This programme includes monitoring and evaluation of National Health Accounts, strengthening capacity in analysis of health financing options, and supporting institutions to implement National Health Insurance, the central means by which South Africa aims to achieve universal health coverage.
Funding from the UK Department for International Development (DFID) under the Program for improving countries’ health financing systems to accelerate progress towards universal health coverage is gratefully acknowledged. This support is provided to WCO through the Health financing team in WHO headquarters.
Health Economist: Mr Tomas Roubal
Roubalt [at] who.int
Country Brief printable version [pdf: 566.5 kB]
Country Brief: Universal Health Coverage through National Health Insurance
· 9% of GDP (US$ 570 per person) is spent on health.
· Public spending accounts for 48% of total spending, and 15.5% of total government expenditures. Most people (>80%) use public services.
· Private insurance accounts for 43% of total health expenditures (THE), covers 17% of the population.
· Out of pocket spending accounts for 7% of THE.
· In December 2015, the government published a White paper on the implementation of National Health Insurance (NHI) to achieve UHC, focusing on the dual objectives of strengthening quality in public facilities, and reducing the costs/fees of private health care.
National Health Insurance (NHI) is the central means by which South Africa aims to achieve universal health coverage, under the principles of solidarity and equity in access. Under NHI, 6 work streams are establishing the implementation roadmap (i.e., Establishment of NHI Fund, benefit package, purchaser-provider split, role of private medical schemes, finalizing the NHI policy papers, and strengthening of District Health System). To address private cost escalation, a market inquiry investigates the submission of all stakeholders on the cost drivers, market concentration and impacts of regulation on the private market.
The majority of people rely on the public health system where the purchasers and providers are the provinces and districts. At provincial level, health programs face competing priorities for limited budgets resulting in substantial variation across regions. For example, 25% of the provincial budget in Mpumalanga was spent on health compared with 36% in Western Cape.
Revenue generation. It is anticipated that participation in NHI will be mandatory, and poor families will be subsidized. NHI will be financed from general taxation, VAT, payroll taxes, surcharge on taxable income, and excises on tobacco, alcohol, and sugar sweetened beverages.
Pooling and purchasing. A National Health Insurance Fund (NHIF) will be established to pool existing and new resources. The NHIF will purchase services by contracting with accredited providers (public and private), and use capitation for primary care, Diagnosis Related Groups for inpatient care and price benchmarking for medicines. The purchaser-provider split will require strengthening of the management of public hospitals, and expanding their autonomy, responsibilities and capabilities.
Benefits packages. The government’s list of non-negotiables broadly defines the scope of the basic health services package. The NHI plans to set up a universal benefit entitlement, which will include evidence-based interventions based on the Health Technology Assessment process.
WHO Strategic areas of work in 2015-2019
EU project: WHO CO received 50% funding to support the NHI work streams,through contracting specific technical experts. WHO was requested by the Honorable Minister to provide specific support in close cooperation with the Workstream leads and the NHI unit. Specifically, WHO will support the NHI work streams as follows:
· WS1: analysis of the constitutionality of the NHI and the governance arrangements of the NHI Fund
· WS2: priority setting for benefits package, phased implementation, and developing Health technology assessment capability
· WS3: identify mechanisms to pay for high-cost services (i.e., dialysis) as part of contracting arrangements private provider, contracting arrangements.
· WS4: Establishing a unifying information system for registration and payment; Conceptual and practical solutions for virtual pooling arrangements
· WS5: Support consultative process of NHI
· WS6: Develop/strengthen mechanisms for risk-adjusted capitation models.
National Health Accounts (NHAs). Strengthening a systematic approach to measure and analyze health expenditures at national and provincial levels, through National Health Accounts (NHA).
 NDP, Chapter 10, Promoting Health
WHO submission to the Health Market Inquiry: responses to comments on the WHO commissioned OECD report on private health care prices.
In response to the OECD working paper on South African private hospital price comparison commissioned by the WHO and presented to the Distinguished Panel for the Health Market Inquiry last February 2016, the WHO received written comments about this study. The attached letter is WHO’s formal submission to the Panel responding to these comments.
WHO’s formal submission [pdf: 970.2 kB]