Key considerations for the national health policy in South Africa : lessons from international experience

Abstract: Countries around the world are seeking to modify their health-financing systems and are implementing reforms to achieve universal health coverage. The National Health Insurance (NHI) came about as a policy option to enable countries to realise the goal of universal health coverage, significantly reducing financial barriers to health care access and catastrophic health expenditures. South Africa has proposed such a health reform option, aimed at ensuring that there is universal access to health care services in the country. The study follows a policy evaluation research approach, and identified key areas to be considered when contemplating a reform option such as the NHI. These are equity considerations in the delivery and financing of the NHI; sustainable economic development and growth to ensure successful reform; the need to control costs or health expenditures; strong government leadership and passion for reform at the top; choice between single- or multiple-payer health insurance systems; and sufficient health infrastructure to support the reform. The study reviews the health systems reforms implemented in Canada, Taiwan, Brazil and Ghana based on the key considerations identified and on the design elements for the expansion of health insurance coverage to draw lessons for South Africa. Health reforms in these countries, with the exception of Brazil, were implemented at a time where these economies were growing and had the fiscal resources to finance the reforms. The study concludes with recommendations that could contribute towards the current policy debate as South Africa moves along its phased implementation of the NHI to ultimately achieve the goal of universal access to health care.M.Com