National Health Insurance
Conclusions and Implications for NHI
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The proportion of people already covered by health insurance is shown to be at least 15.9% in 2008 and possibly 16.4% if bargaining council scheme beneficiaries are included. This is higher than the estimates produced by StatsSA which are from survey, not actual, data. The provinces have very different proportions of their population already on health insurance with Gauteng and the Western Cape having the highest proportions.
The extension of health insurance coverage to more people under a National Health Insurance system will in all likelihood need to proceed in phases. One possible phasing by income level is demonstrated and it is shown that even if all workers (earning any amount) become contributors and their insurable families thus receive cover, only 51.1% of the population would be covered for health insurance.
This will be the affordability dilemma for any National Health Insurance system: there are 48.9% of the population in families who are not reported to be earning any income. Previous analysis using the GHS2005 showed that 54.0% of the population are in households receiving one or more social security grants 11. The old age pension and the child support grant have a major effect on the ability of households to survive.
The impact of increased numbers of people being covered by mandatory health insurance will be felt differently across the provinces. Gauteng and the Western Cape will have the greatest proportion of people eligible for health insurance due to the greater numbers of people earning incomes in those provinces. Others like Limpopo will not experience much effect from mandatory insurance in the early phases. This implies that the transfers to provinces for the lives remaining in the public sector will need to be carefully adjusted as mandatory insurance progresses.
The age and gender differences between existing medical schemes and the various phases of mandatory insurance are substantial. The price impact was demonstrated and generally, the more lives added under mandatory coverage, the lower the average price of healthcare for all. The age and gender effects alone mean that the price of minimum benefits in medical schemes is some 18% to higher than it would be under mandatory insurance covering all income earners. There may well be additional price reductions under mandatory insurance due to the effect of anti-selection in the voluntary environment but the impacts are more difficult to estimate.
This reinforces the conclusions in Policy Brief 1 that it is critical to perform calculations for National Health Insurance by at least age and gender and preferably also by the burden of disease.
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