Health Policy Unit, Mediclinic Southern Africa, Cape Town, South Africa.
Appl Health Econ Health Policy. 2012 May 1;10(3):189-200. doi: 10.2165/11594830-000000000-00000.
A recent health reform proposal in South Africa proposes universal access to a comprehensive package of healthcare services in the public sector, through the implementation of a national health insurance (NHI) scheme. Implementation of the scheme is likely to involve the introduction of a payroll tax. It is implied that the introduction of the payroll tax will significantly reduce the size of the private health insurance market.
The objective of this study was to estimate the impact of an NHI payroll tax on the demand for private health insurance in South Africa, and to explore the broader implications for health policy.
The study applies probit regression analysis on household survey data to estimate the change in demand for private health insurance as a result of income shocks arising from the proposed NHI.
The introduction of payroll taxes for the proposed NHI was estimated to result in a reduction to private health insurance membership of 0.73%. This suggests inelasticity in the demand for private health insurance. In the literature on the subject, this inelasticity is usually due to quality differences between alternatives. In the South African context, there may be other factors at play.
An NHI tax may have a very small impact on the demand for private health insurance. Although additional financial resources will be raised through a payroll tax under the proposed NHI reform, systemic problems within the South African health system can adversely affect the ability of the NHI to translate additional finances into better quality healthcare. If these systemic challenges are not adequately addressed, the introduction of a payroll tax could introduce inefficiencies within the South African health system.
南非最近的一项卫生改革提案提议通过实施国家健康保险（NHI）计划，在公共部门普及综合医疗服务。该计划的实施可能涉及征收工资税。有暗示称，征收工资税将显著缩小私营医疗保险市场的规模。
本研究旨在估计 NHI 工资税对南非私营医疗保险需求的影响，并探讨对更广泛的卫生政策的影响。
该研究应用家庭调查数据的概率回归分析来估计由于拟议的 NHI 引起的收入冲击对私人医疗保险需求的变化。
预计拟议的 NHI 征收工资税将导致私人医疗保险会员人数减少 0.73%。这表明对私人医疗保险的需求缺乏弹性。在该主题的文献中，这种无弹性通常是由于替代方案之间的质量差异所致。在南非的背景下，可能还有其他因素在起作用。
NHI 税可能对私人医疗保险的需求产生非常小的影响。尽管拟议的 NHI 改革通过工资税将筹集额外的资金，但南非卫生系统内的系统性问题可能会对 NHI 将额外资金转化为更高质量的医疗保健的能力产生不利影响。如果这些系统性挑战得不到充分解决，征收工资税可能会给南非卫生系统带来效率低下的问题。
