There have been fierce debates within the private healthcare sector since the South Africa government announced plans to implement universal healthcare coverage through the National Health Insurance (NHI). While there may be challenges, it is critical tha
This is according to Olabode Olajumoke, Health Actuary at Aon Hewitt South Africa, who says that the private sector – including hospitals, healthcare providers, consultants and medical schemes – all have valuable input into how NHI can best fit into current healthcare structures. “The South African private healthcare sector is run very efficiently, comparable with many developed countries, so it is critical that these skills are utilized properly.”
“Government has announced how it foresees NHI being rolled out but if the private sector disagrees with aspects of the proposal or the suggested timeframe, it should collaborate with the public sector by actively suggesting how such proposals can be improved. NHI is here and it is happening, and it will work much more efficiently if the private sector collaborates on the matter rather than rejecting it. The government also has a duty to ensure that the skills provided within the private sector are not laid to waste.”
Olajumoke notes that a critical area where the government could work closely with the private sector (particularly providers and medical schemes) is in to upgrading inefficient medical facilities in the country to the world class levels as seen in the private sector.”
“One of the main factors that needs to be understood regarding NHI is that successful implementation is not just about money but rather about having the right systems and structures in place from the outset. NHI tenets must include a complete overhaul of the current system. The design of the NHI program should include solutions to concerns such as (but not limited to) provider reimbursement arrangements, habits leading to high risk medical claims and fraud. The need for open and honest dialogue among all stakeholders is clear and evident.”
Olajumoke stressed that it is also important to determine how NHI will work in different locations. “In a country as diverse as South Africa it is not feasible to simply have a one-size-fits-all approach to healthcare. If one looks at a sample of primary care issues, they vary hugely between regions. Clinics in remote areas will likely have more cases of malaria or HIV while in metros, cancer is likely to be one of the most significant risks.”
He says the reality is that the first implementation of NHI may not be immediately successful, as there are bound to be teething issues; but it is critical to have integrated systems in place. “Once this has been established, it can be tweaked and adjusted as errors arise.”
“Rather than Government simply mandating how NHI will work in about 15 years time, there needs to be a transparent dialogue with all stakeholders in order to determine what is feasible and what can be done to ensure that the process runs as smoothly as possible. The private sector has a huge role to play, yet it is by continuously presenting viable alternatives that the much needed value from the private sector will be fully embraced into the scheme.”