Public perceptions on national health insurance: Moving towards universal health coverage in South Africa

  • Olive Shisana
  • Thomas Rehle
  • Julia Louw
  • Nompumelelo Zungu-Dirwayi
  • Pelisa Dana
  • Laetitia Rispel


Background. Since 1994, considerable progress has been made in  transforming the South African health care system, implementing  programmes that improve the health of the population, and improving  access to health care services. However, amid escalating health care costs disparities continue to exist between the public and private health sectors. The implementation of a national or social health insunmce remains elusive despite three government-appointed committees on the matter.
Method and objective. This paper reports on the findings of a national probability household sample of the South African population, drawn as part of the 2005 HIV I AIDS national survey, to gauge public opinion on universal health care coverage. The perceptions of South Africans were assessed on selected health care affordability and financing issues.
Results. The majority support efforts to contain medicine costs and one-third are of the opinion that the country can provide everyone with all the needed health care and medical services. A l<1rge percentage of participants thought it more important to provide improved health care coverage even if it meant raising taxes, while a small percentage said it is better to hold down taxes despite lack of access to health care for some South Africans. Almost a quarter of participants were unable to comment on questions posed to them, indicating the need for improved public  education and communication.
Conclusion. The study provides important insights into public opinion on key policy issues. However, greater public awareness is needed to ensure an informed debate, while the design of a universal national health insurance scheme must take into account both the current context and public opinion.

Journal Identifiers

eISSN: 0256-95749
print ISSN: 2078-5135