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National Health Act, 2003 (Act No. 61 of 2003)


National Health Insurance Policy towards Universal Health Coverage

Chapter 7 : Financing of NHI

7.3 NHI Expenditure Projections: and Cost Estimates


199. In its research brief on the Costing of Health Care Reforms to Move towards Universal Health Coverage (UHC)73, the World Health Organisation (WHO) indicates that the costs associated with implementing a UHC programme are influenced by many factors, including design elements and the pace of implementation.


200. The WHO further cautions that while costing assumptions and scenarios may be useful for raising core policy issues regarding the sustainability of reforms, it is not useful to focus on getting the exact number indicating the estimated costs. This is because evidence has shown that countries that have gone down this path have ended up tied to an endless cycle of revisions and efforts to dream up new revenue sources – thus focusing on issues that have more to do with tax policy than health policy. Therefore, focusing on the question of “what will NHI cost” is the wrong approach as it is better to frame the question around the implications of different scenarios for the design and implementation of reforms to move towards UHC.


201. The financing requirement will be dependent on the services covered in the NHI, the resources needed for the NHI fund to provide comprehensive healthcare services for the population. The funding requirements will be determined, discussed and announced during the annual budgeting process. The current subsidy to contributions through the medical tax credit will be reviewed during the phased implementation.



7.3.1 NHI Expenditure Scenarios

7.3.2 Estimates of Public and Private Health Expenditure