Di McIntyre, holds the NRF funded South African Research Chair in Health and Wealth at UCT. Her present focus is on conceptual and empirical research around how to achieve universal coverage in low- and middle- income countries and how to promote health system equity. This includes research on strategic purchasing as part of the RESYST consortium. This email address is being protected from spambots. You need JavaScript enabled to view it.


It has been almost four years since the Green Paper on the proposed National Health Insurance (NHI) was gazetted.  With no White Paper in sight, many are questioning whether the NHI policy will be taken forward or whether there has been a change of heart. There remains considerable confusion about the nature of the proposed reforms and I believe that it will not be possible to overcome the inevitable contestation around a policy of this magnitude until a clear vision is presented. This ‘thought-piece’ outlines my own understanding of the proposed health system reforms.

What are the proposed NHI reforms all about?

The term National Health Insurance is an unfortunate one. It immediately makes people think that what is being proposed is the creation of an insurance scheme, in the mould of private medical schemes.  One of the connotations that goes along with this misconception is that government will need to pay for everyone to become a member of this ‘mega-medical scheme’, which is patently unaffordable given that medical schemes account for nearly half of all health care expenditure in South Africa yet cover less than a fifth of the population. An associated misconception is that the proposed NHI is all (and only) about how to raise more money for health services.