How the quality of healthcare to be accessed through the
government's proposed National Health Insurance Scheme (NHIS)
is measured and defined – and the extent to which this
meets the government's constitutional obligations on healthcare
provision – could be key to the roll-out and success of
such a system in South Africa.
The government last month (August, 2011) released a Green Paper
on the NHIS – updating its stance on certain of the
scheme's key principles. This brings the introduction of the
NHIS, to be phased in over a 14-year period, a step nearer
Neil Kirby, director at Werksmans Attorneys and head of the
firm's Health, Pharmaceuticals and Life Sciences Practice,
points out that much of the emphasis in the discourse on a NHIS
centres on the need to provide accessible healthcare for all (a
constitutional right, along with access to emergency medical
"But the issue of quality healthcare is much more
difficult to define and achieve."
He notes that quality healthcare is defined by individuals based
on the outcome of the healthcare service that they receive: a good
outcome is normally equated with good quality care and a bad
outcome is equated with bad quality care.
"This makes defining a generally-accepted normative quality
of care difficult, if not impossible, and renders it controversial
within the current debate on access to healthcare – at
least in the NHIS paradigm in which we currently find
ourselves," says Kirby.
Kirby believes that crucial factors in making quality healthcare
practical, workable and just in its implementation could be the
obligations laid down in the South African Constitution, including
the Bill of Rights.
Says Kirby: "These obligations effectively represent a
social contract between the citizens of South Africa as a whole
with their government. Accordingly, the Bill of Rights may be
the best place to start in relation to what quality of healthcare
should be in our NHIS."
He submits that measuring quality of care in relation to health
outcomes is only one way of assessing whether or not the level of
healthcare in an NHIS would meet the State's
"A more effective means may be to judge whether the NHIS,
when it is finally implemented, treats the users of the scheme in
such a manner that their other rights contained within the Bill of
Rights are respected in a democracy built on equality, freedom and
Such rights may include: the right to dignity; the right to
life; the right to equality; the right to proper and procedurally
fair administrative justice; and the right to information. These
rights may collectively spell out what it is that quality care
consists of within the NHIS, once it is established, Kirby
"Certainly, pronouncements by our courts already indicate
that a great deal of respect is to be accorded to individuals when
making decisions concerning their healthcare." This is
fundamentally a matter of self determination or choice in the
pursuit of an individual's healthcare priorities, says Kirby,
including choices to smoke, to abuse substances, to exercise, drive
recklessly or engage in potentially dangerous sports, among
He says it is unlikely that the collective impact of these
rights has ever been assessed in trying to determine whether
'quality care' would be available to individuals through an
NHIS, "but they are a powerful platform on which to champion
"Quality is especially important when one considers the
social ends that a co-ordinated healthcare system such as an NHIS
must be designed to achieve in the context of a South African
democracy – one that is premised upon the Constitution
and the Bill of Rights."
Kirby advises that the debate concerning quality of care and its
role in an NHIS should be concluded before the scheme is
implemented. "The role of quality in the ultimate deployment
of an NHIS in South Africa cannot be underestimated and it carries
"Certainly, South Africa may learn from the experience of
other countries that have dealt with, or are dealing with, the
implementation of a NHIS. Quality of care issues have arisen
in such jurisdictions, but after the implementation of such
The content of this article is intended to provide a general
guide to the subject matter. Specialist advice should be sought
about your specific circumstances.
To print this article, all you need is to be registered on Mondaq.com.
Click to Login as an existing user or Register so you can print this article.
The Emirate of Dubai has followed its neighbour Abu Dhabi and introduced a compulsory health insurance for any person staying in Dubai - a new piece of legislation that you have probably already heard about.
President Muhammadu Buhari travelled to the UK on Monday 8 June 2016 for a 10-day holiday according to official statements. However, his seemingly impromptu absence from key engagements as well as the emergence of a communique...
Some comments from our readers… “The articles are extremely timely and highly applicable” “I often find critical information not available elsewhere” “As in-house counsel, Mondaq’s service is of great value”
Register for Access and our Free Biweekly Alert for
This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).