National Health Insurance
Conclusions and Implications for National Health Insurance
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There is excellent data on the prevalence of the Chronic Disease List chronic diseases and the combinations of multiple diseases in medical schemes. The CDL covers the majority of people with chronic conditions but would underestimate the total burden of chronic disease in medical schemes. There is some data on the prevalence of chronic disease in the public sector by broad age bands and gender but much work still needs to be done to calibrate the medical scheme data for the country as a whole.
Despite some reservations, a first estimate of the burden of chronic disease (excluding HIV) for the country as a whole can be made. This shows that a National Health Insurance system would be facing a growing burden of chronic disease, simply due to the growth in the population and the aging of that population (as explored in Policy Brief 1).
This concern is echoed in a paper on “Population Ageing and Health Challenges in South Africa” from the Medical Research Council. The authors said: “Demographic change in South Africa has produced a rapidly ageing population that is expected to continue ageing at a rapid rate for at least the short- to medium-term future. The projection figures illustrate that we have entered an era with steep increases in the number of older persons and much slower growth in the cohorts younger than 60, resulting in little growth in the total population. This is particularly marked for women who comprise a significantly larger number of the older population.”
“Of particular concern is the near doubling of the oldest-old (80 years or older) age group. ... it currently seems that the serious consequences of population ageing are not adequately planned for and responded to by government. ....” “The demographic projections pose clear challenges to the health sector. Not only is there a need to plan for the increase in the numbers in older persons but there is also the need to recognise and plan for an expected increase in chronic morbidity and disability.”
There are several ways a future NHI can tackle this problem other than simply increasing the budget for healthcare. The example of the Western Cape Department of Health was given and their attempts to intervene in the “up-stream” causes of disease. Germany implemented disease management programmes in their national system in 2002 and these have shown significant results in keeping patients healthier and reducing their use of the health system. Other countries to introduce chronic disease management programmes include Singapore, Australia, Japan, Brazil, Argentina, France, Canada, Spain and India.
Interventions in “up-stream” causes for chronic diseases have been developed by medical schemes in South Africa as wellness programmes. There are also programmes for those already diagnosed with a chronic condition, such as disease management programmes and high-cost patient programmes. South African medical schemes and managed care organisations are amongst the leaders worldwide in the growing field of disease management.
South Africa will face a growing burden of chronic disease. Disease management and wellness programmes are areas where the private sector can add significant value to a future National Health Insurance system, no matter the details of the funding design.
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