NHI Snippets (1): Where do I start?

National Health Insurance in South Africa:  Where do I start? 

“Start with something sensational,” said a friend, “otherwise no-one will read your blog.” 

The trouble is, though, that National Health Insurance is a complex concept.  It’s hard to explain and it’s hard to tease out all the arguments underlying the way it has been conceptualised. 

So I think this blog needs an audience that is willing to put an effort into understanding NHI, whether or not I write sensationally.  Let me put my faith in you …


To start, then, I think there are two basic facts about the South African health system that we need to know to gain some perspective on the NHI debate:

Fact 1: 

South Africa channels as much money through medical schemes as it gives in taxes to health care services.1  There is no other country in the world that relies to such an extent on private health insurance.2 

Fact 2:

The health of the average South African is poor relative to the wealth of the country.  South Africa is an outlier on graphs that compare the health indicators of countries against their GDP per capita.3

The poor performance of both the public and private health care sectors lies behind these two facts.  It is this that has driven the development of the NHI proposal.


P.S.  Don’t worry if you don’t understand the term ‘National Health Insurance’ or what the South African government is currently proposing.  I will deal with this in later posts.




1.  McIntyre DE, Doherty JE, Ataguba JE. (forthcoming). Health care financing and expenditure – progress since 1994 and remaining challenges. Health and health care in South Africa (2nd edition). Van Rensburg H. Pretoria: van Schaik Publishers.

2.  Drechsler D, Jutting J. (2005). Is there a role for private health insurance in developing countries?  Berlin:  German Institute for Economic Research.

3.  Langenbrunner J. (2011).  Presentation to National Health Insurance Conference:  Lessons for South Africa, 7-8 December 2011,  Gallagher Estate, Midrand, South Africa

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