Implementation of National Health Insurance in South Africa: views of healthcare managers in a private healthcare institution

South Africa is in the process of reforming its healthcare system by implementing universal health coverage for its citizens. Universal health coverage is defined as the access of all people to comprehensive health services at an affordable cost with protection against catastrophic health expenditures leading to financial hardship. The system being implemented in South Africa is known as National Health Insurance (NHI) and is seen by the South African government as the key to addressing the shortcomings and disparities in the current public and private healthcare sectors. Healthcare managers have a crucial role to play in health reform yet are often overlooked in debate over health reform. The primary aim of this study was to better understand the views of healthcare managers, working in a private healthcare institution in South Africa, towards the implementation of the NHI. The purpose of this was to make recommendations that would assist the private healthcare institution under investigation to optimise the implementation of the NHI. A quantitative research design was used to explore and describe the views of healthcare managers. Firstly, a literature review was conducted to gain international as well as local perspectives of healthcare practitioners on universal health coverage. Secondly, a census survey in the form of an online questionnaire was developed and distributed to 193 healthcare managers representing different managerial and medical disciplines in a private healthcare institution with facilities nation-wide. A total of 63 questionnaires were returned for analysis. Quantitative data were analysed using Microsoft Excel, Statistica and SPSS Statistics. Qualitative data in the form of written comments by the participants were analysed using interpretive analysis that involved sequential steps of familiarisation and immersion, development of themes, coding, elaboration and interpretation and checking. The qualitative element of the study was limited in nature and was used merely to enrich the quantitative findings. The study found that there was a lack of knowledge amongst private healthcare managers concerning the NHI, poor communication from the government regarding the proposed NHI and high levels of negativity towards the ability of the government to successfully implement the NHI. However it was found that despite concerns regarding the NHI, the private healthcare managers surveyed showed a willingness to actively participate in its implementation. Recommendations regarding policy and practise were made for private healthcare institutions as well as for the South African government in order to assist with the implementation of the NHI