oa South African Health Review - Social or national health insurance : pooling of resources and purchasing of health care
There has been an ongoing debate for almost two decades about the possibility of introducing some form of social or national health insurance in South Africa. Despite a range of policy proposals being put forward to pursue this option for financing health care services, no real progress has been made in achieving policy agreement or in getting close to implementing a mandatory health insurance system. One possible contributory factor for this lack of progress is that mandatory health insurance is perceived to be a complex reform and the use of complicated terminology in debates has limited the degree of constructive engagement between key stakeholders and the extent to which consensus could be achieved. For this reason, the objective of this chapter is to clarify some of the key health insurance concepts and to demystify the mandatory health insurance debates. The chapter summarises the South African debates about mandatory health insurance. In particular, areas of agreement and key areas of difference of opinion in these debates are highlighted. This review also highlights that there is considerable consistency in the core objectives of the mandatory health insurance proposals that have been advanced over the years, namely that it is a mechanism for addressing key problems facing private health insurance and for dealing with the massive public-private health sector mix disparities in South Africa. These health system problems have become even more acute in recent years, which make the need to reach some agreement on mandatory health insurance and to pursue its implementation even more urgent.
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