Exploring the di/erent financing models for Universal Health Coverage in di/erent countries: Lessons for South Africa

Abstract

Introduction Several countries have implemented various financing models to establish universal healthcare coverage (UHC). These financing models are established to ensure population coverage and financial protection, as recommended by the WHO (2020). The systems range from national health insurance (NHI), social health insurance (SHI), and voluntary health insurance (VHI). South Africa has recently introduced the NHI Act 2024, as a single-payer model, which has raised concerns as to whether the country will be able to finance such a system. Purpose This study examines the various models used in countries with established UHC systems. It examines the United Kingdom, Canada, Australia, and Ghana, to draw lessons for South Africa. The research explores taxation structures, mandatory contributions, and cost-sharing mechanisms as potential sources of revenue. Method The study uses a qualitative research design, examining empirical evidence of healthcare funding. Results The findings suggest that most countries incorporate incremental reforms, rather than fundamental ones. Whereby a combination of financing approaches is employed, there isn’t one that is most preferred. Financing approaches include different contributing and financing mechanisms through incorporating progressive taxation, hypothecated taxes, and premiums. These may provide sustainable sources of revenue for funding the NHI in South Africa. Additionally, the research highlights the importance of incremental reforms, financial 4 protection mechanisms for certain groups of people, and ways to include the informal sector in health financing. Conclusion South Africa has an opportunity to adopt an approach that promotes equity, access, and financial protection for all by looking at adopting some of these funding models but carefully adjusting them to fit the country in an incremental manner.