What is National Health Insurance?
National Health Insurance (NHI) is a health financing system that is designed to pool funds to provide access to quality, affordable personal health services for all South Africans, based on their health needs and irrespective of their socioeconomic status. NHI is a massive reorganisation of the current health care system, both public and private.
It has the following features:
- Universal access
- Mandatory prepayment of health care
- Comprehensive services
- Financial risk protection
- Single fund options
- Strategic purchaser options
- Single-payer options
How is it different from the current system?
The South African health system has been described as a two-tiered system divided along socio-economic lines. NHI will create a unified system.
Central to its design is the focus on Ideal clinics as the gatekeepers of care. Another area of focus is on central control, through the public health system, with private doctors and hospitals contracted in to fill the shortage areas.
How will it affect patients?
- Mandatory prepayment of health care: everybody will pay towards the NHI fund.
- Ideal clinics as gatekeepers: all care will be accessed through Ideal clinics, and if you don’t a bypass charge will be applied. Emergency care would presumably be an exception.
- Provider choice must be based on geography: patients will be assigned to an Ideal clinic and that will be their first contact point of care.
- Medical aids will probably disappear, to be replaced by health insurance for top up care
- When the fund goes live, private doctors and hospitals will initially not be covered
How will it affect General Practitioners ?
Primary Health Care (PHC) is being reengineered through four streams to improve timely access, promote health and prevent disease.
To better utilise the available human resources for health in the country, there will be an increase of contracted private practitioners at the primary health care level. The expansion of contracted providers beyond general practitioners (GPs) will also include, amongst others, practitioners dealing with physical barriers to learning such as audiologists, speech therapists, oral hygienists, occupational therapists, psychologists, physiotherapists and optometrists for school going children. This will focus especially on children who have been identified in quintile one and two schools, during the period of piloting of NHI.
Outcomes will be measured and monitored through a performance management framework and will be in accordance with agreed upon performance standards. Eventually, performance management will cover public health outcomes in a specified catchment population. For this model to be successful, the clinic settings and environment must comply with the Ideal clinic model specifications.
How will it affect private specialists and private hospitals?
Accredited private sector providers, such as private hospitals and specialists, will be contracted at higher levels of care. During this phase, additional revenue for the NHI will be mobilised through the introduction of mandatory prepayment from those who are eligible.
Links / References:
Dr William Kleynhans, Chief Medical Officer at Allegra Pty Ltd.