Explore the resource requirements for achieving universal health coverage in South Africa through a case study conducted by Di McIntyre. The study delves into the implications of different financing reforms, revenue potential, and key design features impacting affordability. Various reform scenarios are discussed, including the status quo, extended schemes, and a universal system, each with distinct approaches to funding and coverage. Core methods and assumptions are detailed, along with benchmarked projections, population data sources, utilisation patterns, and unit costs. The study provides valuable insights into the potential pathways towards achieving universal health coverage in South Africa.
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Presentation Transcript
Modelling the resource requirements for universal coverage: A case study of South Africa Di McIntyre Health Economics Unit University of Cape Town SHIELD project: Strategies for Health Insurance for Equity in Less Developed Countries
Background Proposal to introduce universal coverage in South Africa: Heated debate with particular concerns about affordability Modelling useful to explore likely implications of different financing reforms: Resource requirements (and impact of key design features) Revenue potential
Broad approach used Identified the key scenarios: What kind of financing reforms are being considered, proposed, or might be feasible? Resource requirements: Population x utilisation x unit costs (Excel spreadsheet model) Absolute amount and relative to GDP Revenue: Health sector share of government budget; additional tax or mandatory contributions
Reform scenarios Status quo: Limited growth in private insurance (<20% of population); limited improvement in public sector Extended schemes: Mandatory extension of private insurance to all formal sector workers and dependents (<40%) Universal system: Core of substantially improved public services; access to all; mainly tax funded including additional payment by formal sector
Core methods and assumptions Benchmarked baseline 15 year projections Population Sources: Census, schemes, SHIELD household surveys Disaggregation: Age & sex, insurance status Reliable projections (AIDS impact not adequately accounted for in official stats) Utilisation Source: SHIELD household surveys; benchmarked against HMIS & scheme data Disaggregation: Age & sex, insurance status, type of service Normative targets and cross-checked with international experience Unit costs Data from Treasury & HMIS Scheme claims Audited public & scheme expenditure Real increases: trends & improved resources Expenditure benchmark
Public funding requirements Status quo: Will decline to 10.5% of government budget Extended schemes: Will decline to 9.4% of government budget (but increased costs of covering civil servants) Universal system: Increase share of government budget to 15% plus Proportional income tax of 4% (2% employer & 2% employee) Or, progressive income tax of 1.2% to 6%
Conclusions UC is lowest cost option in SA, but places greatest burden on public funds and requires: Increased allocations for health in line with Abuja target, and Additional taxes Modelling illustrates likely resource requirements for reform scenarios, but also provides insights into reform design (sensitivity analyses)
Pre-conditions for success Cost containment: Minimise unit costs, careful purchasing from non- government providers Minimise administration costs: avoid fragmentation Contain utilisation: strengthen primary & community services; improved gate keeping Need for ongoing M&E, refine model with updated data
SHIELD partners Funding: European Commission and IDRC For more informaton visit: http://web.uct.ac.za/depts/heu/SHIELD/about/about.htm
