Professor Crisp outlined the challenges and advancements in the NHI system during a recent webinar.
Image: IOL/ RON AI
Professor Nicholas Crisp, Deputy Director-General for National Health Insurance (NHI), said that considerable advancements had been made, including the registration of millions of individuals, the development of digital systems, and enhanced focus on risk identification and fraud management, among others.
Crisp was speaking during the Human Sciences Research Council’s (HSRC) webinar on NHI and Universal Health Coverage (UHC) on Tuesday.
Crisp said that over the past period, since the end of Covid, the National Department of Health has been building the technical administrative capabilities to administer the fund.
“That means that we have to be able to register every user, 63 million people. We’ve got about 35 million registered at the moment. That registration has to be linked to the Department of Home Affairs, into the population register, and has to be verifiable every single time a person makes contact with a healthcare provider,” Crisp said.
He said that the second area is around the accreditation of providers.
“The fund needs to make sure that if it’s paying public money, it’s paying it to a provider that actually exists, that does what they say they’re going to do, and that contracts with the fund to deliver a certain amount of benefits and the quality of those benefits,” Crisp explained.
He said registration, either as an establishment (the building/service location) or as individual providers registered with professional councils, must be verifiable and contractual.
“Building that capability has kept us busy.”
Crisp explained that the fund will also manage major procurement for all formulary items. To establish a formulary, benefits must be introduced. Initially, these benefits will be limited, focusing solely on the primary healthcare sector, but they will be systematically expanded over time.
“We’ve been working on that quite intensely.”
The Deputy Director-General said they have been working on supporting digital systems, including the health patient registration system and the common electronic medical record, which starts its national rollout in April.
“We also have interoperability with all the hospital systems and other systems that are used predominantly in the private sector, but also in the public sector, and a number of other digital systems that will make it seamless for the provider when they’re looking after a patient,” Crisp said.
Crisp also said they have been working on risk identification and fraud management. He said that any system, including the current system, is open to fraud.
“The design of the NHI removes the bulk of those perverse incentives and reduces the capabilities for fraud. But as you know, fraud and corruption are relatively easy, and people have become masters at that.
“We have spent a lot of time, particularly in the past year, identifying within the systems where people will try to corrupt or defraud the system. Primarily in the payments space, which is our responsibility, but also in the provider space, so that we can monitor that and either prevent them outright or be able to flag when there’s behaviour that is out of pattern,” Crisp said.
However, Crisp has spent significant time defending them in court, citing about 15 cases, including ones in the Constitutional and High Courts.
He said the government agreed last week to halt implementation of the first proclamation until a Constitutional Court review regarding public participation challenges is decided. This is expected in October or November, following May’s hearing. The department will then address other High Court challenges.
A major concern raised in court papers regarding private sector costs is professional indemnity insurance.
thobeka.ngema@inl.co.za