sectors
	9. Conclusions and Actions Needed
	10. Policy Brief 8 : Resources

Policy Brief 9: Affordability of Health Insurance	0. Executive Summary of Policy Brief 9
	1. Income and Social Security in South Africa
	2. Income and Medical Scheme Membership
	3. Studies of Affordability of Minimum Benefits for Lower Income Workers
	4. Affordability in the Low Income Medical Schemes (LIMS) Process
	5. Affordability and Sequence of Reform Study
	6. Expanding Coverage for Health Insurance
	7. Implications for Healthcare Reform in 2010
	8. Policy Brief 9 : Resources

Policy Brief 10: Defining the Benefit Package	0. Executive Summary of Policy Brief 10
	1. Legal and Constitutional Imperatives
	2. Public Sector Standards and Private Sector Minimum Benefits
	3. Prescribed Minimum Benefits in Medical Schemes
	4. Minimum Benefits in Other Countries
	5. The Initial Design of PMBs for Medical Schemes
	6. Subsequent Changes to PMBs for Medical Schemes
	7. The PMB Review Process in 2008
	8. The Design of LIMS Minimum Benefits
	9. Package Design and Affordability
	10. The Implications for a National System
	11. Policy Brief 10: Resources

Policy Brief 11: Estimating Delivery Efficiency under NHI	0. Executive Summary of Policy Brief 11
	1. NHS in the UK compared to South African Hospitals
	2. NHS in the UK compared to Managed Care in the USA
	3. Levels of Managed Care Efficiency in the USA
	4. Comparison of Bed Utilisation in the USA and South Africa
	5. Impact of Different Forms of Managed Care
	6. Why are Managed Care Plans Less Expensive?
	7. Cost for Hospital Admissions in the Public Sector in South Africa
	8. Cost for Medicines in the Public Sector in South Africa
	9. Assumption for Delivery Efficiency in South Africa
	10. Policy Brief 11: Resources

Policy Brief 12: Impact of Healthcare Reform on Members	0. Executive Summary of Policy Brief 12
	1. Reforms for Risk Cross-Subsidies and Income Cross-Subsidies
	2. Sequencing the Reforms needed for the Risk Equalisation Fund
	3. Benefit Design and Option Design Reforms
	4. The Implications for Healthcare Reform
	5. Policy Brief 12: Resources

Policy Brief 13: Savings under NHI: Non-Healthcare Costs	0. Executive Summary Policy Brief 13
	1. Official Definition of Non-Healthcare Costs
	2. Unpacking Gross Administration Expenditure
	3. Non-Healthcare Costs by Administrator
	4. Non-Healthcare Costs of Schemes with more than 100,000 Beneficiaries
	5. Historical Non-Healthcare Costs
	6. Studies of Administration Costs in Other Countries
	7. Conclusions and Implications for Health Insurance in South Africa
	8. Policy Brief 13: Resources

Policy Brief 14: Comparison of NHI Proposals	0. Executive Summary Policy Brief 14
	1. National Health Insurance as Envisaged Pre- and Post-Polokwane
	2. Features of the ANC 2010 NHI Proposals
	3. Contradictions and Concerns with the ANC 2010 NHI Proposals
	4. Conclusions
	5. Resources

Policy Brief 15: NHI and Workplace Healthcare	1. Overview of Workplace Healthcare in South Africa
	2. Restricted Membership Medical Schemes
	3. Low Income Workers and Medical Schemes
	4. Bargaining Council Schemes
	5. Bargaining Council Schemes and Healthcare Delivery
	6. Employer Clinics and Extending Occupational Health Facilities
	7. The Mining Model
	8. Employer Provision of HIV/AIDS Treatment
	9. ANC NHI Proposals and Effect on Workers
	10. Resources

Policy Brief 16: Universal Coverage and Equitable Financing	1. The Meaning of Universal Coverage
	2. The Current Status of Universal Coverage in South Africa
	3. A Potential Path to Improving Universal Coverage
	4. Reforms Needed in the National Health System
	5. The Policy for Subsidies in the National Health System
	6. ILO Policy on the Use of Multiple Financing Mechanisms
	7. A Potential Equitable Subsidy Framework
	8. Resources

