The power, the purse strings and the NHI | News | Health | M&G

The National Health Insurance Bill proposes major shifts in who controls our national and provincial health budgets. Will the draft legislation rob provinces of traditional control, or will it open up new and more effective ways of making sure money goes where it’s needed most?

These equations are meant to ensure that money is allocated fairly across provinces and South Africa’s 278 municipalities. But there are no similar mechanisms to guide resource allocations at the provincial level — once provinces receive their share, they can decide themselves how that money is distributed.

The concept essentially ensures that the provider of health services and buyer thereof are not the same organisation, as is currently the case — on which the NHI reforms are based. In a purchaser-provider split, the purchasers of healthcare services — in this case, the NHI Fund — are organisationally different from those who provide the care and who are often contracted by the purchaser.

The NHI Bill also proposes that health facilities are given much more control over their income and budgets by paying them directly for their services. But, there’s an important omission in the 2019 iteration of the Bill: How will these contracting units be funded? The 2018 version of the Bill proposed that funds should be allocated to contracting units through risk-adjusted capitation – this means that budgets would be calculated based on the actual health needs of the overall population that is covered.

If we set aside just for a moment what drives this and the lack of any kind of community mental health response to levels of post-traumatic stress experienced by such communities, this is an obvious case of significant system failure. By localising health planning— and budgets — we can better generate data about an area’s health needs that can be used to design broader, more appropriate health responses.

Source: Healthcare Press (healthcarepress.net)

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