A critical analysis of the suitability of a national health insurance scheme in South Africa

Abstract

In South Africa’s two-tiered health system, some enjoy health care based on ability to pay and others utilize services in an under-funded sector. The rift in the two, public and private sectors, primarily exists because income categories either curb or allow the necessary contributions. This thesis reports on the various contributing mechanisms, through which health care can be ensured universally, without causing impoverishment. The framework or criteria selected for this study includes feasibility, equity, efficiency and sustainability of a contributing mechanism. Furthermore, the contributing mechanisms – tax-funded, NHI, voluntary health insurance and out-ofpocket – are resident within four health care models namely, Beveridge, Bismarck, NHI and Out-of-pocket. These models are discussed as well as relevant country examples are provided. In the pursuit of answering whether the NHI scheme is suitable for South Africa, the study shows that government or tax-funding and NHI provides the contributing mechanisms that are applicable to the South African situation within the context of different challenges. It is recommended that, in the government’s discussions about health care reform, prepayment, universalism and health care expenditure, amongst others, be considered.