South Africa: Why South Africans Need National Health Insurance


The government recently published an updated National Health Insurance Bill for public scrutiny and commentary, inciting support and opposition, informed by three primary considerations: economic interests, ideological prisms and lived experiences within the nation's health system. This article combines all these dimensions and demonstrates how NHI benefits transcend the current narrow focus on fiscal or revenue issues.

We present four compelling reasons, based on documented research and extensive health worker policy dialogues, which justify why South Africans need the NHI.

The first relates to the unequal structure of the nation's health system. It is characterised by stark inequalities based on race, class and gender. For example, data from the StatsSA General Household Survey (2018) reveals that only 16% of South Africans have access to medical aids. This membership is dominated by white citizens (72%) while only 10% of Africans have access to medical schemes.

Furthermore, South Africa's health finance is very skewed when contrasted with other countries. An impressive 8.5% of GDP is spent on overall health services, but this is largely consumed by private health sector users and providers. How does a country justify a "two-tiered" health system in which half of the overall health expenditure is spent on...

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