National Health Insurance: What does the South African public think?

1. National Health Insurance: What does the South African public think? Charles Hongoro 23rd August 2010

2. Outline • Why a SAS on NHI? • Survey Methodology • Findings • Summary of Key findings • Concluding remarks

3. Background • NHI as a Service Delivery Issue • The NHI debate in various media: print, radio, television, etc. • Expert debates and views • Decided to survey the public as the major stakeholder in all this • What are the public Attitudes and Perceptions of NHI?

4. Social Attitudes Study Domains:(K22Qs) • Current Health Care System • Media/Information Exposure/ • Costs of medical Care • Universal Coverage • Quality of health services • Knowledge of NHI proposal • Views on NHI- purpose, governance, costs, versus current system, • Views on potential NHI impact

5. Survey Design • SASAS survey designed to yield a nationally representative sample of adults 16 years & older • The sampling frame for this survey is enumeration areas (EAs) close to the HSRC Master Sample (2006) which consists of 1 000 primary sampling units (PSUs). • The 2001 pop. Census EAs were used as PSUs. • These PSUs were drawn, with probability proportional to size, from a pre-Census 2001 list of EAs provided by Stats SA.

6. Selection of Households & Individuals Selection of Households & Individuals: • Households & lists of eligible individuals at visiting point randomly selected • Individuals to be interviewed selected randomly (KG) Questionnaire pretested amongst urban & rural residents: Translation: Afrikaans, Zulu, Xhosa, Tswana and Tsonga Quality control: various cross-checks

7. Un-weighted & Weighted Sample

8. Category of Findings • ALL (OVERALL) • By age • By Race • By province • By Income group • BY MEDICAL COVERAGE • By Payment Mechanism/Main provider

9. Characteristics of Respondents • Mean age: 40 yrs [16 – 93 years] • 39% Married,48% Never married, 13% Other • MA/HI Cover: YES=27%, NO=73% • Over 40% matriculated • 32% Employed Full Time; 21% Unemployed & looking for Work; 12% pensioners • Grants: 20% Old Age, 24% Child Support, 6% Disability • Income S: 64% S/Wages, 25% grants, 4% remittances • Total Monthly HHD Income: 61% (R751 - R15 000) • 65% described themselves as Just Getting Along/ Poor/ Very Poor • 62% Urban Formal, 9% Urban Informal, 18% Rural, Informal (Tribal), 11% Rural Formal settements

10. For those without medical aid:

11. Results by Medical Aid Coverage Results by Medical Aid Coverage

12. How serious do you think it is that many South Africans lack access to a medical aid scheme and private health care facilities?

13. Is it right or wrong that people with higher incomes can buy better health care than people with lower incomes?

14. How satisfied or dissatisfied are you with the quality of the health care you receive?

15. How satisfied or dissatisfied are you with the cost of your health care?

16. Have you had great difficulty affording the cost of necessary medical care?

17. Have you had great difficulty affording the cost of prescription drugs?

18. Have you put off or postponed getting health care you needed?

19. In the past six months, have you seen, read or heard any news or information about a proposal of national health insurance for all South Africans?

20. Would you say that you know a lot, a fair amount, a little or not yet enough about the proposed national health insurance?

21. Should national health insurance for all South Africans be ....

22. Which priority do you think the country should focus on first?

23. Do you think that as a country we could afford to provide everyone with all the health and medical services which they need, OR would that cost more than we can afford?

24. Which of the following do you think is more important?

25. Which medical aid system would you prefer?

26. If the planned national health insurance lowered your health care costs and provided cover to all South Africans, but limited your choice of doctor, hospital or treatment, would you support or oppose such a plan?

27. If there was a health insurance scheme that would cover the health care costs of all South Africans, who would you trust most to run this scheme?

28. Do you agree or disagree that it would be cheaper to have a government operated national health insurance compared to the current arrangements?

29. If government goes ahead and introduces A health insurance scheme that would cover health care costs for all South Africans, do you think you and your family would be

30. If government goes ahead and introduces a health insurance scheme that would cover health care costs for all South Africans, do you think the country as a whole would be

31. Do you believe that the proposed national health insurance would make the quality of the health care you receive...

32. Summary of key findings (1) • People perceive lack of access to medical aid and private health facilities as a serious challenge in the current system • Although the majority of people still think that it is right for high income people to access better care, a notable number (23-30%) think it is somewhat or definitely wrong • There are considerable challenges in accessing and affording needed care even amongst those with MA, although the problem is more amongst those who do not have Medical Aid and use OOP.

33. Summary of key findings (2) • People with medical aid or some other form of private health insurance are more satisfied with the quality of services they receive. The public sector still remains reportedly unsatisfactory • A greater proportion of people with medical aid are satisfied with the costs of health care than those without. However, 25% of those with MA are still not satisfied with the cost of health care. • Challenges in accessing prescription drugs are higher amongst those without medical aid cover or other form of health insurance

34. Summary of key findings (3) • Incidences of delaying access to needed care are higher amongst those without medical care particularly those relying OOP • Knowledge about NHI is generally low but relatively less so amongst those with MA or some other form of private health insurance. • Most of them admitted that they do not know enough yet about NHI. • People support universal coverage and rate it as a top priority for the country

35. Summary of key findings (4) • The majority of people think that the country can afford NHI and that they will support it even if it contains some restrictions • An NHI run by an organisation linked to gvt is reportedly one that the majority would trust, although 25% (41%/25%) preferred a private organisation • That NHI might be cheaper than the current system and would make families and the country better off

36. Concluding Remarks • The Public thinks Health Care Quality & Costs immediate challenges • The public would support NHI if it improves quality of services & reduces costs of health care, and provides some choice • The public certainly wants the current health care system reformed and current debates are about how to do so! • Issues raised by the public resonate with technical review of the health sector(e.g. DBSA diagnosis & roadmap ) • Government response: 10-points plan, and re-engineering of PHC

37. Concluding remarks • Such social attitude surveys are refreshing because they bring the public face to what is often seen as technocratic responses to health care challenges • Successful implementation of major transformative policies such as NHI requires that public interest remains the focus • The major stakeholder here is the public which pays for health care and is entitled to receive good quality care as and when need arises .

38. Concluding remarks • Public perceptions critical especially after wider information sharing and consultations on NHI • Are we a caring society? Is social solidarity something that we adequately embrace as a society? • How then can we reconfigure the health care system for quality improvement and containment of health care costs? • Is Affordability the major issue?

39. I Thank You