National Health Insurance in South Africa

The feasiblenessof the proposed National Health Insurance

Prior to the 1994 democratic discovery, South Africa had a fragmented wellness system designed along racial lines. One system was extremely resourced and benefitted the white minority. The other was consistently under-resourced and was for the colored bulk. ( Department of Health, 2011 )

Presently, South Africa is in the procedure of set uping the National Health Insurance ( NHI ) due to unequal entree to healthcare amongst different socio-economic groups. The NHI will try to increase the handiness of health care to those who can non afford it or whose state of affairs prevents them from achieving the health care they need. It will be implemented over a period of 14 old ages. However, the funding required badly undermines the feasibleness of the NHI on the wellness systems in South Africa.

At present, the Constitution has outlawed any signifier of racial favoritism and guarantees the rules of socioeconomic rights including the right to wellness. However, this has promoted private and public health care. Additionally, more money is spent on the private sector instead than on the populace sector – which serves the bulk of the South African population. Therefore, the bulk of South Africans from low or in-between categories do non hold health care coverage, but need it more than anybody else. ( Department of Health, 2011 )

Therefore, the NHI will suggest a individual National Health Insurance Fund ( NHIF ) for wellness insurance. This NHIF will be mandatory for all South Africans – from certain income brackets – to lend to the wellness fund. Therefore, the NHI will derive its pecuniary parts from revenue enhancements. Therefore, the NHI will work as a manner to buy and supply wellness attention to all South African occupants without take awaying from other societal services.[ 2 ]

However, the thought of the NHIF leaves many South Africans in uncertainty as to whether or non the NHI will work. Presently, the huge bulk of wellness attention financess come from single parts coming from upper category patients paying straight for wellness attention in the private sector. However, from the manner the NHIF will work, it appears that the NHI will set a load on the upper category to pay for all lower category wellness attention. Therefore, health care fund grosss will be shifted from single parts to general revenue enhancement gross.[ 3 ]Through this, the funding required badly undermines the feasibleness of the NHI on the wellness systems in South Africa.

The NHI is executable due to a few grounds, such as: the inclusion and acknowledgment of traditional therapists in the wellness sector every bit good as the promoting of holding more private General Practitioners ( GPs ) included in presenting primary health care.

Integration of Traditional Medicine

Under the NHI Traditional therapists will be integrated into primary health care installations and infirmaries following the assignment of an Interim Traditional Health Practitioners Council ( ITHPC ) . The ITHPC will hold 20 members and will be constituted by representatives of practicians from all the nine states. It includes a legal expert ; a member of the HPCSA ; a member of the SA Pharmacy Council ; community representatives ; diviners ; herb doctors ; traditional birth attenders ; traditional sawboness ; faculty members ; research workers ; and the National Department of Health.[ 4 ]

DrGwen Ramakgopa, Deputy Health Minister of South Africa, stated that: “The primary function of the ITHPC is to help the wellness ministry and the state to accomplish [ the end of the NHI ] within the following three old ages of their term of office.”

Therefore, from this, it is apparent that the ITHPC will modulate how traditional wellness practicians will be added to the official registry of practicians in South Africa. Furthermore, the ITHPC will modulate what responsibilities traditional wellness practicians will hold. For illustration: supply ill notes to patients or organizing portion of the ITHPC’s work traveling frontward.

However, in order to protect the populace from undependable traditional therapists the ITHPC chair-person, herbalist Abram Conrad Tsiane, states that the ITHPC will set up a registry of traditional therapists in order to guarantee dependable intervention from traditional therapists.[ 4 ]

Traditional medical specialty has been recognised and endorsed by the World Health Organisation ( WHO ) since 1978.[ 4 ]Therefore, the ITHPC will promote many primary health care installations and infirmaries to get down working in coaction with traditional wellness practicians to handle infective diseases ( such as HIV/AIDS and TB ) and chronic unwellnesss ( such as Diabetess ) .

However, before traditional therapists can work in coaction with medical practicians, they must be trained in wellness publicity every bit good as to recognize symptoms that require referral to wellness installations. Therefore, Dr Ramakgopa has stated that traditional therapists will sit on clinic commissions, infirmary boards, territory wellness commissions, every bit good as provincial and national consultative constructions to guarantee that they receive the necessary preparation in wellness publicity.[ 4 ]

Integration of GPs

Under the NHI there has been a considerable sum of accent placed on holding private General Practitioners ( GPs ) included in presenting primary health care.

The cardinal aim of the NHI will be the close the spread between GPs and specializers so that patients can entree healthcare suppliers at an earlier province instead than what is available in the current health care system. GPs will be – along with divisional, probationary and third infirmaries – a point of bringing for primary health care. They will besides supply a full scope of primary attention services in medical Centres or comparable agreements in order to be every bit near as possible to their patients. ( Dr Tony Behrman, 2011 )

This is an invitation for GPs to work together with specializers and paramedical forces in order to develop the health care system in South Africa. Payment for GPs will be through a risk-adjusted capitation system which is linked to public presentation of the GPs. This is utile as it aims to incentivise GPs to guarantee that they provide the best health care for patients. Healthcare coding systems will be introduced – it is a system that accredits GPs to supply services under the NHI. Through this, merely accredited GPs will be contracted to supply primary health care. ( Dr Tony Behrman, 2011 )

For GPs, the NHI offers a important chance for the development of working relationships between them, specializers and the province. The NHI may non be a menace to GPs.

