M.A. (Public Management and Governance) / The study deals with the nature and problems of the proposed National Health Insurance system in South Africa in order to develop a management and governance model to promote universal healthcare in South Africa. The general aim of the study is, therefore, to analyse the concepts and policy initiatives related to the resolution on the National Health Insurance (NHI) scheme being passed at the ANC’s 52nd National Conference in Polokwane in 2009. Calls for a NHI together with relevant legislation and programmes, have consistently formed an integral part of Government’s national effort to build a united national health system in which the public health sector plays a dominant role as provider of first choice. The proposed NHI is a state-mandated and state-administered health insurance scheme that provides universal and comprehensive cover to all South Africans in spite of their financial status. In essence therefore, the vision of the NHI system is to be inclusive of the unemployed and the indigent who will also be afforded the opportunity to receive healthcare which is on par with everyone else’s and not based on what they can or cannot afford. This enquiry is premised on the variables that have influenced the development of South Africa’s healthcare system, the implementation challenges of the proposed NHI, according to the National Health Insurance Policy Paper of 2011, and the lessons that South Africa can derive from the implementation of the national health insurance schemes of Brazil and Ghana. The dissertation concludes that there are certain challenges in the current NHI debate in terms of the lack of technical details on the proposed NHI system, a lack of transparency in terms of the process, as well as problems related to the exclusion of the main stakeholders in the public and private health sector.

M.Com. (Business Management) / The success of National Health Insurance (NHI) according to literature depends on a number of factors; this includes awareness and knowledge of the benefit of the policy by the public, and the increase and equitable utilisation of the healthcare facilities once the policy is promulgated into a law. The aim of this study is to provide insight into what the effect of government communication and public debate has been on creating awareness and building knowledge on the NHI subject amongst university students, and to establish the attitude and readiness status of students to utilize the NHI platform to access healthcare service. A cross-sectional, descriptive, empirical survey was conducted amongst a sample of one hundred and thirteen (n=113) students at the University of Johannesburg to address the research questions. The survey used self-administered questionnaires to gather primary quantitative data. This study deployed rigorous statistical analysis that included both descriptive and inferential statistical analyses methods. Findings from this study revealed that the majority of the students are aware of NHI; albeit possess a low level of functional knowledge on the subject. The majority of the students prospectively show less preference to use NHI to access health compared to using medical aids, and this is more apparent amongst the male students. From this study, undergraduates show more preference to use NHI over medical aids to access healthcare than postgraduate students. This insight about university students will inform policy makers and businesses on how to develop communication and engagement strategies geared at achieving success on NHI development and healthcare access. The study acknowledges the limitations of a small sample size, and the influence of the respondents’ family socio-economic standing on their attitude to NHI as a healthcare access platform.

M. Tech. Organisational Leadership / The objective of this research is to assess the perceptions held by the medical aid schemes and the general public on the National Health Insurance (NHI). It also identifies areas that need attention to improve service delivery through the National Health Insurance model.

The Department of Health (DOH) has embarked on a noble initiative to address the disproportionate distribution of resources and spending within the public and private healthcare sectors. Social Health Insurance (SHI) has thus been mooted as the vehicle to obtain a more equitable healthcare dispensation. This thesis explores the state of preparedness of the DOH, for the implementation of SHI. Ten aspects of health have been identified which will assist in determining if sufficient reforms have been implemented to facilitate the successful implementation of SHI. The prospective mechanism of financing of SHI is compared to the highly acclaimed model employed by the Australian Department of Health. Two research methodologies have been utilized viz. the case study approach and semi structured interviews, to provide comprehensive data. This enabled the researcher to adequately answer the research question. The responses from the respondents on the 10 aspects of healthcare have been arranged into themes to facilitate a greater understanding of the issues being highlighted. Established strategic management instruments have been utilized to analyze the data obtained and evaluate the preparedness of the DOH for the implementation of SHI. Following the data analysis, recommendations are proposed that would facilitate the successful implementation of SHI, thereby promoting its viability and sustainability in providing quality healthcare to all who call South Africa home. / Thesis (MBA)--University of KwaZulu-Natal, 2006.

