Financing the National Health Insurance Scheme of South Africa: Opportunities and Challenges

Nevondwe, Lufuno; Odeku, Kola O.

doi:10.1080/09718923.2014.11893264

Cited by 6 publications

(10 citation statements)

References 13 publications

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“…Low-income countries (LICs) face substantial challenges in financing healthcare [1, 2]. Health services are unaffordable and even unavailable to the majority of poor people in these countries [3].…”

Section: Introductionmentioning

confidence: 99%

Household satisfaction with community-based health insurance scheme and associated factors in piloted Sheko district; Southwest Ethiopia

Kebede

Geberetsadik

2019

PLoS ONE

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Background Community-based health insurance (CBHI) scheme is an emerging strategy for providing financial protection against health-related poverty. It is being piloted in the Sheko district, but community satisfaction with the scheme has not yet studied. Therefore, this study aimed to assess the level of household’s satisfaction to CBHI scheme and associated factors in a piloted Sheko district; southwest Ethiopia. Methods A community-based cross-sectional study was conducted in Sheko district from March to April 2018. Data was collected on 528 households by using simple random sampling method. Trained data collectors gathered the data using a pre-tested and structured questionnaire. Descriptive statistics, bivariate and multivariable logistic regression analyses were performed. To determine the independent predictors of household’s satisfaction to CBHI, a cut point of p values < 0.05 were used. Results This study showed that more than half (54.7%) of the households were satisfied with the CBHI scheme. Satisfaction to CBHI was positively associated with adequate knowledge of CBHI benefit packages (AOR = 2.29, 95% CI = 1.55–3.38), type of health facility visit (AOR = 1.93, 95% CI = 1.09–3.39), laboratory service provision (AOR = 2.07, 95% CI = 1.15–373) and length of enrollment (AOR = 1.53, 95% CI = 1.01–2.32). Conclusions Household’s satisfaction to CBHI scheme was moderate. Modifiable factors, including adequate knowledge of CBHI benefit packages, type of health facility visit, laboratory service provision, and length of enrollment were independent determinants of satisfaction. In order to augment enrollee’s satisfaction to CBHI, efforts should be given to improving their knowledge of CBHI benefit packages through education and information campaigns. Furthermore, due consideration should also be given to improving the quality of health services.

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Section: Introductionmentioning

confidence: 99%

Household satisfaction with community-based health insurance scheme and associated factors in piloted Sheko district; Southwest Ethiopia

Kebede

Geberetsadik

2019

PLoS ONE

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“…The results of the study will raise awareness among stakeholders, the general public, medical schemes, healthcare service providers, police and prosecutors, which could assist in curbing fraud in healthcare claims. As SA plans to implement National Health Insurance, [8] the policymakers should also take cognisance of the fraud perpetrated against the medical schemes and proactively put mitigating strategies in place. The Ghanaian national health insurance study indicated that publicly funded insurance schemes are also prone to fraud.…”

Section: Discussionmentioning

confidence: 99%

“…[7] In SA, medical schemes provide a superior quality of healthcare than the public sector. [8] In 2015, there was a total of 83 medical schemes, which paid an overall amount of ZAR138.6 billion for healthcare claims. [9] The huge amount of money expended on claims makes healthcare funders vulnerable to fraud.…”

Section: Researchmentioning

confidence: 99%

Understanding the types of fraud in claims to South African medical schemes

Legotlo

Mutezo

2018

S Afr Med J

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Background. Medical schemes play a significant role in funding private healthcare in South Africa (SA). However, the sector is negatively affected by the high rate of fraudulent claims. Objectives. To identify the types of fraudulent activities committed in SA medical scheme claims. Methods. A cross-sectional qualitative study was conducted, adopting a case study strategy. A sample of 15 employees was purposively selected from a single medical scheme administration company in SA. Semi-structured interviews were conducted to collect data from study participants. A thematic analysis of the data was done using ATLAS.ti software (ATLAS.ti Scientific Software Development, Germany). Results. The study population comprised the 17 companies that administer medical schemes in SA. Data were collected from 15 study participants, who were selected from the medical scheme administrator chosen as a case study. The study found that medical schemes were defrauded in numerous ways. The perpetrators of this type of fraud include healthcare service providers, medical scheme members, employees, brokers and syndicates. Medical schemes are mostly defrauded by the submission of false claims by service providers and syndicates. Fraud committed by medical scheme members encompasses the sharing of medical scheme benefits with non-members (card farming) and non-disclosure of pre-existing conditions at the application stage. Conclusions. The study concluded that perpetrators of fraud have found several ways of defrauding SA medical schemes regarding claims. Understanding and identifying the types of fraud events facing medical schemes is the initial step towards establishing methods to mitigate this risk. Future studies should examine strategies to manage fraudulent medical scheme claims.

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“…Contributions to the NHI will be mandatory for all citizens and permanent residence permit holders although one will remain with an option to continue with voluntary private medical schemes (NHI Green Paper 2011). Nevondwe and Odeku argue that funding contributions of the NHI would be linked to an individual's ability to pay and benefits from health services would be in line with an individuals need for care Nevondwe and Odeku 2014). Funding the NHI will be the greatest challenge in implementing the scheme.…”

Section: The Nhi Frameworkmentioning

confidence: 99%

“…South Africa is in the process of adopting its own model of NHI that is underpinned by various national economic growth policies implemented since 1994 ( Mayosi et al 2009). By introducing the NHI the government seems to be taking a different direction from the policy position of the past two decades (Nevondwe and Odeku 2014). South Africa can learn from the progressive lessons and challenges experienced by Singapore to implement and operationalize its NHI.…”

Section: Introductionmentioning

confidence: 99%

Access to Quality Health Services for All South Africans through the National Health Insurance Scheme: Lessons from Singapore

Nevondwe¹,

Odeku²

2014

MJSS

Self Cite

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The South African health system both in the public and private sectors is fraught with many challenges which render the system unsustainable, costly, hospi-centric, and destructive. In order to curb this loop hole in the health sector, South Africa introduced the National Health Insurance (NHI) that is aimed at providing universal coverage of health care. The objectives of NHI is to provide improved access to quality health services for all South Africans irrespective of whether they are employed or not; to pool risks and funds so that equity and social solidarity will be achieved through the creation of a single fund, to procure services on behalf of the entire population and efficiently mobilize and control key financial resources and to strengthen the under-resourced and strained public sector so as to improve health systems performance. This paper evaluates the Reconstruction and Development Programme (RDP), Growth, Employment and Redistribution (GER), New Growth Path (NGP) and National Development Plan (NDP) policies to determine the challenges and positive aspects of these policies that can be used for the successful implementation of the NHI. The paper further draws lessons from Singapore that has already implemented the NHI and argues that South Africa can learn a lot from these countries experiences. It is concluded that each of the countries provide inspiring positive lessons and also show areas of challenges from which South Africa can draw some lessons

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Financing the National Health Insurance Scheme of South Africa: Opportunities and Challenges

Cited by 6 publications

References 13 publications

Household satisfaction with community-based health insurance scheme and associated factors in piloted Sheko district; Southwest Ethiopia

Household satisfaction with community-based health insurance scheme and associated factors in piloted Sheko district; Southwest Ethiopia

Understanding the types of fraud in claims to South African medical schemes

Access to Quality Health Services for All South Africans through the National Health Insurance Scheme: Lessons from Singapore

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