The Pros and Cons of National Health Insurance (NHI): Lessons for South Africa from Successful Implementations Around the World

National health insurance (NHI) is a healthcare financing system that has gained attention and traction in many countries around the world. Essentially, NHI is a system where citizens pay into a pool, which is then used to provide universal healthcare coverage to all citizens. The idea behind NHI is to provide affordable, high-quality healthcare to all citizens, regardless of their income or social status.

The United Nations has recognised that access to quality healthcare is a basic human right. In fact, the UN has set a goal of achieving universal health coverage (UHC) by 2030. UHC means that everyone, regardless of their income or social status, has access to quality healthcare services without suffering financial hardship.

NHI has been successfully implemented in many countries around the world. For example, Ghana implemented its own NHI program in 2003, and has seen great success. Prior to the implementation of NHI, Ghana had an extremely high out-of-pocket healthcare expenditure rate, which meant that many people could not afford to access healthcare services. Since the implementation of NHI, the number of people with access to healthcare services has increased dramatically, and the overall health of the population has improved.

Another success story is the case of South Korea. The country implemented its own NHI system in 1989, with notable successes. South Korea's NHI system covers over 97% of the population, and the country has one of the lowest healthcare expenditure rates among OECD countries.

For South Africa, NHI has the potential to be a game-changer in terms of healthcare financing. Currently, the country has a fragmented healthcare system. Despite an equal split in the healthcare expenditure between the public and private healthcare sectors, the former bears the responsibility for 84% of the population while the latter only covers the remaining 16%. This suggests great inefficiencies in how resources within a single country are distributed. Ironically, the country spends around 8% of its GDP on healthcare, 3% above the 5% target recommended by the World Health Organization.

This is not to suggest that the NHI is a perfect system. Like any complex healthcare financing model, there will be pros and cons. One of the biggest advantages of NHI is that it can provide affordable, high-quality healthcare to all citizens. This means that people who would otherwise not be able to afford healthcare services can access them. Additionally, NHI can help to reduce healthcare inequality and improve the overall health of the population.

However, there are concerns that the country may not have the necessary infrastructure and resources to support NHI. Additionally, there are concerns about the potential cost of implementing NHI, and whether the government will be able to sustain the program in the long term.

These concerns should however, not be inflated to deflect from the overall benefit that NHI will have for the majority of citizens, particularly the poor and vulnerable. As already stated, South Africa does not have a problem of inadequate funding for healthcare; its share of GDP spend is above the recommended threshold. The country’s primary problem is its inefficient and disproportionate distribution of its healthcare expenditure, which unjustly favours a tiny section of the population at the expense of the majority. It is therefore important that as the debates on the NHI Bill rages on, more voices must be heard in the camp supporting the poor and marginalized.

Many eminent people and organizations have expressed support for the NHI and Universal Health Coverage. In 2019, the UN General Assembly adopted a resolution recognizing the importance of UHC and calling on countries to implement policies and programs to achieve this goal. Additionally, organizations such as the World Health Organization and the African Union have called for increased investment in healthcare and the implementation of UHC.

In conclusion, NHI has the potential to revolutionise healthcare financing in South Africa. Despite concerns about its implementation and sustainability, many successful implementations of NHI in other countries provide a roadmap for success. By providing affordable, high-quality healthcare to all citizens, NHI could help to improve the overall health of the population and reduce healthcare inequality. It is up to the South African government and its citizens to work together to ensure the success of NHI and achieve universal health coverage for all.