South Africa possesses a highly fragmented health system with wide disparities in health spending and inequitable distribution of both health care professionals and resources. The national health system (NHI) of South Africa consists of a large public sector and small private sectors which are overused and under resourced and a smaller private sector which is underused and over resourced. In broad terms, the NHI promises a health care system in which everyone, regardless of income level, can access decent health services at a cost that is affordable to them and to the country as a whole. The relevance of this study is to contribute to the NHI debate while simultaneously providing insights from other countries which have implemented national health care systems. As such, the South African government can then appropriately implement as well as finance the new NHI system specific to South Africa’s current socio-economic status. The objective of this study was to examine health care financing models in different countries in order to draw lessons for South Africa when implementing the NHI. A case study was conducted by examining ten countries with a national health insurance system, in order to evaluate the health financing models in each country. The following specific objectives are pursued: firstly, to review the current health management system and the policy proposed for NHI; secondly, to examine health financing models in a selected number of countries around the world and lastly to draw lessons to inform the South African NHI policy debate. The main findings were firstly, wealthier nations tend to have a much healthier population; this is the result of these developed countries investing significantly in their public health sectors. Secondly, the governments in developing nations allocate a smaller percentage of their GDP and government expenditure on health care. Lastly, South Africa is classified as an upper middle income developing country; however, the health status of South Africans mirrors that of countries which perform worse than South Africa on health matters. In other words the health care in South Africa is not operating at the standard it should be given the resources South Africa possesses. The cause of this may be attributed to South Africa being stuck in what is referred to as the “middle income trap” amongst other reasons.

South Africa possesses a highly fragmented health system with wide disparities in health spending and inequitable distribution of both health care professionals and resources. The national health system (NHI) of South Africa consists of a large public sector and small private sectors which are overused and under resourced and a smaller private sector which is underused and over resourced. In broad terms, the NHI promises a health care system in which everyone, regardless of income level, can access decent health services at a cost that is affordable to them and to the country as a whole. The relevance of this study is to contribute to the NHI debate while simultaneously providing insights from other countries which have implemented national health care systems. As such, the South African government can then appropriately implement as well as finance the new NHI system specific to South Africa’s current socio-economic status. The objective of this study was to examine health care financing models in different countries in order to draw lessons for South Africa when implementing the NHI. A case study was conducted by examining ten countries with a national health insurance system, in order to evaluate the health financing models in each country. The following specific objectives are pursued: firstly, to review the current health management system and the policy proposed for NHI; secondly, to examine health financing models in a selected number of countries around the world and lastly to draw lessons to inform the South African NHI policy debate. The main findings were firstly, wealthier nations tend to have a much healthier population; this is the result of these developed countries investing significantly in their public health sectors. Secondly, the governments in developing nations allocate a smaller percentage of their GDP and government expenditure on health care. Lastly, South Africa is classified as an upper middle income developing country; however, the health status of South Africans mirrors that of countries which perform worse than South Africa on health matters. In other words the health care in South Africa is not operating at the standard it should be given the resources South Africa possesses. The cause of this may be attributed to South Africa being stuck in what is referred to as the “middle income trap” amongst other reasons.

