National Health Insurance “The dream [vision] of UHC in South Africa: A

national perspective. Demystifying the NHI scheme”

'Nurses: A leading force for change, advancing the NHI‘

City of Johannesburg, Indaba Hotel

30th May 2014

Outline

• Preamble

• Status quo

• NHI policy proposals

• Conclusion

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Preamble • A health system consists of ALL organizations, people and

actions whose primary interest is to promote, restore and/or maintain health.

• Health is a public good

• Good health services are those which deliver effective, safe, quality personal and non-personal health interventions to those who need them, when and where needed, with minimum waste of resources

– Effectively address patient expectations

– Fairly accessible

– Responsive to health needs

– Value for money

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Status Quo

• Inherent public-private split:

– Public: 84 % = primarily through tax-funding

– Private: 16% = VHI (medical schemes)

• Fragmentation and entrenched imbalances between sectors:

– Fragmented funding pools & weak cross-subsidisation

• Entrenched inequities in the health system

– Health workforce

– Accessibility

• Hospicentric system

• Quadruple BOD

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Evidence shows an inverted & unfair health system…

Source: "Who benefits from health care in South Africa?" HEU, UCT.

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There are no simple solutions to the systemic challenges...

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Should anything be done…?

• Three diametrically different positions:

– Position 1: DO NOTHING – All is well and let the market take control.

– Position 2: MIDDLE GROUND – Leave the private sector alone; focus ONLY on fixing the problems in the public sector.

– Position 3: DO SOMETHING – Overhaul the entire health system to the benefit of all South Africans.

What is the best option for the South African context and how best do we achieve it?

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We cannot wish our problems away so we must get up, roll-up our sleeves and take action now

• NHI as a mechanism to achieve UHC

– Critical towards realising the vision of a long and healthy life for all South Africans

• The overall aim is that every citizen must have the right to access quality affordable healthcare and such access must not be determined by the socioeconomic status of an individual

• In line with the 1978 Alma Ata Declaration of “Health For All”, the heartbeat of NHI is going to be Primary Health Care (PHC)

– Re-engineer health system to focus on promotion, prevention and community outreach

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Principles behind the reforms…

• Right to access health care

• Social solidarity

• Equity

• Health care as a Public Good

• Affordability

• Efficiency

• Effectiveness

• Appropriateness

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Why…

• To achieve improved access to quality health services for all South Africans

• To eliminate the fragmentation in funding pools

• Single fund, publicly-administered

• Entrench equity and social solidarity

• To realise economies of scale in the procurement and distribution of key health resources

• To strengthen the under-resourced and strained public sector so as to improve overall health system performance

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How…

http://www.wpro.who.int/health_services/health_systems_framework/en/ 11 CoJ

Integrate the funding sources… • NHI requires the reconfiguration of the institutions and

organisations involved in

– Funding (revenue mobilisation)

– Pooling (putting money into a single pot)

– Purchasing (how to buy services) and

– Provision of health care services (access, quality & scope)

• Objective of minimising inequities between public and private as well as within the public sector

• Entrench

– Financial risk protection

– Equitable access to defined health service entitlements

– Value for money (health outcomes)

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Is the money available…?

• The most common source of funding for all government

programmes is general tax

– Government is exploring various funding sources for financing NHI and will release a discussion paper

• Most health financing schemes in countries where UHC has been successful have pooled their healthcare funds into a single fund

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Who will be covered… Section 27. Health care, food, water and social security

1. Everyone has the right to have access to

a. health care services, including reproductive health care;

b. sufficient food and water; and

c. social security, including, if they are unable to support themselves and their dependants, appropriate social assistance.

2. The State must take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of each of these rights.

3. No one may be refused emergency medical treatment.

Citizens | Permanent residents | Students & Tourists |

Refugees & Asylum seekers | Undocumented residents 14

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When… • NHI to be implemented over a phased period.

– 14 year outlook

– No big bang approach

• Various interventions being implemented across the country as part of preparatory work

– PHC re-engineering; infrastructure upgrades; quality of care; NHI pilots; facility improvement teams; etc

• Draft White Paper available

– Needs to go through formal policy processes and approvals

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Conclusion • Many stakeholders with varied standpoints

– Governance must be proactively managed

– Adequate opportunity for participation/involvement in processes

• Universal coverage must remain an unwavering objective

– Social justice, equity and fairness should be basis of the reforms

– “Hardware” i.e. Infrastructural, HR issues important BUT “software” critical too i.e. Organisational culture

• Status quo is untenable = each sector has its own ills and these must be addressed holistically

• Not a one-size fits all set of reforms

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Thank you

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Contact details

Moremi Nkosi

Email: NkosiMo@health.gov.za

Office: 012 395 8175

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