The National Health Insurance (NHI) scheme will be implemented parallel to a massive effort to strengthen the health system over the next five years, according to a confidential NHI policy proposal in possession of Health-e.

 South Africa’€™s health system is already undergoing a transformation that will see a shift from the current hospital based curative approach focus to a community- and clinic-based primary health care system. There are many building blocks that need to be put in place as part of the process that will take many years to complete.

The confidential proposal explains that an NHI system will provide a mechanism for improving cross-subsidisation in the overall health system, with funding contributions being linked to an individual’€™s ability to pay while benefits would be in line with an individual’€™s need for care.

The government accepts that, in order to implement the NHI, there will have to be a parallel effort to improve the public health system, with the major focus on improved infrastructure, human resources and management.

According to the confidential proposal, ‘€œthe NHI is being developed within the context of intensified health system reform, that is, the NHI is implemented as the system is improved ‘€“ once a facility meets standards of quality of care, it is designated an NHI facility.’€

At the core of this proposed health sector reforms is the reconfiguration of the institutions and organisations involved in the funding, pooling, purchasing and provision of health care services in the South African health system.

An NHI Fund is to be established to receive funds, pool these resources and purchase services on behalf of the entire population. The Fund will be publicly administered as a single purchaser with provincial sub-offices to negotiate and contract with the health care providers.

The fund will be managed by a Chief Executive Officer who reports directly to the health minister in the same way the head of the SA Revenue Service reports to the Minister of Finance.

The CEO will be supported by an Executive Management Team and technical committees dealing with, among others, pricing, auditing and benefits.

The NHI Fund will also be advised by a committee of experts in fields such as  financing, nursing, public health, HIV/AIDS and research.

The minister will be responsible for oversight of the NHI Fund and development of NHI policy.

The NHI Fund will contract and directly reimburse both public and private providers.

A comprehensive package of services covered by the NHI Fund will be delivered through a Primary Health Care approach.

According to the policy proposal, the package of health services will include

primary care preventive and promotive services, maternal health services, paediatric and child health services, HIV/AIDS and TB services, chronic disease management, inpatient care, outpatient care, emergency care, prescription drugs, technologies for diagnosis and treatment, rehabilitation, mental health services, some dental services, substance abuse treatment, basic vision care and hearing services (including provision of hearing aids).

Public and private health care providers will be accredited according to criteria to be developed.

The success of the NHI hinges on the accelerated and visible improvements in the provision of care. Both public and private facilities will be accredited by the National Office of Standards Compliance, which has already been established.

This office, a separate entity that reports to the minster, aims to accredit at least 25 percent of all facilities annually within a five-year period.

This process will be supported by quality improvement and assurance programmes assisting facilities to reach accreditation status.

An engineering consultant has already been working closely with the provinces to audit the infrastructure of healthcare facilities. There is widespread agreement that the physical state of hospitals and clinics will need to be improved if there was any hope of South Africans utilising health services, especially those currently using private health care.

The proposal makes the following point: ‘€œSouth Africa has the chance to make history by following the best evidence on health from around the world, implementing a highly effective, fair and cost effective NHI system. The timing is right as a NHI will help protect the poor, provide an enabling environment to prevent further cost escalation in the private insurance market and help secure a wealthier future for South Africans.’€

It is expected that a White Paper will be discussed at the next Cabinet meeting and released to the public soon after.