Financing the national health insurance in South Africa to achieve an appropriate degree of coverage of effective health services and levels of financial protection - a descriptive, experimental quantitative study.

Introduction: the financial obligations that come with the implementation of a system that will ensure equitable access to healthcare are an important consideration to realise the national health insurance (NHI). The aim of this manuscript was to evaluate whether there is sufficient policy consensus in finding innovative and sustainable ways to address the healthcare finance fundamentals of the NHI. Methods: a descriptive, experimental quantitative study employing a 5-point Likert scale questionnaire was used to collect the data. The participants were drawn from individuals and stakeholders who interact with and/or are in the employment of the organisations concerned with healthcare regulation and service delivery. Results: the study found that the funding initiatives employing budget prioritization for healthcare reforms (76%), reducing reliance on payroll taxes (68%), and permitting the private insurance to play a role (62%) were preferred; however, 70% of the respondents were opposed to new payroll taxes. The study found that 64% endorsed supply-side policies for benefit package expansion, 60% supported capping health expenditure and restricting catastrophic co-payments, and 77% favoured prioritizing primary care and cost-effective services. There was limited support (42%) for the consolidation of medical aids, and opinions were divided on maintaining multiple risk pools. There was consensus across occupational groups on NHI funding (P = 0.603) but marked differences by occupation for "getting more value for money" (P = 0.041) and "pooling and redistribution of resources" (P = 0.032), particularly between leadership/governance and information/research-service delivery roles. Correlation analysis showed the three main subthemes had moderate positive relationships (r = 0.34-0.66), suggesting that challenges or improvements in one area are likely to impact others. Conclusion: these findings highlight a critical need for nuanced, occupation-sensitive approaches to policy development and implementation, given the fact that there are divergent views on funding policies.