Page 47 - IRMSA Risk Report 2021

CONSULTANT
NATIONAL HEALTH INSURANCE OFFICE

NICHOLAS

CRISP

EXPERT OPINION

There are more positives than negatives that will come out
of the Coronavirus pandemic. Part of the NHI’s budget was
“given up” to help fund the Coronavirus, however, this budget
was ultimately used to improve infrastructure, facilities
and equipment. The virus also helped government learn
new lessons around staffing, health and safety, and health NHI will save costs and is the answer to achieving universal
products, all of which will help boost the implementation of health coverage.
the NHI. In addition, the entire NHI’s digital capabilities have
been converted to look after Covid-19. This means that we Given the positives as well as the challenges, on balance,
now have a competent digital system in place with reliable there is a golden opportunity to strike now. More creative
data including data from the private sector. We now have an solutions are required to divert much needed capital budget
established patient registry through the deployment of the towards healthcare infrastructure, equipment and systems.
Health Patient Registration system in our public healthcare Big business and international sovereign loans backed by
facilities and hospitals. Treasury to set up low cost/affordable capital funding will form
part of the funding model. A positive spin-off of a significant
A health systems dashboard will also soon go live. This system capital infrastructure project will be to create much needed
will support the government with early warning signs in jobs and boost industries that provide services to healthcare.
surveying hospitals infrastructure, alerting us to impending
critical mass reach in various areas of our operations, and The investment must include the revival of Nursing Colleges
giving us an opportunity to respond before there is a crisis on and increased contribution towards creating a larger and
the ground. Information about procedures done in all hospitals more sustainable pipeline of healthcare workers. General tax
in South Africa will be automated and made shareable under revenue, payroll tax and/or surcharge on personal income
this system. tax are possible avenues to raise funding. At the same time a
single healthcare system will provide access to synergies not
Contrary to popular belief, almost all the equipment in the any different to that experienced through corporate mergers.
emergency field hospitals can and has been re-installed in the For example, the number of actuaries employed by the private
current public healthcare system. This has sped up planned sector can be reduced to achieve significant cost savings. The
infrastructure development required to bring the public private sector also uses the “fee-for-service payment system/
healthcare facilities up to standard. Most major hospitals that supplier induced demand system”, which plays a significant
were allocated to serve Covid-19 patients now have proper role in driving up costs. We must take full advantage of the
oxygen facilities that will be used for years to come. structures created to achieve further cooperation between
public and private healthcare. Engagements that have already
Medical practitioners and specialists suffered between 50% been stepped-up must be further leveraged to deal with and
to 80% loss in income directly as a result of the lockdown. provide solutions towards the challenging issues such as
This meant that most of them now view the NHI from a “Complementary Services”, “Capped Payment Method” and
more positive lens. Engagement with the private sector has “Common Treatment guidelines”.
increased and cooperation to fight the virus came naturally.
Most providers accepted the tariffs and some doctors offered We will have to redouble our efforts to convince the public
their services for free. that we know how to minimise the risk of fraud to the Fund.
We plan to do this by making sure that every transaction of the
The NHI is a significant undertaking and the complexity of the Fund is in the public domain. The system will be automated to
public and private health systems cannot be underestimated. flag anything that is irregular – and that also protects it from
The pandemic has placed enormous strain on the economy cyber-attacks.
and as a result austerity measures in all departments including
health are unavoidable. This has the potential of setting back Overall, South Africa needs to spend money to “make change”
the timeline to implement the NHI. Lack of access to capital to and the country will need to invest to reform the system.
build much needed infrastructure increases the risk of “failure Currently, 8.5% of GDP is spent on healthcare, which is good
to reform our healthcare systems”. Labour unrest, some of as a developing nation, but this money is not spent wisely.
it justified by poor safety of public healthcare workers, is The NHI is a funding mechanism which changes the way we
unfortunately ill-timed. purchase our healthcare. The same money needs to come into
a central pool of funds, not through 10 different government
We are in a perfect storm in the form of a poor economy, departments and 78 medical schemes. We would like to have
increasing unemployment, need for austerity measures that one common, sizeable, pool of funds which we can use to
need to be balanced with much needed investment in public leverage to purchase the goods and services (needed) to run
healthcare worker safety, salary increases and investment in healthcare. All of the resources used or spent in both the
training facilities to address the massive shortage in healthcare private and public healthcare sectors must contribute towards
workers. Additionally, the R2-billion PPE scandal has led to the fund. The fund will purchase healthcare from all adequate
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a waste of much needed equipment as well as increased public and private healthcare providers. The aim is to provide
! resistance to change. Whilst private medical practitioners decent healthcare for every single person, irrespective of
may be more amenable towards the NHI, the various private
whether they can afford to pay for it or not.
medical schemes are not convinced that the
Sources: Health Market Inquiry Report, September 2019, Article by Staff Writer – BusinessTech, 24 August 2020 and 3 September 2020
47
Article by Joan van Dyk – Bhekisisa, 7 October 2020