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Universal Healthcare: One place, many paths

Universal Healthcare

Perspectives on Universal Healthcare (UHC). UHC is the greatest gift a country can give its people. We all have a responsibility to make it a success.



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Something to teach, something to learn

Many of us fear getting sick –the pain, the isolation, the uncertainty, the disability, the untoward effects of the medications, the complexity of seeking care, the impact on our families and our ability to work, and the deep fear of becoming financially devastated. We all know that healthcare is becoming prohibitively expensive so many of us question whether we will be able to afford treatment when we are faced with a diagnosis of a major disease.

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.

In our country, 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.

As the KPMG Head of Health for Africa, I am regularly involved in consultations with different governments, ministries of health and private sector organisations around the world, to discuss their progress along the difficult path towards achieving UHC. Many admire South Africa, having supported us during our liberation struggle, closely following our post-Apartheid development and respecting our tremendous response to the HIV/AIDS epidemic. They are now keen to learn more about how we plan to achieve UHC, given our current social, political and economic constraints.

The world is watching to see how we:

  • finance this massive investment
  • design an insurance fund that can provide coverage to our diverse population
  • reform our provider market
  • structure a sustainable benefits package
  • align our polarised market
  • overcome vested interests
  • upgrade the existing public healthcare services
  • collaborate with the private health sector
  • demonstrate good governance, accountability and brave leadership
  • create momentum that sustains through political cycles

And most importantly, how we overcome the magnetic pull of the present to ensure we take the right steps now, that will set our country up for success over the long term, because we all understand that the attainment of UHC is indisputably linked to our future economic and social stability and progress.

Considering the place that we are at as a nation, I thought it would be opportune to share a few of the similarities and differences that I have noticed in my study of UHC systems in other countries and our own. We all have something to teach and 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. We all have a responsibility to make it a success.

* World Health Organization, Making fair choices on the path to universal health coverage,WHO (2014)
** Nicholson D et al, Delivering universal health coverage:A guide for policymakers,World Innovation Summit for Health (2015)

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© 2020 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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