Do South Africans really understand the National Health Insurance scheme?: a survey of adults in three provinces

A study was conducted among adult residents using health services in three provinces of South Africa to determine their understanding of the new National Health Insurance (NHI). The study was carried out among adult respondents in Limpopo, KwaZulu-Natal and the Eastern Cape provinces. A cross-sectional descriptive study design was used to select a sample of 784 from all the three provinces using a two-stage systematic sampling design. Data were collected using mobile phone assisted personal interviews (MPAPI). The respondents had a poor understanding of what the NHI would pay for. In this study, 48.1% knew that the NHI fund would pay for medical expenses if a person got sick, and 45.7% knew that with health insurance, basic health requirement is ensured and that if one becomes ill, medical treatment would be paid by the NHI fund. Again, 50.9% of South African respondents did not understand how the NHI fund will pay for health care received. Public awareness campaigns about the NHI were generally good while the education campaigns to increase understanding of the scheme were inadequate and did not penetrate many communities where information about the NHI was sought. We recommend a comprehensive community consultation plan to increase understanding of the NHI using various strategies such as house to house campaigns, town hall-type of meetings, workplace consultations and road shows at significant sites in communities such as clinics, schools, mines, farms and pension paypoints.