David Jackson: Business Day
THE first provisional steps towards the implementation of a National Health Insurance scheme (NHI) are under way as the government begins a series of dialogues with key role players and stakeholders. This will pave the way for a system that is set to change the face of healthcare delivery in SA eventually. Ashleigh Theophanides, healthcare director at Deloitte, said it was clear that the government was focusing on two processes as it laid the groundwork for meeting the principles and objectives outlined in the green paper on the NHI. The first of these processes is health reform itself, as the state seeks to rectify many of the inefficiencies in the public health sector both from a resource and from a management perspective. The second focus involves an examination of finance mechanisms that potentially could be introduced to generate additional revenue to ensure that the principles underpinning health coverage, as spelt out in the South African Constitution, are supported and provided for. Theophanides said that there were an insufficient number of hospital beds and nurses in the country to service the population, so it would be important for the National Health Insurance scheme to enable healthcare to be purchased for both the public and private sectors. Theophanides said that since 1994 there had been improved access to public healthcare facilities, for example, but while healthcare provision in the private sector was often seen as world-class, there was a concern about the quality of service that was being rendered in public facilities. She believes the engagement process that the government has initiated over the past few weeks indicates that it is trying to obtain input from as many sources as possible. The first step would be to try to clarify the objectives of 10 pilot projects outlined in the green paper, which the government is implementing as part of the preparatory build-up to the introduction of the NHI.
The Department of Health intends to select 10 districts for these pilot schemes to measure and evaluate various aspects of healthcare management, performance and delivery, among others. Theophanides said that depending on the outcomes, these pilot schemes could have a bearing on healthcare delivery under the future NHI. She believes that two other essential pillars in the preparatory build-up should include an assessment of the staff complement that will be needed to cover healthcare needs under the NHI, as well as an examination of how the benefit packages that will form the basis for the comprehensive benefit packages referred to in the green paper will be structured and defined. The necessary administrative, infrastructural and information systems to support this would then have to be put in place. Theophanides said that for the NHI and health reform to work it was important that every person got involved in some way. She said there was a time period available for comment on the green paper, and emphasis should be put on how the public as well as the private healthcare sectors could be made more efficient. She said the economic benefits of introducing a scheme that could produce quality health outcomes would result in a significant improvement to SA's GDP, which was to the ultimate benefit to the country. The initial emphasis in the NHI will be on primary healthcare, which will have the biggest impact on the largest part of the population. A subset of primary healthcare is preventative care. Theophanides said if the population could be educated about HIV/AIDS and other lifestyle diseases, such as diabetes and hypertension, for example, SA could start to bring down the spiralling costs of healthcare by concentrating on prevention and ensuring that all available funds could be distributed to touch the largest part of the population. The she said, would result in far better health outcomes in a shorter period.
Peter Jordaan, acting principal officer of Fedhealth, said the plan showed a practical understanding of the complex challenges involved in improving healthcare delivery in SA. It was encouraging to see that all the various building blocks necessary for a sustainable model had been highlighted deliberately. On the issue of piloting, Jordaan believes this is critical so that one can learn from the actual implementation. He said that at present there was fragmented care and this would hopefully address that issue. Jordaan said it was encouraging to see a strong focus on primary care, as this was Fedhealth's own strategy being implemented in the private sector. Similarly, he said, the focus on performance-based monitoring and recognition would add real value to the effect of the total healthcare system. Jordaan said the shortage of resources to service the implementation had often been raised, and while this latest paper addressed and acknowledged the shortage in resources it also provided a plan, with tangible milestones, to address this. He said that the next five years at least would be spent in strengthening critical competencies and promoting the most efficient use of the limited resources available. He said the private sector was paying a lot for medical coverage but without receiving the widely desired outcomes. Jordaan said that if NHI was successful he believed it would achieve its objective and truly benefit all South Africans with universal care created for all.
