1. The Impact of Chronic Disease on a Future NHI
National Health Insurance Policy Brief 3
The Impact of Chronic Disease on a Future NHI
27 June 2009

2. Rate of Chronic Disease in Medical Schemes 2009
The 25 Chronic Disease List (CDL) diseases must be covered by medical schemes as part of the Prescribed Minimum Benefit (PMB) package. Strong pattern by age for chronic disease and multiple chronic disease.
Source: IMSA NHI Policy Brief 3: Chronic Disease and Future NHI

3. Diabetes Mellitus Type 2 Diagnosis and Treated
More prevalent in males than females. Diagnosed cases requires ICD-10 diagnosis by healthcare practitioner. About two-thirds meet “treated patient” criteria. Need to prove regular supply of appropriate drugs paid from risk pool (not personal medical savings accounts).
Source: IMSA NHI Policy Brief 3: Chronic Disease and Future NHI

4. Comparison Medical Schemes and SADHS 2003: Diabetes
Comparison of Demographic and Health Survey results to REF Study 2005 results. First comparison of public and private prevalence but see report for reservations in SADHS methodology.
Day C, Gray A. Health and Related Indicators. In: Harrison S, Bhana R, Ntuli A, eds. South African Health Review Durban: Health Systems Trust; URL:
Source: IMSA NHI Policy Brief 3: Chronic Disease and Future NHI

5. Comparison Medical Schemes and SADHS 2003: Asthma
Comparison of Demographic and Health Survey results to REF Study 2005 results. First comparison of public and private prevalence but see report for reservations in SADHS methodology.
Day C, Gray A. Health and Related Indicators. In: Harrison S, Bhana R, Ntuli A, eds. South African Health Review Durban: Health Systems Trust; URL:
Source: IMSA NHI Policy Brief 3: Chronic Disease and Future NHI

6. Comparison Medical Schemes & SADHS 2003: Hyperlipidaemia
Comparison of Demographic and Health Survey results to REF Study 2005 results. First comparison of public and private prevalence but see report for reservations in SADHS methodology.
Day C, Gray A. Health and Related Indicators. In: Harrison S, Bhana R, Ntuli A, eds. South African Health Review Durban: Health Systems Trust; URL:
Source: IMSA NHI Policy Brief 3: Chronic Disease and Future NHI

7. Comparison Medical Schemes and SADHS 2003: Hypertension
Comparison of Demographic and Health Survey results to REF Study 2005 results. First comparison of public and private prevalence but see report for reservations in SADHS methodology.
Day C, Gray A. Health and Related Indicators. In: Harrison S, Bhana R, Ntuli A, eds. South African Health Review Durban: Health Systems Trust; URL:
Source: IMSA NHI Policy Brief 3: Chronic Disease and Future NHI

8. Needing Treatment for CDL Chronic Diseases 1985 to 2025
Shows sensitivity to higher and lower rates of chronic disease by age and gender. The aging and growth of the population mean a substantial increase in the numbers needing treatment from 2.99 million in 1994 to 5.13 million by 2025 (172% increase).
Source: IMSA NHI Policy Brief 3: Chronic Disease and Future NHI

9. Estimated Numbers Needing Treatment under Future NHI
Assumes public prevalence, diagnosis and treatment rates are the same as in medical schemes.
Source: IMSA NHI Policy Brief 3: Chronic Disease and Future NHI

10. Implications for NHI
Despite some reservations, a first estimate of the burden of chronic disease (excluding HIV) for the country as a whole can be made. This shows that a National Health Insurance system would be facing a growing burden of chronic disease, simply due to the growth in the population and the aging of that population.
 This concern is echoed by the MRC: “Demographic change in South Africa has produced a rapidly ageing population that is expected to continue ageing at a rapid rate for at least the short- to medium-term future. ... it currently seems that the serious consequences of population ageing are not adequately planned for and responded to by government. ....”. “The demographic projections pose clear challenges to the health sector. Not only is there a need to plan for the increase in the numbers in older persons but there is also the need to recognise and plan for an expected increase in chronic morbidity and disability.”
Source: IMSA NHI Policy Brief 3: Chronic Disease and Future NHI

11. Multiple CDL Diseases in Medical Schemes, excl. HIV
At older ages, nearly half the beneficiaries on medical schemes with chronic disease have more than one chronic disease. REF Study 2005 showed people being diagnosed for up to eleven simultaneous conditions and treated for up to nine simultaneous conditions.
Source: IMSA NHI Policy Brief 3: Chronic Disease and Future NHI

12. Common Combinations of Chronic Conditions, excl. HIV
Data from REF Study 2005 in medical schemes. Analysis excludes HIV as epidemic is progressing each year.
Source: IMSA NHI Policy Brief 3: Chronic Disease and Future NHI

13. Numbers with Combinations of Chronic Conditions 2009
This analysis restricted to medical scheme population and excludes HIV (dealt with in Policy Brief 4).
Source: IMSA NHI Policy Brief 3: Chronic Disease and Future NHI

14. Managing Chronic Disease
There are several ways a future NHI can tackle this problem other than simply increasing the budget for healthcare. Example of Western Cape Department of Health: attempts to intervene in the “up-stream” causes of disease.
Germany implemented disease management programmes in their national system in Other countries to introduce chronic disease management programmes include Singapore, Australia, Japan, Brazil, Argentina, France, Canada, Spain and India.
Medical schemes in South Africa have developed wellness programmes, disease management programmes and high-cost patient programmes. South African medical schemes and managed care organisations are amongst the leaders worldwide in this field.  
Disease management and wellness programmes are areas where the private sector can add significant value to a future National Health Insurance system, no matter the details of the funding design.
Source: IMSA NHI Policy Brief 3: Chronic Disease and Future NHI

15. Innovative Medicines South Africa (IMSA) is a pharmaceutical industry association promoting the value of medicine innovation in healthcare. IMSA and its member companies are working towards the development of a National Health Insurance system with universal coverage and sustainable access to innovative research-based healthcare.
Contact details: Val Beaumont (Executive Director) Tel: Fax:
Innovative Medicines SA (IMSA) Cell:
PO Box 2008, Houghton, South Africa

16. Professor Heather McLeod
Material produced for IMSA by
Professor Heather McLeod