Browsing by Subject "Healthcare Financing"

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    Open Access
    The cost of free health care for all Kenyans: assessing the financial sustainability of contributory and non-contributory financing mechanisms
    (2017) Okungu, Vincent; Chuma, Jane; McIntyre, Di
    BACKGROUND: The need to provide quality and equitable health services and protect populations from impoverishing health care costs has pushed universal health coverage (UHC) to the top of global health policy agenda. In many developing countries where the majority of the population works in the informal sector, there are critical debates over the best financing mechanisms to progress towards UHC. In Kenya, government health policy has prioritized contributory financing strategy (social health insurance) as the main financing mechanism for UHC. However, there are currently no studies that have assessed the cost of either social health insurance (SHI) as the contributory approach or an alternative financing mechanism involving non-contributory (general tax funding) approaches to UHC in Kenya. The aim of this study was to critically assess the financial requirements of both contributory and non-contributory mechanisms to financing UHC in Kenya in the context of large informal sector populations. METHODS: SimIns Basic® model, Version 2.1, 2008 (WHO/GTZ), was used to assess the feasibility of UHC in Kenya and provide estimates of financial resource needs for UHC over a 17-year period (2013-2030). Data sources included review of national and international literature on inflation, demography, macro-economy, health insurance, health services unit costs and utilization rates. The data were triangulated across geographic regions for accuracy and integrity of the simulation. SimIns models for 10 years only so data from the final year of the model was used to project for another 7 years. The 17-year period was necessary because the Government of Kenya aims to achieve UHC by 2030. RESULTS AND CONCLUSIONS: The results show that SHI is financially sustainable (Sustainability in this study is used to mean that expenditure does not outstrip revenue.) (revenues and expenditure match) within the first five years of implementation, but it becomes less sustainable with time. Modelling for a non-contributory scenario, on the other hand, showed greater sustainability both in the short- and long-term. The financial resource requirements for universal access to health care through general government revenue are compared with a contributory health insurance scheme approach. Although both funding options would require considerable government subsidies, given the magnitude of the informal sector in Kenya and their limited financial capacity, a tax-funded system would be less costly and more sustainable in the long-term than an insurance scheme approach. However, more innovative financing for health care as well as giving the health sector higher priority in government expenditure will be required to make the non-contributory financing mechanism more sustainable.
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    Open Access
    The perceptions of private health insurance administrator senior managers about the National Health Insurance (NHI) in South Africa, Cape Town
    (2025) Mxoli, Nonkqubela; Shung, King Maylene
    South Africa is implementing a National Health Insurance system (NHI) as a funding mechanism towards attaining Universal Health Coverage (UHC). The main aim of the NHI is to protect citizens from financial hardships caused by out-of-pocket payments for accessing health services. In South Africa, a strong, robust private healthcare sector co-exists alongside the public health sector and consumes a disproportionate amount of healthcare; the healthcare sector co-exists the public health sector and consumes a disproportionate amount of healthcare resources it serves. It is essential, however, to understand the perspectives of all role-players in a complex health system, especially in times of significant policy change. This study focuses on garnering the perspectives of a somewhat ‘silent' group of actors in the private sector, namely administrators of medical schemes, a collective entity which manages a significant proportion of health care funds in the health care system. Study aim: This study explored the perspectives of senior managers in the health insurance administrator industry about the implementation of NHI in South Africa and their perceived role in it. This may contribute towards informing current policy initiatives underway to establish and implement an NHI system by adding perspectives of an otherwise unheard group. Methods: This study employed a qualitative study design to explore the perceptions of senior managers working in the Private Health Insurance Administrator (PHIA). First, relevant NHI-related policy documents were reviewed to identify the current policy stance on the role of medical schemes and PHIA within the NHI environment. This was followed by individual interviews with the senior managers, using a topic guide with pre-determined semi-structured questions. A purposive sampling technique was used to identify and select appropriate participants. Thematic analysis was used to identify key themes and subthemes, which informed the results and conclusions of the study. Results: The senior managers generally understood the proposed funding mechanism for the NHI and fully supported the move towards UHC. Similar to others, they highlighted concerns about the sustainability of the funding base if done through general taxes due to the small tax base. They also raised concerns about human resource shortages, particularly in the public sector, and corruption in the healthcare system, which threatens the sustainability of the NHI fund. Senior managers expressed uncertainties about their roles, which need to be clearly articulated in NHI policy documents. Software issues of trust, accountability, transparency, and social values were raised. However, senior managers felt that they had much expertise and practical tools to offer and expressed willingness to participate and contribute to the success of the NHI implementation. Conclusion: The results presented a gap in current policy about the future role of the PHIA/MSA industry in an NHI system and the value of exploring otherwise unheard voices within the context of the NHI implementation in South Africa. Moreover, senior managers in the PHIA industry are willing to contribute their experience and expertise to overall Universal Health Coverage (UHC) efforts.