NHI is about fairer access and better use of resources

Private medical schemes in SA accumulate most of the money in the country’s health sector but serve only about 16% of the populationThe National Health Insurance Bill introduced to the National Assembly aims to move SA towards universal health coverage. The term means something different from either a general legal entitlement for all people to get some type of care, or simply an affiliation to any type of health insurance programme.

Framed in this way, the concept of universal health coverage is relevant to all countries, and the pathways chosen in any country should be driven by the progressive realisation of these goals. Beyond this, and worth noting, universal health coverage is a population-wide and system-wide aim. This means the unit of analysis for assessing progress on universal health coverage goals and for thinking about related reforms is the entire population and system.

Beyond the three universal health coverage goals, there is also a set of intermediate objectives that reflect how health systems, and particularly their financing arrangements, can influence progress towards the goals. These are:Improving efficiency in health resource use; andThe assumption behind the specification of these objectives is that such improvements have a plausible link to improvements in the ability of a country to sustain progress on the universal health coverage goals.

Finally, it is important to be clear on ends and means. Universal health coverage is a set of goals and therefore an “end” of health policy. It is not something to implement. The NHI or any other scheme or set of reforms are “means”, and the design and implementation should be guided by their impacts on the universal health coverage goals .

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