The National Health Insurance (NHI) is not a radical shift to dismantle a functioning system, but an opportunity to review two poorly functioning ones.
The public sector sees very high volumes of patients but gives them bad service and produces very poor outcomes. The private sector is modelled on low volume, high cost care – it uses its huge quantities of resources badly, to service very few people.
As the Health Market Inquiry (HMI) report makes clear, the large commercial medical schemes are resisting needed reforms that with better productivity would lead to the convergence of the two systems. In particular, they persist with an outdated tariff system that pays for services not outcomes and doesn’t support team-based delivery models. This is probably because it threatens their claim payment and ‘managed care’ role that justifies a very high income. This strategy is counterproductive for their members.
The National Health Insurance (NHI) Bill of 2018 will be published in the Government Gazette shortly for public comment.
A key provision of the bill will be the establishment of an NHI fund to pay for health services so that all South Africans have access to quality care.
“The bill seeks to establish the NHI Fund of South Africa, as a public entity, so as to provide for a sustained universal health access that is affordable and of high quality. It also sets out its functions, powers and duties,” Cabinet said in a statement following its regular fortnightly meeting.
The bill provides a framework for the active purchasing of health care services by the fund on behalf of users and creates mechanisms for the equitable, effective and efficient use of the resources of the fund to meet the health needs of users.
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