Health care financing in South Africa: moving towards universal coverage

Abstract

The World Health Organisation (WHO) has encouraged countries to move towards achieving universal coverage – equity in access and guaranteed financial risk protection – where prepayment and pooling of resources and risks are the basic principles. South Africa currently finances health care through a variety of mechanism. These mechanisms do not all align themselves to the principles of universal coverage. There is high fragmentation in medical schemes, limited risk pool and lack of cross-subsidization. There is maldistribution of resources between the public and private sectors relative to the population each serves. In the past, there have been failed attempts to develop some sort of universal coverage systems. In 2007, the African National Congress (ANC) committed itself to the establishment of a national health insurance (NHI) system as a step towards achieving universal coverage. Though there are no official documents providing details, this paper provides an overview of the current messages around what the NHI is all about and what the NHI is not. If the NHI is well planned, managed and effectively implemented, it is likely to improve the overall health outcomes of South Africans as well as move the country towards achieving the Millennium Development Goals (MDGs).