Perceptions and attitudes of South African physiotherapists towards National Health Insurance

Background: The National Health Insurance (NHI) Act 20 of 2023 aims for universal health coverage. However, rehabilitation professions, especially physiotherapy, had limited involvement during key phases of NHI policy development, including the Green and White Papers, pilot projects, and the NHI Bill. President Cyril Ramaphosa enacted the NHI Bill in May 2024. Aim: To assess South African physiotherapists’ perceptions and attitudes towards NHI, focusing on their perception of its objectives and implications for their profession. Setting: An online survey was conducted among 146 South African physiotherapists. Methods: A quantitative, non-experimental online survey was used. Results: The data analysis revealed significant demographic influences on perceptions regarding NHI. Gender, age and professional experience played a role in shaping responses. Male physiotherapists were more likely than their female counterparts to perceive NHI as a means of addressing past healthcare disparities and increasing universal coverage. Professional experience and qualifications also played a crucial role, with distinct perspectives based on respondents’ qualifications. Age influenced opinions on the impact of NHI on physiotherapists in private practice, with younger physiotherapists perceiving more negative impacts compared to older colleagues. Conclusion: Physiotherapists acknowledge NHI’s potential to address healthcare disparities, but express concerns about its implementation and impact. They advocate for more inclusive policymaking, better communication, and improved strategies to ensure NHI meets diverse healthcare needs nationwide. Contribution: Developing demographic-sensitive strategies and addressing resource allocation and infrastructure challenges are crucial to implementing NHI effectively.