Support for social health insurance in South Africa

A national cross-sectional survey was carried out in South Africa to gain an understanding of the perceptions and priorities of the likely members of a future social health insurance (SHI). More than 1,000 employees were interviewed in a variety of employment sectors, including state and parastatal organisations, formal and informal private sectors. This article reports on respondents’ level of support for a compulsory contribution towards a hospital insurance scheme funding care at public sector hospitals in South Africa. The results showed that only 11 per cent of employees supported an SHI scheme if public hospitals remain as they are. Support increased to 53 per cent if preferential access to treatment was offered to those contributing to the scheme. Support was almost unanimous (87 per cent) if public hospitals were improved. The levels of support differed by current type of health insurance. Thus, support for a compulsory SHI tax to fund care in public hospitals was conditional upon either improving the hospitals or providing differential treatment to contributing members. If one or both of these conditions are not met, its long-term success will be compromised