Payment and integration pains diagnosed for NHI
zz Scheme will raise patients' expectationsJuly 30, 2010 Edition 1
SLINDILE KHANYILE
INTEGRATING the public and private health sectors in order to implement the proposed national health insurance (NHI) could be fraught with difficulties and might prove difficult in practice, according to a research report from Econex.
The report specifically looks at the challenges of combining the two systems, as would be required for uniform contracting in an NHI type system. The study says while primary healthcare will be strengthened due to the approach suggested by the model, it could also result in higher detection rates, thus increasing the number of secondary and tertiary care visits.
The report says the private sector currently provides mostly curative care while the primary health-care model is, by nature, more preventative. It says that while the nation will benefit from such an approach, the overall costs may not necessarily come down.
Mariné Erasmus, an economist at Econex, yesterday said the costs would rise in the short to medium term because the system would draw in more people, as the service would be free. She said the cost could decrease in the long term.
The report highlights the differences between the public and the private sectors, particularly in the way service is provided, and the different payment models. Currently, private doctors are mainly paid on a fee-for-service basis by medical aid schemes and are mostly not employed by the private hospitals. There are also a number of cash practices with patients paying out of pocket.
It is envisaged that under a proposed NHI system there will be no cash payments, as there will be no charges at the point of service.
"Doctors in the private and the public sector are not paid in the same way, how you incentivise doctors under the NHI will have to be addressed," said Erasmus. "At the moment, people with medical aid have a choice. They can walk into any doctor or specialist's room but, under the NHI, the chances of us walking into any (private or public) doctor's room are slim. It is quite impossible to give everyone free choice, you have to manage your choice."
Another challenge would be that of capacity because unrestricted access to any provider of choice, as suggested in the NHI proposal, appeared to be based on a widely held assumption that private providers were able to accommodate many more patients than they currently do. There are 122 000 hospital beds in South Africa.
"One hundred percent occupancy is neither practical nor possible. High occupancy rates (over 80 percent) place strain on the hospital support services, increase pressure on nursing procedures and patient care, increase the risk of adverse events and also present challenges for infection control," says the report.
The research says very few providers will contract with the NHI for anything less than what they are currently charging. It says some doctors and specialists may simply leave the country.
Norman Mabasa, the chairman of the SA Medical Association, said Econex's analysis was correct, but the issues were not insurmountable if the NHI was phased in slowly.
