5. NHI AND THE FOUR UHC ALTERNATIVES In the earlier report 7, the four scenarios that were presented (Status Quo Gold Standard, NHI Rejigged, Power to the People, and Reorienting Towards Value) allowed the reader to reimagine UHC implementation in South Africa. We conducted a comprehensive literature review before the report and also used interviews and documentation to differentiate the scenarios. Each scenario has the five policy objectives embedded into its core, and therefore represent a reimagining of the ‘how’ for NHI (see Table 6). The scenarios may help the South African government and various UHC stakeholders to continue furthering the important UHC agenda, without risking the public purse or service continuity.
Table 6: Alternative UHC scenarios explored in this document Model
NHI costing estimate: upper threshold (in R billion)
NHI costing estimate: lower threshold (in R billion)
Implications for total health expenditure
Status Quo
• Better service delivery
• Better data quality
• Equity within the public sector, but not
Gold Standard
through improvements
and transparency to
between sectors.
in quality of care and
facilitate evidence for
• Improved public sector governance.
system hardware.
decision-making.
• Sustainability of the public sector strengthened, but costs likely to continue to spiral in the private sector. • Public sector efficiency improved through data and decision-making. • Minimum quality standard is raised.
NHI Rejigged
• Better regulation of private sector that will bring down high costs. • Improved quality of care in the public sector.
• Earlier development of basic benefit package. • Development of risk equalisation fund
• Efficiency gains as a result of shifts in
Fund.
People
• More competition
insurer by allowing for
between insurers to
multiple purchasers, but
encourage better ad-
with a centralised risk
ministration of funds.
equalisation fund to ensure equity across funds. • This should ensure administration of funds is more responsive to client
• Improved governance in both sectors. • Improved sustainability in both sectors.
foundation for NHI
• User given a choice of
proved equity between sectors.
transitional central across sectors to lay
Power to the
• Equity within each sector, and then im-
• Government is able to hold insurer to account because they are not solely reliant on them.
incentives in the private sector. • Minimum quality standard is raised as equity improves. • Equity across the system as a whole. • Governance strengthened through bottom-up accountability. • Sustainability driven through strategic purchasing and competition between purchasers. • Competing insurers incentivised to drive efficiency. • Quality driven through greater participation.
needs (smaller bureaucracies).
TRADE-OFFS ON THE ROAD TO UHC: A QUANTITATIVE ASSESSMENT OF ALTERNATIVE PATHWAYS FOR SOUTH AFRICA | 10
