Plans to overhaul health system for NHI

Monday, February 22, 2010

Pretoria - Government has acknowledged that the implementation of the proposed National Health Insurance (NHI) scheme requires an extensive overhaul of the public and private health care systems.

Health Minister Aaron Motsoaledi recently said South Africa, due to its unique challenges, needed to develop its own affordable and sustainable reform path that is different from other NHI systems around the world.

Research is now focused on identifying measures that might enable a feasible transition to an NHI model over the next five years. These include improving public health funding, decentralising financial management to hospitals and local health districts and improving public health management.

Motsoaledi has developed what he termed a 10-point plan to get NHI off the ground. The plan includes improving quality of services, overhaul of the health system and its management, review of drug policy and strengthening research and development, among other things.

Other proposals include developing a purchaser-provider split in the public health system and contracting with general practitioners as part of an expansion of the capacity of district health authorities.

The development of a common plan for public and private services, such as emergency transport, radiology, trauma and Aids treatment, has been suggested while a system of risk equalization for medical schemes has also been proposed.

Medical schemes in South Africa are obliged to offer a prescribed set of minimum benefits comprising reimbursement of costs of hospital care and medicine for a range of treatment requirements.

In a bid to improve the fairness of coverage for these minimum benefits, the Department of Heath and the Council for Medical Schemes are proposing the establishment of a system of risk equalisation between schemes. They say this will improve both efficiency and risk pooling.