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Committee reports of the Taylor Committee into a social security system for South Africa.

Committee Report No 6: Various social security aspects of the South African Health System
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Table of contents

6.1. Introduction
6.2. Evaluation of current policy context
  6.2.1. Public sector
  6.2.2. Private sector
6.3. Stakeholder Views
  6.3.1. Overview
  6.3.2. Willingness to pay
  6.3.3. Ability-to-pay
  6.3.4. Earmarked tax
  6.3.5. Funding of the public sector
  6.3.6. Tiering
  6.3.7. Improvement of public sector services
  6.3.8. Injection of funds
  6.3.9. Phasing
  6.3.10. Revenue retention at facility level
  6.3.11. Benefits
  6.3.12. Concluding remarks
6.4. Strategic elements of the health system affecting equity
  6.4.1. Overall level of funding for the health system
  6.4.2. Income-based cross-subsidies
  6.4.3. Health-related cross-subsidies
  6.4.4. Basic essential service and benefits
  6.4.5. Concluding remarks
6.5. NHI as an option for South Africa
  6.5.1. Universal systems
  6.5.2. Findings
6.6. Financial framework of the Public Health System
  6.6.1. Introduction
  6.6.2. Allocation of funds arising from general taxes
  6.6.3. Allocation of funds arising from user fees
  6.6.4. Allocation of funds arising from earmarked taxes
  6.6.5. Concluding remarks
6.7. Reform of the tax regime and subsidies for medical scheme cover
  6.7.1. Overview
  6.7.2. Value of the tax deduction
  6.7.3. NHI Committee proposals
  6.7.4. Assessment of the tax subsidy framework
  6.7.5. Reform recommendations
6.8. State-sponsored medical scheme
  6.8.1. Overview
  6.8.2. Purpose of a state-sponsored low-cost scheme
  6.8.3. Target group for cover
  6.8.4. Benefits
  6.8.5. Contributions
  6.8.6. Relationship to public hospitals
  6.8.7. Recommendations
6.9. Risk-equalisation
  6.9.1. Overview
  6.9.2. Purpose of risk equalisation
  6.9.3. Definition of risk adjustment
  6.9.4. International review of risk-equalisation mechanisms
  6.9.5. Evaluation of residual risk selection in the South African medical schemes environment
  6.9.6. Risk-equalisation for South Africa
6.10. Overall findings
  6.10.1. Problems Identified with the existing strategic framework
  6.10.2. Role and scope of government Involvement
6.11. Recommendations
  6.11.1. Overview
  6.11.2. Reform strategy
  6.11.3. Strategic financial framework
  6.11.4. Coverage
  6.11.5. Concluding remarks
6.12. Concluding remarks
 
  REFERENCES - 19Kb < 1min (3 pages)
 


6.1 Introduction


Transformation of the health system in South Africa has been and remains an urgent priority for the democratic government. South Africa has introduced significant policy shifts and institutional changes to deal with the underlying problems of an inequitable race-based system. Through its primary healthcare approach, the government prioritised the needs of women and children by extending free healthcare for children under the age of six and pregnant women. The free healthcare programme was thereafter extended to all South Africans using public primary healthcare facilities. At hospital level, payment for services is means tested, and indigent citizens are entitled to receive free services

Health interventions are critical in determining how governments address issues of capability poverty. In the design of social security reform, health indicators are used to identify the extent to which deprivation and exclusion from essential health services affect the life chances of people. This section of the report addresses key strategic policy areas and sets out a medium- to long-term approach to address the underlying challenges in access to healthcare.

Healthcare provision constitutes an essential component of a minimum package of goods and services for the development and advancement of people. Moreover, given the history of unequal allocation of resources, high levels of poverty and unemployment, a central policy objective is to achieve equity in, and access to, healthcare services. The relationship between public and private health provision and the roles and responsibilities that are located in these environments are examined by the Committee to ensure the sustainable, equitable use of resources in the interests of all.

An overview of developments in South Africa’s health system indicates that the reform direction and approach developed and proposed in the 1995 National Health Insurance (NHI) Paper remains a valid point of departure for ongoing reform. This requires that South Africa move, over time, toward an NHI system that integrates the public sector and medical schemes within the context of a universal contributory system.

This chapter specifically addresses a number of areas identified by the Committee to be of particular importance from a strategic point of view. These are ultimately drawn together to form an integrated reform path.

[Table of contents]



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