An evaluation of the National Health Insurance scheme in the light of South Africa’s constitutional and international law obligations imposed by the right to health

Du Toit, Michelle (2017-12)

Thesis (LLM)--Stellenbosch University, 2017.

Thesis

ENGLISH ABSTRACT : This study ultimately concerns the right to health care under constitutional law and international law and the National Health Insurance scheme proposed for South Africa. The study begins by contextualising the need for health care system reform. It does so through exposing the historical context of the right to health care in South Africa and how the current context has inherited the inequalities created and manifested by colonialism and apartheid. This is done to motivate the need for reform. The study examines the constitutional and international law obligations imposed by the right to health. The normative content of the right to health, and the obligations under constitutional and international law, are informed by jurisprudence of the Constitutional Court and General Comments of the United Nations Committee on Economic, Social and Cultural Rights, respectively. The obligations imposed by children’s right to basic health care is also examined, as well as the obligations imposed on private entities and in the context of business activities. These obligations provide a framework by which the National Health Insurance scheme can be evaluated to determine compatibility with the right to health and the obligations it imposes. The National Health Insurance scheme is analysed as a policy. The National Health Insurance scheme is a financing scheme for universal health coverage. It is thus analysed in the framework of financing models for universal health coverage. The analysis further considers issues raised on the National Health Insurance scheme which include implementation costs, quality of health care in the public sector, participation in policy development and the impact which it may have on private rights and interests. The National Health Insurance scheme is then evaluated for compliance with the constitutional and international law obligations imposed by the right to health. This includes the obligations to respect, protect, promote and fulfil, the obligation to take legislative and other measures, the obligation to progressively realise the right, and to do so within available resources. Fundamental is the obligation that measures taken must be reasonable. Therefore, the reasonableness of the National Health Insurance scheme is evaluated per the framework established. This study argues that reform is necessary and that the National Health Insurance scheme is a viable means by which to address issues on unequal access to and quality of health care. It argues that the National Health Insurance scheme complies with the obligations imposed by constitutional and international law and addresses ways in which such compliance can be strengthened.

AFRIKAANSE OPSOMMING : Hierdie studie gaan oor die reg op gesondheidsorg kragtens die grondwetlike en internasionale reg en die Nasionale Gesondheidsversekeringsskema wat vir Suid-Afrika voorgestel word. Die studie begin deur die behoefte aan hervorming van gesondheidsorgstelsel te kontekstualiseer. Dit doen dit deur die historiese konteks van die reg op gesondheidsorg in Suid-Afrika uiteen te sit en hoe die huidige konteks die ongelykhede wat deur kolonialisme en apartheid geskep is, geërf het. Dit word gedoen om die behoefte aan hervorming te motiveer. Die studie ondersoek die konstitusionele en internasionale regsverpligtinge wat deur die reg op gesondheid gestel word. Die normatiewe inhoud van die reg op gesondheid en die verpligtinge ingevolge die grondwetlike en internasionale reg word deur die regswetenskap van die Konstitusionele Hof en Algemene Kommentaar van die Verenigde Nasies se Komitee oor Ekonomiese, Sosiale en Kulturele Regte, op die hoogte gebring. Die verpligtinge wat opgelê word deur kinders se reg op basiese gesondheidsorg word ook ondersoek, sowel as die verpligtinge wat aan private entiteite en in die konteks van sakebedrywighede opgelê word. Hierdie verpligtinge voorsien 'n raamwerk waarvolgens die Nasionale Gesondheidsversekeringsskema geëvalueer kan word om te bepaal of dit verenigbaar is met die reg op gesondheid en die verpligtinge wat dit oplê. Die Nasionale Gesondheidsversekeringskema word as 'n beleid ontleed. Die Nasionale Gesondheidsversekeringskema is 'n finansieringskema vir universele gesondheidsdekking. Dit word dus ontleed in die raamwerk van finansieringsmodelle vir universele gesondheidsdekking. Die analise handel ook die implementeringskoste, die gehalte van gesondheidsorg in die openbare sektor, deelname aan beleidsontwikkeling en die impak wat die Nasionale Gesondheidsversekeringskema op private regte en belange het. Die Nasionale Gesondheidsversekeringskema word dan geëvalueer vir nakoming van die grondwetlike en internasionale regsverpligtinge wat deur die reg op gesondheid gestel word. Dit sluit in die verpligtinge om wetgewende en ander maatreëls te onderneem, te beskerm, te bevorder en te vervul, die verpligting om die reg te besef, en dit binne beskikbare bronne te doen. Fundamenteel is die verpligting dat maatreëls geneem moet redelik wees. Daarom word die redelikheid van die Nasionale Gesondheidsversekeringsskema geëvalueer volgens die vasgestelde raamwerk. Hierdie studie beweer dat hervorming nodig is en dat die Nasionale Gesondheidsversekeringskema 'n lewensvatbare manier is om kwessies aan te spreek oor ongelyke toegang tot en kwaliteit van gesondheidsorg. Dit beweer dat die Nasionale Gesondheidsversekeringskema voldoen aan die verpligtinge wat deur konstitusionele en internasionale reg opgelê word en spreek maniere aan waarop sodanige nakoming versterk kan word.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/102753
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