There are several reasons to revisit the National Health Insurance (NHI) reform pathway. We find ourselves in changed circumstances, entering a period of austerity worsened by the Covid-19 pandemic. The reform, as conceptualised, requires substantial reorganisation of a fragile system in a short time. This big-bang approach poses several risks, the biggest being that the system is never reformed.

Incremental reform processes with realistic milestones are better suited to building trust. The starting point is one of an ailing public sector, a more resource-intensive but also fragile private sector, fragmented financing, inequities within and between the public and private sectors, weak accountability and a trust deficit...

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