South Africa has a complex healthcare system. The provision and financing of health care in South Africa occur within two fundamentally different systems: the public healthcare sector and non-governmental not-for-profit organisations, on the one hand, and the private healthcare system, on the other hand. The socioeconomic status of an individual in South Africa is the primary determinant of the system through which he or she will receive access to healthcare. The healthcare services provided by the public and private sectors are perceived to be unequal. The introduction of healthcare reforms by the South African government through the National Health Insurance (NHI) aims to address these disparities. The primary objective of this study was to contribute to the successful implementation of the proposed South African NHI by identifying critical success factors that would impact such implementation. A sample of managerial representatives of the following healthcare institutions in the Nelson Mandela Bay Municipality (NMBM) was drawn: Large private hospitals groups; Eastern Cape Department of Health; Independent medical practitioners groups; South African Dental Association; Pharmacy Association of South Africa; Optometrist Association of South Africa. A total of 250 questionnaires were distributed among these institutions and approximately 233 usable questionnaires were returned (response rate 93.2 percent). A literature review was conducted to identify the various viewpoints (critical success factors, as well as positive and negative perceptions) on NHIs in other countries, as well as the proposed one in South Africa. About 43 of such viewpoints were identified. The 233 respondents were surveyed on these 43 viewpoints. The empirical results revealed the following three critical success factors for the successful implementation of the South African NHI: The projected benefits for stakeholders, with specific reference to medical aid schemes; the projected benefits to the private healthcare sector in servicing the public sector; and strategic leadership. The empirical results also showed that the healthcare managers, who serve the poor versus the affluent geographical areas of the NMBM, differ with regard to their projected success of the NHI. Finally, the study highlighted these health managers’ general perceptions about the envisaged benefits and shortcomings of the NHI.

The aim of this study was to capture nurses’ experiences and reality of practice in order to understand their views on National Health Insurance (NHI) policy. A hermeneutic phenomenological research design was used to collect data from professional nurses working at Embuleni Hospital in the Gert Sibande District of Mpumalanga province. A sample of 10 professional nurses was included in the study and semi-structured interviews were used to collect data which was analysed following van Manen’s (1990) approach. The results revealed that professional nurses are of the view that the policy on management of hospitals is the source of health system problems which have caused inequalities and insufficient management of rural hospitals, thus affecting their efficiency in service delivery. However, the study revealed that professional nurses viewed the same policy in the light of national core-standards which they use as an objective tool for the purpose of monitoring their practice. The findings present an opportunity for policy makers to use evidence-based knowledge in realigning policy for relevance, bringing nurses on board in the policy process and understanding the key constituents of policy content. / Health Studies / M.A. (Public Health)

The aim of this study was to capture nurses’ experiences and reality of practice in order to understand their views on National Health Insurance (NHI) policy. A hermeneutic phenomenological research design was used to collect data from professional nurses working at Embuleni Hospital in the Gert Sibande District of Mpumalanga province. A sample of 10 professional nurses was included in the study and semi-structured interviews were used to collect data which was analysed following van Manen’s (1990) approach. The results revealed that professional nurses are of the view that the policy on management of hospitals is the source of health system problems which have caused inequalities and insufficient management of rural hospitals, thus affecting their efficiency in service delivery. However, the study revealed that professional nurses viewed the same policy in the light of national core-standards which they use as an objective tool for the purpose of monitoring their practice. The findings present an opportunity for policy makers to use evidence-based knowledge in realigning policy for relevance, bringing nurses on board in the policy process and understanding the key constituents of policy content. / Health Studies / M. A. (Public Health)

With the advent of the new National Health Act, health care in South Africa is at a critical point as this will be the first time in history that a National Health Insurance is being implemented in this country. Globally National Health Insurance has been around for more than a hundred years, however some countries with long established national health schemes are currently grappling with funding issues surrounding their health systems. South Africa should take note of these issues as it embarks on this journey. The objective of this study was to perform a literature review on how South Africa’s National Health Insurance can be funded taking cognisance of the history of the country and experiences of other countries. It is imperative for each country to achieve optimal health care funding to ensure the success and long-term sustainability of National Health Insurance. The analysis of the problems experienced by other countries revealed that balancing the three main funding options namely, allocated from the national revenue fund, user charges and or donations or grants from international organisations, is critical as the funds needed in a system to achieve coverage at an affordable cost is dependent on the current state of health care in a country. Considering South Africa’s history and current inequality in society and health care it is clear that the majority of funding for the National Health Insurance should be supplied by the national revenue fund. The required funds can either be raised by increasing existing taxes or introducing a new tax specifically aimed at financing the National Health Insurance. The use of user charges is important however, although not purely for a revenue collection point, but from a cost control point of view as well. Some studies have revealed that the lack of user charges results in a misuse of the system. / Financial Accounting / M. Phil. (Accounting Science)