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How can private healthcare contribute to NHI?

The private healthcare sector needs to firm up its collaboration effort to the National Health Insurance (NHI) programme in a way that is relevant for members and patients, and overall healthcare general population - as this is aligned to the principles of universal health coverage (UHC).
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Universal Health Coverage (UHC) is not just the responsibility of the Department of Health or the minister, it’s for everybody, including the private sector, says Dr Ali Hamdulay, chairperson of the Board of Healthcare Funders (BHF).

“With the National Health Insurance (NHI) Bill and the Medical Schemes Amendment Bill now in the final phases, discussions on collaboration should begin to filter down into practical and tangible projects and expectations that can be implemented,” he says.

“Enough has been said, it’s about time we demonstrate what the industry can do to contribute towards universal health coverage through NHI as the mechanism that will enable the delivery of access to equitable healthcare for all. The private sector has a lot to offer and must now contribute towards supporting efforts to get NHI moving.

“Of interest, among other things include the private sector’s critical skills offering which can provide a springboard on which government can begin to get things moving with NHI, sharing of case studies from the different schemes, technology being used to deliver healthcare services and innovations being used to tackle some of the industry challenges within the private sector, in order to provide government a springboard on which to kickstart NHI,” says Hamdulay.

“There is no need to reinvent the wheel when we can collaborate to make this work for the greater population of the country.”

NHI is for all

As part of efforts to support the principles of universal health coverage, the Council for Medical Schemes (CMS) is launching a number of units within the regulator. These units will focus on coding, health technology assessment (HTA) capabilities and anti-fraud strategies to ensure that when NHI takes off, systems are in place to proactively address some of the challenges that the industry continues to grapple with.

“There is a need for very close alignment with the Department of Health (DoH) as the agency that will drive the NHI structures. Entities that already have a lot of the capabilities required for NHI implementation should come on board in partnering with the department to ensure the success of NHI for the benefit of the entire population of the country.

“The private sector needs to realise that NHI is not for some South Africans, it’s for all,” said Dr Clarence Mini, chairperson of the CMS.
While plans are underway to ensure the successful implementation of NHI, without a doubt the healthcare sector continues to experience several challenges and vulnerabilities. These must be addressed to ensure NHI efficiencies and success.

Fraud, waste and abuse is still on top of the list of industry challenges. In fact, each year fraud, waste and abuse costs the industry over R20bn per annum.

Fighting fraud and corruption

According to Advocate Andy Mothibi, chief executive and head of the Special Investigating Unit (SIU), government has launched a national anti-corruption strategy (NACS) under the Anti-Corruption Task Team (ACTT). The strategy includes corruption risk vulnerability sector assessments which has identified the health sector as one of the vulnerable sectors.

“The NHI will be included as part of the health sector vulnerability assessment as well,” says Mothibi.

He noted that, the SIU has also convened health sector anti-corruption forum which includes private and public health care sector stakeholders, including the BHF and CMS among others.

“The forum will play a critical part in identifying maladministration, malpractice and corruption in both the private and public health sector.

“Continued collaborations with all stakeholders will be critical in addressing current healthcare challenges that are impeding significant progression towards fully serving the healthcare needs of the population.”

“These measures have been put in place to ensure that the industry reinforces measures to tackle fraud, waste and abuse and begin to redirect funds towards projects that will positively impact the greater population and ensure that the private sector allocate resources towards ensuring access to healthcare for all,” said Mothibi.

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