oa South African Health Review - National Health Insurance : providing a vocabulary for public engagement : perspectives on a national health insurance

Volume 2010, Issue 1
  • ISSN : 1025-1715



There has been considerable confusion and media debate about the proposal to introduce a national health insurance (NHI) in South Africa. The purpose of this chapter is to demystify the proposed health system reform. It explains the objective of the proposed reform, evaluates how South Africa currently fares relative to this objective and explores the implications of lessons from international experience for the South African health system. It also considers what is required to ensure that a reformed health system is affordable and sustainable.

This chapter argues that the term 'NHI' has itself contributed to the confusion about the intended reform and that the focus should instead be placed on the core objective of the reform, which is to achieve a universal health system. A universal system is one that ensures that everyone is able to use health services when needed and that provides financial protection against the costs of health care for everyone. The reality is that many South Africans cannot access health care when needed.
Another misconception is that the proposed reform is simply about how to fund health services. Instead, it is very much about ensuring that South Africans have real access to appropriate, efficient, quality health services.
A key area of contention has been whether a universal system is affordable or not. Not only is it premature to declare the NHI unaffordable when there are no details of the proposed reforms in the public domain, but it is also important to recognise that it is not the universality of a health system that makes it unaffordable. It is, instead, inappropriate design of a health system that can make it unaffordable.
There is neither doubt that health system change is needed in South Africa, nor dispute that it is possible to achieve an affordable universal system. What is required is constructive and evidence-informed debate from all stakeholders on how best to achieve improved health for all South Africans through health system reform.

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