1. NATIONAL HEALTH INSURANCE 14 th October 2016 Dr Anban Pillay 1

2. OUTLINE Introduction Profile of South Africa Health System Challenges Envisioning a future health system NHI Proposition Pillars of NHI Purchasing of Services Contracting of providers Payment mechanisms Conclusion 2

3. INTRODUCTION SA is in the process of implementing National Health Insurance (NHI) NHI as a health financing mechanism that will move us towards universal health coverage (UHC) NHI is aimed at ensuring that: all South Africans have access to quality health care irrespective of their socio-economic status health services are delivered equitably the population does not pay for accessing health services at the point of use the population has financial risk protection against catastrophic health expenditure NHI will be implemented over in a phased approach over a 14yr period that started in 2012 3 3

4. PROFILE OF SOUTH AFRICA Population at 55million (>60% urban) Middle-income (2014) : GDP = $349 billion Total expenditure on health pc (2013): $ 1 121 Total expenditure on health % GDP (2013): 8.93 Life expectancy 60.6/64.3 years ( Midyear Population Estimates 2015, StatsSA) High inequality (Gini-coefficient) = 0.69 4 4

5. BURDEN OF DISEASE (BOD) 5 5

6. Year Crude birth rate Life expectancy at birth Infant mortality rate Under 5 mortality rate Crude death rate MaleFemaleTotal 200224,451,155,753,457,885,213,9 200324,250,554,852,756,283,514,5 200424,050,254,152,254,380,915 200523,850,253,952,152,077,415,2 200623,651,054,853,049,472,914,5 200723,457,256,654,745,867,413,4 200823,253,858,156,045,064,712,6 200923,155,159,457,340,959,911,8 201023,056,160,358,238,953,811,4 201122,856,660,658,737,850,411,3 201222,757,661,359,336,848,311,0 201322,658,262,160,235,245,610,7 201422,459,163,161,234,444,110,2 6 Source: Statistics South Africa (2014): Statistical release P0302. Mid-year population estimates, 2014 PROGRESS MADE IN REDUCING BOD

7. BENEFIT INCIDENCE WITH LEVELS OF HEALTH CARE NEED (In the Public and Private Sectors) Source: Ataguba & McIntyre (2009) 7 7

8. 49% of THE R153billion $ $ $ $ $ $$ $ $ $ $ $ $ $ $$ $ $ $ $ $ $$ $ $ $ $$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 49% of THE R151billion Fee for Service Salaries; historical budgets; budget deficits 8

9. PER CAPITA EXPENDITURE COMPARED TO OTHER BRICS COUNTRIES 9 9

10. SOUTH AFRICA IS AN OUTLIER: WORLD’S LARGEST SHARE OF SPENDING FROM VHI Source: WHO estimates for 2012, countries with population > 600,000 10

11. The NDP (2030) envisions a health system that works for everyone and produces positive health outcomes, and is accessible to all By 2030, South Africa should have:  Raised the life expectancy of South Africans to at least 70 years;  Produced a generation of under-20s that is largely free of HIV;  Reduced the burden of disease;  Achieved an infant mortality rate of less than 20 deaths per thousand live births, including an under-5 mortality rate of less than 30 per thousand;  Achieved a significant shift in equity, efficiency and quality of health service provision;  Achieved universal coverage;  Significantly reduced the social determinants of disease and adverse environmental factors. NATIONAL DEVELOPMENT PLAN 2030 Vision and Trajectory for Health 11

12. GUIDING PRINCIPLES FOR NHI Universalism Health as a Human Right Social Solidarity Equity Public Good Affordability Efficiency Effectiveness Appropriateness 12 Section 27(1): Everyone has the right to have access to health care services, sufficient food and water, and social security, if they are unable to support themselves and their dependents 12

13. THE EQUITY AND SOLIDARITY PRINCIPLES 13 National Health Insurance solidarity principle poorrich contributionaccording toincome Healthy young childless ill old families benefitaccording toneed

14. Health care COVERED POPULATION Stewardship of financing and provision (governance, regulation, information) Collection of funds Provision of services Purchasing of services Pooling of funds Allocation mechanisms Allocation mechanisms (provider payment) Allocation mechanisms Social solidarity and cross-subsidisation Economies of scale and efficiencies Single Pool for Income and Risk Single Payor / purchaser Prepayment Taxes/ Contributions Financial Risk Protection 14

15. 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 PHASE 1 1.Development of Enabling Legislation 2.PHC Reengineering 3.Establishment of Office of Health Standards Compliance 4.Quality Improvement 5.Health Facility accreditation 6.Human resources development 7.Health facility improvement (infrastructure / technology) PHASE 1 1.Development of Enabling Legislation 2.PHC Reengineering 3.Establishment of Office of Health Standards Compliance 4.Quality Improvement 5.Health Facility accreditation 6.Human resources development 7.Health facility improvement (infrastructure / technology) PHASE 2 1.Population registration 2.Establishment of institutional arrangements for the NHI fund 3.Provider accreditation 4.Contracting of Providers PHASE 2 1.Population registration 2.Establishment of institutional arrangements for the NHI fund 3.Provider accreditation 4.Contracting of Providers Phase 1-3: Move towards UHC – Population Coverage, Service Coverage and Financial Risk Protection 0% 100% Phase 1-3: Move towards UHC – Population Coverage, Service Coverage and Financial Risk Protection 0% 100% PHASE 3 1.Full implementation of NHI 2.Provider accreditation 3.Contracting of Providers PHASE 3 1.Full implementation of NHI 2.Provider accreditation 3.Contracting of Providers IMPLEMENTATION PHASES AND PROPOSED TIMELINES 15

16. CONCLUSION 16

17. 17 WISH YOU WERE HERE! 17