BACKGROUND: National Health Insurance (NHI) is currently high on the health policy agenda. The intention of this financing system is to promote efficiency and the equitable distribution of financial and human resources, improving health outcomes for the majority. However, there are some key prerequisites that need to be in place before an NHI can achieve these goals. OBJECTIVES: To explore public perceptions on what changes in the public health system are necessary to ensure acceptability and sustainability of an NHI, and whether South Africans are ready for a change in the health system. METHODS: A cross-sectional nationally representative survey of 4 800 households was undertaken, using a structured questionnaire. Data were analysed in STATA IC10. RESULTS AND CONCLUSIONS: There is dissatisfaction with both public and private sectors, suggesting South Africans are ready for health system change. Concerns about the quality of public sector services relate primarily to patient-provider engagements (empathic staff attitudes, communication and confidentiality issues), cleanliness of facilities and drug availability. There are concerns about the affordability of medical schemes and how the profit motive affects private providers' behaviour. South Africans do not appear to be well acquainted or generally supportive of the notion of risk cross-subsidies. However, there is strong support for income cross-subsidies. Public engagement is essential to improve understanding of the core principles of universal pre-payment mechanisms and the rationale for the development of NHI. Importantly, public support for pre-payment is unlikely to be forthcoming unless there is confidence in the availability of quality health services.

Este artigo conceitual discute a meta política do acesso eqüitativo à assistência em saúde, com um foco especial no papel da escolha. Estabelece um arcabouço teórico baseado nas três dimensões do acesso: disponibilidade, acessibilidade financeira e aceitabilidade. No que diz respeito a cada uma dessas dimensões, o "grau de ajuste" entre o sistema de saúde e os indivíduos ou comunidades tem um papel determinante no nível de acesso aos serviços de saúde, na medida em que define o conjunto de escolhas. No entanto, em última análise, é o grau de informação sobre as escolhas que determina o acesso aos serviços de saúde. Portanto, acesso é definido como liberdade de utilização. O artigo analisa a informação e suas características (que atravessam as diversas dimensões do acesso), argumentando que uma política de saúde eqüitativa deve estimular a ação comunicativa para fortalecer os indivíduos e as comunidades na expansão dos seus conjuntos de escolhas subjetivas.

This conceptual paper addresses the health policy goal of equitable access to health care from a perspective that highlights the role of choice. It sketches a framework around the three access dimensions availability, affordability, and acceptability. The "degree of fit" with respect to each of these dimensions between the health system and individuals or communities plays a role in determining the level of access to health services by outlining the existing choice set. Yet it is the degree of informedness about the choices that ultimately determines access to health services. Access is therefore defined as the freedom to utilize. The paper focuses on information and its properties, which cut across the dimensions of access. It is argued that equity-oriented health policy should stimulate communicative action in order to empower individuals and communities by expanding their subjective choice sets.

Este artigo conceitual discute a meta política do acesso eqüitativo à assistência em saúde, com um foco especial no papel da escolha. Estabelece um arcabouço teórico baseado nas três dimensões do acesso: disponibilidade, acessibilidade financeira e aceitabilidade. No que diz respeito a cada uma dessas dimensões, o "grau de ajuste" entre o sistema de saúde e os indivíduos ou comunidades tem um papel determinante no nível de acesso aos serviços de saúde, na medida em que define o conjunto de escolhas. No entanto, em última análise, é o grau de informação sobre as escolhas que determina o acesso aos serviços de saúde. Portanto, acesso é definido como liberdade de utilização. O artigo analisa a informação e suas características (que atravessam as diversas dimensões do acesso), argumentando que uma política de saúde eqüitativa deve estimular a ação comunicativa para fortalecer os indivíduos e as comunidades na expansão dos seus conjuntos de escolhas subjetivas.

This conceptual paper addresses the health policy goal of equitable access to health care from a perspective that highlights the role of choice. It sketches a framework around the three access dimensions availability, affordability, and acceptability. The "degree of fit" with respect to each of these dimensions between the health system and individuals or communities plays a role in determining the level of access to health services by outlining the existing choice set. Yet it is the degree of informedness about the choices that ultimately determines access to health services. Access is therefore defined as the freedom to utilize. The paper focuses on information and its properties, which cut across the dimensions of access. It is argued that equity-oriented health policy should stimulate communicative action in order to empower individuals and communities by expanding their subjective choice sets.