Policy Brief 17:LIMS Reforms and Equitable Subsidies	1. The Initial Costing of the Proposed LIMS Benefit Package		Evaluation of LIMS Reforms Equitable Subsidy Framework
	2. Cost Curves for LIMS Minimum Package by Age and Gender
	3. The Population for LIMS and the Impact on the Medical Schemes Population
	4. Cost and Community Rate for Benefits under LIMS
	5. Evaluation of LIMS Reforms on a Benchmark Family
	6. Integrating LIMS with the Public Sector and Health Insurance
	7. Extending the Proposed Equitable Subsidy Framework
	8. Resources

Policy Brief 18:Projected Population and HIV/AIDS Update	0. Executive Summary Policy Brief 18
	1. Revised Total Population Estimates
	2. Key Changes in the ASSA2008 Projections
	3. Impact of Revised Population Estimates on Price of NHI
	4. Revised Projection of HIV/AIDS
	5. Provincial Modelling using ASSA2008
	6. Conclusions and Implications
	7. Resources

Policy Brief 19:Projected Population and HIV/AIDS Update	0. Executive Summary of Policy Brief 19
	1. WHO Report on Non-communicable Diseases
	2. Cancer Incidence using GLOBOCAN 2008
	3. Chronic Disease Prevalence
	4. Conclusions and Implications for a Future NHI
	5. Resources

Policy Brief 20: The Tax Base in South Africa	1. Total Tax Revenue in South Africa
	2. Categories of Tax and Tax Instruments
	3. Personal Taxation by Income Band
	4. The Definition of Taxable Income
	5. Contributions Related to Payroll
	6. The Cost of Collection and Administration of Taxes
	7. Issues and Implications for a Future NHI
	8. Resources

Policy Brief 21: Myths about Medical Schemes	0. Executive Summary of Policy Brief 21
	1. Myth that Medical Scheme Beneficiaries are mostly White
	2. Myth that Medical Schemes are for the Wealthy
	3. Myths about the Population Covered by Medical Schemes
	4. Myth that Medical Schemes Profit from their Members
	5. Myths about Public and Private Expenditure on Healthcare
	6. Conclusions
	7. Resources

Glossary	1. Health System Goals and Objectives
	2. Social Security Systems
	3. The Healthcare Financing Function
	4. The Role of Private Health Insurance
	5. Providers and Stakeholders in South Africa
	6 .Health Insurance Terms
	7. Medical Scheme Terms
	8. Reimbursement of Healthcare Providers
	9. Managed Care
	10. Healthcare Terms

National Health Insurance

Policy Brief 1: The Population for Universal Coverage

Policy Brief 2: Expanding Health Insurance Coverage

Policy Brief 3: The Impact of Chronic Disease on a Future NHI

Policy Brief 4: The Impact of HIV on a Future NHI

Policy Brief 5 : The Impact of Cancer on a future NHI

Policy Brief 6: Costing and Long-term Modelling of NHI

Policy Brief 7: The Future Role of Private Health Insurance

Policy Brief 8: Reducing Fragmented Risk Pools

Policy Brief 9: Affordability of Health Insurance

Policy Brief 10: Defining the Benefit Package

Policy Brief 11: Estimating Delivery Efficiency under NHI

Policy Brief 12: Impact of Healthcare Reform on Members

Policy Brief 13: Savings under NHI: Non-Healthcare Costs

Policy Brief 14: Comparison of NHI Proposals

Policy Brief 15: NHI and Workplace Healthcare

Policy Brief 16: Universal Coverage and Equitable Financing

Policy Brief 17:LIMS Reforms and Equitable Subsidies

Policy Brief 18:Projected Population and HIV/AIDS Update

Policy Brief 19:Projected Population and HIV/AIDS Update

Policy Brief 20: The Tax Base in South Africa

Policy Brief 21: Myths about Medical Schemes

Glossary

Policy Brief 8:
Reducing Fragmented Risk Pools

Policy Brief 9:
Affordability of Health Insurance

Policy Brief 10:
Defining the Benefit Package

Policy Brief 11:
Estimating Delivery Efficiency under NHI

Policy Brief 12:
Impact of Healthcare Reform on Members

Policy Brief 13:
Savings under NHI: Non-Healthcare Costs