Universal Healthcare: One place, many paths

Universal Healthcare: One place, many paths

In a country which has a fully functional National Health Insurance (NHI) system or Universal Healthcare Coverage (UHC) every citizen has access to care regardless of their ability to pay. The standards of care are defined, consistent and transparent, and populations are cared for in a holistic, integrated, humane manner.

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Healthcare, a constitutional right

In South Africa, not only is access to healthcare our Constitutional right, but it is a part of our path to economic transformation and social upliftment. Today, we stand at the intersection between circumstance, history, ideology and reality. Our actions, or failure to act, will determine the health and wellbeing of many future generations of South Africans, the future economic performance of our country and the extent to which we overcome our current challenges, inequalities and divisions.

Something to teach, something to learn

From a review of different countries that have achieved UHC around the world it is clear that many lessons can be learned. Firstly, some mandatory element is essential to rapid progress towards UHC –systems that rely on voluntary enrolment into private insurance, like the United States, simply don’t see the benefits accrue to those who would benefit most. 

Secondly, countries that have pursued a ‘breadth then depth’ strategy have seen much greater success than the reverse –this means starting with a shallow layer of coverage for everyone and improving it, rather than trying to get full UHC for a particular group or community then spreading it out. 

Thirdly, while some systems have achieved UHC purely through mandatory private insurance, KPMG analysis suggests that some form of public option –whether it competes with private insurers or acts as a single or dominant payer –is associated with a number of important benefits.

Just as important as any of these design features, however, is the political will and skill to carry through change. Even perfectly designed UHC programmes hit multiple hurdles and setbacks along the way, and take a decade at an absolute minimum to implement. Determination to hold the course, overcome opposition and see through delivery from policy to people’s pockets is the most important success factor of all.

UHC is the greatest gift a country can give its people. 

© 2022 KPMG Services Proprietary Limited, a South African company and a member firm of the KPMG network of independent member firms affiliated with KPMG International, a Swiss cooperative. All rights reserved.

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