Shivani Ranchod, Anja Smith and Jodi Wishnia | December 2019
In this brief…
South Africa has been bruised by the capture, corruption and failure of large State institutions. It is therefore not unexpected that there is wide-spread cynicism about the creation of a new entity of unprecedented size to purchase healthcare services. The idea of a gargantuan single purchaser of health services has faced resistance from across the political spectrum. The intricacies of how a single purchaser would work, and the implications for providers and the health system at large will likely only unfold over time. We aim to provide an overview of the possibilities, strengths and implementation challenges of a single purchaser system.
The creation of the NHI Fund is predicated on two ideas: the need to create a purchaser-provider split in the healthcare system, and that a single purchaser is the best way to achieve cost efficiency and improved quality of care. In order to engage with questions of accountability, governance and the ability of the Fund to drive improved healthcare outcomes for South Africa, we need to take a step back and understand the roles of purchasers and providers of healthcare and explore the benefits and challenges of separating these roles.