top of page

National Health Insurance (NHI): Lessons from the German healthcare system

The Inclusive Society Institute (ISI) is currently involved in an extensive research programme seeking alternative pathways to universal access and affordable healthcare in South Africa. It recently released a report on its NHI roundtable dialogue, which brought together the diverse range of healthcare stakeholders to interrogate the draft legislation which is now before the National Assembly’s Portfolio Committee on Health. One of the report’s recommendations is that the portfolio committee consider alternative international examples of universal healthcare models, the German healthcare system being one such model.

In line with the aforementioned recommendation, the ISI, in cooperation with the Friedrich Ebert Stiftung, hosted a seminar on Wednesday afternoon, 19 February 2020, at the Taj Hotel in Cape Town. The seminar was attended by delegates from the healthcare industry, academics, Members of Parliament serving on the National Assembly’s Portfolio Committee for Health and Dr. Gwen Ramakgopa, a representative of the ANC’s National Executive Committee for Education and Health. The ranking Member of Parliament was Dr. Sibongiseni Dhlomo, Chairperson of the Parliamentary Portfolio Committee on Health.

The key presenters included Germany’s former Minister of Health, Hon. Ulla Schmidt, who currently serves as a Member of the Bundestag, and Mr. Franz Knieps, who serves on the board of German Health Insurance BKK. Hon. Schmidt was Europe’s longest serving Minister of Health and oversee the implementation of the national health insurance system of Germany. Mr. Knieps, a former German Director General of Health, also made an extensive technical presentation during the seminar.

​The German healthcare system is based on solidarity, where the rich subsidise the poor, and the healthy the sick. It has a universal healthcare system where all citizens are compelled to have health insurance. All citizens belong to the national insurance scheme, but they may opt out if they take out private health insurance. The State funds the premiums of the unemployed and for certain categories of social beneficiaries. Whilst the proposed South African model suggests a single fund, in order to promote competition, there exists a number of funds in Germany. Standards are assured through an independent and autonomous healthcare standards authority. Another key feature of the German system is that healthcare specialists, providers and patients accept joint responsibility for the various funds’ governance.


bottom of page