A digital health strategy, established during Covid, will help drive the National Health Insurance (NHI) scheme. It will enable the government to access all patient records and track treatment outcomes, says the director-general of health, Sandile Buthelezi.
NHI, meant to deliver universal health care, was recently signed into law by President Cyril Ramaphosa, but is expected to face litigation from several parties.
Buthelezi, who addressed a Board of Healthcare Funders conference in Cape Town recently, said the system would be linked to biometric identity systems at home affairs and monitor 55,000 health-care facilities. The system was tested during the pandemic.
“The digitised Covid vaccine system was a test of how we can use the private system and how it responded to the insured or uninsured. We can code where you came into the system and at what cost,” he told the conference.
The NHI still needed “a lot of work”, said Buthelezi. “It’s a long road and a phased approach as we go section by section and promulgate regulations.”
Buthelezi told the conference that the disparities in health care pained him. He said patients from Diepsloot had to go to Tembisa Hospital on the east rand, a distance of 30km, passing about four private hospitals.
He said the department was struggling to get more doctors employed as part of setting up NHI but worked in a highly litigious environment. “Every week there are new court papers on my desk.”
There was enough money to start the NHI, but it needed to be spent better. “Spending 13% of our GDP on health care when other comparable countries are doing better needs urgent addressing.”
Buthelezi listed an overhauled coding system, standardisation of data collection, capacity building to inform policy development and quality standards as among the key reforms required.
“The office of health-care standards compliance is critical in putting patient safety at the centre. We’re also working with the Special Investigating Unit and our lawyers are cleaning up in the litigation forum.”
Buthelezi said the private sector would be “critical in whatever we’re going to do. We will procure from both sectors.”
It’s a long road and a phased approach as we go section by section and promulgate regulations
— Sandile Buthelezi
He said during the Covid vaccination drive, connecting pharmacies to the digital network “almost cost me my job — but we had to save lives and it was a steep learning curve. In future we’ll have proper contracting systems.”
The Government Employee Medical Scheme had significant capability that would be of great use for the NHI, he said. “They have built capacity, but we must also bring in labour. We’ve signed a memorandum of understanding at the negotiating council to ensure this happens. We don’t want to lose any capability and skills.”
Mark Blecher, chief director for health & social development in the National Treasury, told the conference that low economic growth, lower than projected tax revenues and debt interest payments consuming 21% of revenue made it “difficult to move simultaneously with numerous large spending proposals”.
Debt interest was the second biggest expenditure, outstripping education, and health and any increase in tax needed to result in tangible benefits to taxpayers, he said.
There were other pressures in a limited fiscal space. Interest payments displaced R150bn in noninterest spending annually, while other top funding pressures were for mandatory social security, Eskom, health and NHI, public employment programmes, early childhood development, higher education, infrastructure backlogs, wage pressures and social grant shortfalls where coverage could exceed half South Africa’s population if uptake and allocations continued to grow.
Among the reasons NHI would take years to roll out, Blecher said, were the wide range of public sector reforms required in its early stages and the shifting of funds from provinces to NHI.
Other challenges included finding a way to form a common basic benefit package across public and private sector financing. Much medical scheme regulatory reform had been stalled for a decade or more, “waiting for an NHI”, he said.
Blecher questioned “whether we should not be more active as a country” in dealing with regulatory reform, given that it will still take several years to roll out NHI.
He said reimbursement would have to be reformed, with primary care playing a greater role in implementing recommendations of the health market inquiry that reviewed the private health-care market.
Short-term reforms that were “attractive to users” should be prioritised. These included identifying improved and more efficient care options.
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