On 16 August 2022, the Inclusive Society Institute’s (ISI) research team looking into the National Health Insurance (NHI) proposals of government, as contained in the draft bill currently before Parliament’s Portfolio Committee on Health, presented the outcomes of their research to National Treasury. The ISI team was led by the Institute’s lead researcher, Professor Shivani Ranchod, whilst the Treasury team was led by Dr Mark Belcher, their Social Services Director.
The ISI did extensive research into alternative pathways to Universal Health Care, including a costing exercise into both the NHI proposals as contained in the Bill, and the alternatives put forward in the research. The Institute also raised its concerns with the Bill, which included, amongst others:
Issues of governance, where the Institute maintains too much power vest in the Minister apropos the appointment of the Board and CEO. The ISI position is that the board must be selected via a public process and the CEO should be appointed by the board.
The phasing out of private medical aids in South Africa. The ISI’s position is that private medical aids should be permitted to co-exist within the public health environment.
Competition needs to be introduced into the NHI system through more than a single fund. The ISI’s view is that the introduction of competition through the establishment of more than one NHI fund will help drive costs down and mitigate against corruption.
The pace at which the transition to the NHI is envisaged. The ISI’s position is that the initial focus should be on improving the quality of the public health system, through which public trust in government’s ability to roll-out the NHI could be built. The guiding principle should be ‘don’t break what’s working until an alternative that works is in place’.
The Institute’s reports can be accessed via the following links:
Lessons for South Africa on transitioning to universal health coverage from the German experience
Briefing document - Brief to Senior Counsel for formal legal opinion
Reimagined pathways for UHC in South Africa: A critical policy assessment of NHI choices
Trade-offs on the road to UHC: A quantitative assessment of alternative pathways for South Africa
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