Will universal healthcare as envisaged for National Health Insurance (NHI) in South Africa support the principles of integrated, holistic care, being such important components of any successful healthcare solution?
Much has been said and written about the recent developments around National Health Insurance, since being approved by Parliament in June. Most observers have their doubts around a number of aspects related to NHI, such as affordability, uncertainty of benefits and government’s ability to manage such a vast project. Others have indicated their excitement about the prospect of access to care, not based on affordability.
If we put our differences and doubts aside and merely look at the principle of universal care, as envisaged, and how it could contribute to improved health outcomes, we need to acknowledge a number of positives.
For any healthcare system to be successful the principles of integration and holistic care are two of the cornerstones. The current private and public healthcare sectors both run short on delivering on these two components of an effective health delivery system.
Integration in the healthcare context means to co-ordinate and align different healthcare services and providers to ensure the effective delivery of quality care. By, for example, having one administration platform, processes can be streamlined and duplication prevented. One way of achieving that is to share patient information or to have a gatekeeper who acts as coordinator of care. When we look at the NHI Bill, it proposes a centralised electronic health system which clearly supports the above principles. All treating doctors and other health professionals will have access to this centralised system containing a full history of the patient, allowing for coordination of care. Patient records will be available to all treating doctors and protocols will be standardised. The Bill also speaks of a gatekeeping function through primary care-based referrals into higher levels of care being envisaged. This will ensure appropriate referrals and containment of costs.
In terms of holistic care, the Bill indicates that the proposed NHI system will make provision for a range of health promotion programmes including education and awareness campaigns, community-based initiatives and other interventions to prevent chronic diseases and promote healthy living, facilitated by appointed ward health agents. The objectives of the NHI Bill include health promotion and preventative services. These programmes recognise that holistic care aims to prevent disease and to improve not only physical wellness, but also recognise the importance of mental and social wellbeing. These programmes will be delivered in communities and at schools, with a strong focus on education.
With reference to effective delivery of services, it is important to note that the NHI system provider payment mechanisms will be determined by the NHI Fund in consultation with the Minister and will typically be capitation or capped case-based fees, taking into account the performance of the healthcare provider. This means that there will be pre-determined fees paid to providers per event/visit and these could be adjusted, based on the outcome. By not allowing fee-for-service payment mechanisms, over-servicing will be prevented. With the vast population’s dire healthcare needs, optimally spreading the healthcare rand should rightfully top the agenda, but not ignore the quality aspects – typically at risk of being compromised within such payment systems. Around the world, this is a challenge in other universal coverage systems.
Source: NHI Bill (B11B 2019)
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