However, there will be some signifier of opposition, to the NHI, by GPs due to the confusion over how they will acquire paid. Currently, GPs operate harmonizing to a fee-for-service payment system where the patient pays for each service, get downing with the audience. Under the NHI, GPs will be paid through a capitation payment system where each individual will pay the same sum. Furthermore, GPs chiefly use medical assistance strategies as a signifier of payment. Therefore, the thought of capitation is unusual to many GPs due to merely 10 % of their patients being capitated. Besides, another concern for GPs is that under the NHI patients will confer with for fiddling grounds because the service is free.

Additionally, Professor Luiz – from the UCT Graduate School of Business ( GSB ) – believes that another issue will be that GPs will show concerns about the capacity of authorities to pay them on clip. Therefore, as a solution to this, Professor Luiz suggested that basic contractual parametric quantities should be set in order to avoid bad inducements. Besides, Professor Luiz believes that GP patterns should be financially incentivised in order to guarantee an adequately competitory market and guarantee the feasibleness of the NHI.

Therefore, supplying contracts for private GPs to be included in presenting primary health care will necessitate the turn toing use in the model of mensurable patient satisfaction and clinical results. This is because the hazard of use is likely to be adjusted increasingly as more information is collected in the NHI.

Why NHI is non executable

There is much anxiousness environing South Africa and the NHI. However, to find why the NHI is non executable, it is critical to analyze two peculiar states that have implemented similar health care systems, viz. : the UK and USA.

In the UK, the National Health Scheme ( NHS ) was implemented in 1948. Through the NHS infirmaries, physicians, nurses, druggists, lens makers and tooth doctors united under one administration to supply free bringing for their services. The NHS follows a simple system: everyone will hold free entree to the wellness services and the NHS will be financed wholly from revenue enhancement, intending that people from different income brackets contribute to the NHS harmonizing to their agencies. Even though the NHS remains free – in footings of bringing – for every occupant in the UK, patients will still be charged for some prescriptions, and optical and dental services.[ 5 ]

However, jobs with the NHS have arisen since its execution in 1948. Even though it employs over 1.7 million medically-trained professionals, presently merely half of them are clinically trained. Besides, even though curates of wellness have promised to supply more support to infirmaries in ‘rural’ countries, many nurses in these infirmaries are confronting occupation cuts and increased degrees of work ensuing in nurses supplying limited clip of attention to patients.[ 5 ]

Additionally, the Royal College of Nurses – which supports the 400000 nurses in the UK – revealed that the NHS struggles to supply services for infirmaries in ‘rural’ countries. This is because the NHS is neglecting to maintain up with the immense demand for health care by the aging population due to staff cutbacks and infirmary bed deficits.[ 5 ]

The USA is besides confronting a similar job. On a planetary graduated table, the USA has the most expensive wellness system. They spend 20 % of GDP ( i.e. R20 trillion ) on health care entirely. However, the wellness systems in the USA are merely favorable to those who are wealth.

In March 2010, Obamacare became jurisprudence in the USA. While some alterations sing wellness insurance ordinances and coverage have occurred between 2009 and 2013, most betterments will merely take topographic point this twelvemonth. Under the Obamacare, health care for the aged is comparatively good, because they are covered by Affordable Care Act. This Act besides caters for people younger than 65.[ 5 ]

However, the job that Obamacare is confronting is that private wellness insurance continues to stay expensive for both employers and employees. Individual insurance companies are go oning to decline insurance to the sick. In add-on to the jobs with Obamacare, handiness to physicians is disputing and limited under Medicaid, because the mean cost for a audience with a physician is R1600. Through this, a important figure of Americans are without any insurance at all and are largely catered for by charities.[ 5 ]

Taking lessons from these two illustrations it is apparent that the NHI will non be executable with the current degrees of corruptness and bad infirmary direction in the public sector.A batch of work has to be done to root out corruptness in the public wellness sector before the strategy can be implemented.


In shutting, whether the NHI will be executable or non will be debated for every bit long as the divide between socialism and the free market is with us. This is because the NHI serves as a support mechanism instead than a solution for South African health care. For the NHI non to meet the same jobs as the NHS and Obamacare bringing is indispensable and must be carefully examined on a regular basis in the hapless public wellness systems of South Africa. Additionally, upgrading and keeping the infirmaries in South Africa is indispensable. This will let for the capableness of supplying the benefits of a state-regulated health care, as envisaged in NHI, which uses indefensible extra personal revenue enhancements to accomplish criterions of excellence in this construct.


  1. Department of Health ( 2011, August 12 ) .National Health Insurance in South Africa Policy Paper. Retrieved March 21, 2014, from hypertext transfer protocol: //
  2. hypertext transfer protocol: // # National_health_insurance
  3. hypertext transfer protocol: // # National_health_insurance
  4. Medical Chronical‘Traditional therapists to be integrated into NHI’ .( 2013, March 5 ) . Retrieved March 22, 2014, from hypertext transfer protocol: //
  5. African Health Placements ( n.d. ) .Health insurance around the universe – lessons for South Africa – See more at:hypertext transfer protocol: // # sthash.hUqlGGxe.dpuf. Retrieved March 25, 2014, from hypertext transfer protocol: //
  6. Dr Tony Behrman, CEO CPC/Qualicare ( 2011, September 11 ) .NHI: a Windfall for GPs?Retrieved March 26, 2014, from hypertext transfer protocol: //
  7. SABC. ( 2012, February 20 ) .NHI non executable: Medscheme.Retrieved March 26, 2014, from hypertext transfer protocol: // -Medscheme-20120220
  8. Levin, Dr A. M. ( 2012 ) . Doctor ‘s Voice: NHI – Doomed to be Stillborn?Medical Chronical

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