National health insurance in the face of COVID-19: urban tendencies in South Africa

Abstract

South Africa is set to implement a universal health care system, called National Health Insurance (NHI). The country is plagued by inequality at various levels, and the NHI will attempt to provide more equitable access to health. A national online COVID-19 survey in 2020, measured respondents’ favour or not of such a system. Multivariate logistic regression identified unique determinants of perception of NHI among urban residents (total respondents 12,682) in South Africa. Data were benchmarked using 2019 mid-year population estimates. Results showed that the majority (77.5%) of urban residents were in favour of NHI in South Africa. Furthermore, township (aOR = 1.36, 95% CI [1.10–1.69], p = 0.005) and informal settlement (aOR = 1.55, 95% CI [1.09–2.20], p = 0.016) residents were significantly more likely to be in favour of NHI than those residing in inner cities. This research sheds light on urban people’s perception of the NHI system for South Africa. The findings showed, respondents were mostly in favour of the NHI. It is recommended that the question of NHI be repeated in future research, during a time when knowledge of the COVID-19 pandemic has broadened and to a population with more representative education levels.