Abstract
Background: South African healthcare works on a split public and private healthcare system. Those with sufficient funds or individuals who have bought into medical insurance schemes have access to privatised healthcare while the rest of the population utilise public facilities in a tiered system. The National Health Insurance (NHI) has been proposed to overhaul this system in line with Universal Health Coverage (UHC). However, there is a lack of research into the viewpoints of the private healthcare users who stand to lose the most with implementation of the NHI system.
Objective: The study aimed to identify the knowledge, attitudes and perceptions of private healthcare users towards NHI in South Africa, while noting differences between users paying out-of-pocket compared to those using medical aid schemes. The study also determined factors that were associated with support of NHI, while also attempting to calculate the cost of medical aid membership in order to compare this to the projected cost of NHI.
Methods: A cross-sectional quantitative study design was used to collect responses from 489 participants using a systematic sampling strategy at two distinct study sites in Pretoria, South Africa. The data collection tool comprised 23 items to assess factors relating to demographics, knowledge of NHI, attitude towards NHI and perceptions towards NHI. Measures of frequency, proportion and central tendency were used to describe the study population and their knowledge, attitude and perceptions to NHI. A chi-square test was calculated for the categorical variables to determine if there are differences between medical aid users and those without medical aid A step wise logistic regression with odds ratio’s analyses was performed to assess factors associated with the support of NHI, using a 95% confidence interval (CI) and significance level of <0.05. The average cost of medical aid membership and the average cost of personal income tax after a projected increase to cover for NHI funding was compared to determine which would be more costly.