Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town.
S Afr Med J. 2009 Oct;99(10):725-9.
National Health Insurance (NHI) is currently high on the health policy agenda. The intention of this financing system is to promote efficiency and the equitable distribution of financial and human resources, improving health outcomes for the majority. However, there are some key prerequisites that need to be in place before an NHI can achieve these goals.
To explore public perceptions on what changes in the public health system are necessary to ensure acceptability and sustainability of an NHI, and whether South Africans are ready for a change in the health system.
A cross-sectional nationally representative survey of 4 800 households was undertaken, using a structured questionnaire. Data were analysed in STATA IC10.
There is dissatisfaction with both public and private sectors, suggesting South Africans are ready for health system change. Concerns about the quality of public sector services relate primarily to patient-provider engagements (empathic staff attitudes, communication and confidentiality issues), cleanliness of facilities and drug availability. There are concerns about the affordability of medical schemes and how the profit motive affects private providers' behaviour. South Africans do not appear to be well acquainted or generally supportive of the notion of risk cross-subsidies. However, there is strong support for income cross-subsidies. Public engagement is essential to improve understanding of the core priniciples of universal pre-payment mechanisms and the rationale for the development of NHI. Importantly, public support for pre-payment is unlikely to be forthcoming unless there is coinfidence in the availability of quality health services.
国家健康保险（NHI）目前是卫生政策议程上的重点。该融资系统的目的是提高效率和公平分配财务和人力资源，为大多数人改善健康结果。然而，在 NHI 能够实现这些目标之前，需要满足一些关键的先决条件。
探讨公众对公共卫生系统需要进行哪些变革以确保 NHI 的可接受性和可持续性的看法，以及南非人是否准备好改变卫生系统。
对 4800 户家庭进行了横断面全国代表性调查，使用结构化问卷。数据在 STATA IC10 中进行分析。
公共部门和私营部门都存在不满，这表明南非人已经准备好进行卫生系统变革。对公共部门服务质量的担忧主要涉及医患互动（有同情心的员工态度、沟通和保密性问题）、设施清洁度和药物供应。人们担心医疗计划的可负担性以及利润动机如何影响私人提供者的行为。南非人似乎不太了解或普遍支持风险交叉补贴的概念。然而，对收入交叉补贴有强烈的支持。公众参与对于提高对普遍预付款机制的核心原则和 NHI 发展的基本原理的理解至关重要。重要的是，除非对优质卫生服务的可用性有信心，否则公众不太可能支持预付款。
