Comments on select aspects of the NHI White Paper

In this Occasional Note we unpack the financing implications of the National Health Insurance (NHI)
White Paper, released during December 2015. While the White Paper deals with many policy and practical aspects of the planned NHI, this Note only considers the financing requirements. While the NHI is expected to yield universal coverage to all South Africans, and improve health outcomes, there are deep concerns about the affordability of such an ambitious programme. In this Note we show that the White Paper presents very little new financial information, compared to the earlier Green Paper. We show that the financing estimates in the White Paper are based on optimistic GDP growth assumptions, and will probably require greater funding than anticipated. In addition, the burden of disease should be taken into account in modelling expected demand shifts. Financing issues cannot be ignored as an underestimation of the costs will impact negatively on service delivery and the management of expectations under a NHI.