| Summary |
Social health insurance was first proposed in the 1980s. It was seen as a key mechanism for extending health care coverage and promoting equity in South Africa. Lack of policy action has meant that the SHI has not been implemented and wide disparities between health care in the public and private sectors remain untouched. This summary brief explains why consensus was never reached on the exact form social health insurance should take, and suggests strategies for building support amongst important stakeholders. The chapter critiques features of the governments most recent proposal, published in 1997. |
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Introduction
Social Health Insurance was first discussed in the late 1980s as a mechanism the public sector could use to harness resources spent in the private sector, thereby improving health care coverage. Several recent documents associated closely with the new government have also highlighted the need for SHI in South Africa (see Table 1).
Table 1: A chronology of official documentation proposing SHI
1994 |
The ANC Health Plan |
1997 |
White Paper for the Transformation of the Health System in South Africa |
1997 |
A Social Health Insurance System for South Africa |
1999 |
1999 Election Manifesto of the ANC |
1999 |
Health Sector Strategic Framework, 1999-2004 |
What is SHI?
Key features that are common to all SHI everywhere are:
- It is legislated by government and requires regular, compulsory contributions by members
- Eligible members cannot opt out of a scheme or be excluded by the scheme
- Premiums are calculated according to ability to pay (i.e. according to income)
- Benefit packages are standardised and
- Contributions are ear-marked for spending on health services
These features make it possible to:
- Have large risk pools' where a stable membership of contributors and their dependants cross-subsidises the care of the elderly, sick and poor with premiums paid by the healthy and wealthy
- Reduce the number of people whose health care has to be funded out of the public budget, and
- Contribute to the public budget through fees paid by SHI members to public
services
These characteristics have the effect of improving equity within the membership of the scheme and across the entire health care system. |
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