Into to Health Systems Flashcards

Question

Ensuring the appropriate services are provided at an appropriate quality

Answer 1

The services axis depicts the quality health services they need across the major causes of ill health – including: -The unfinished agenda of the MDGs -Non-communicable diseases -Mental health -Injuries This is not solely treatment though UHC must also include prevention, promotion (personal and nonpersonal), rehabilitation and palliative services, and population-based interventions e.g. reduce tobacco consumption, alcohol harms etc

Answer 2

The multiplicity of funders in the private sector add an estimated 15% to the cost of the private sector (administrative costs) Access to quality health care services determined by race, gender, geographic location, SES. Two-tiered health system perpetuates inequality Only those with financial means / employer assisted health benefits have access to healthcare paid through medical aids A family with a household income of R20 000 per month will spend ~ R3800 on an average medical scheme package (excl. co-payments and levies) This is 19% of their disposable income Medical scheme premiums increasing above inflation, this proportion of income is likely to rise At least ¼ of population pays for private health care services out of pocket. Even those with medical schemes often pay additional out-of-pocket payments through co-payments or when benefits have run out

Answer 3

revenue collection: SARS distribution of funds: treasury purchasing and provision of services: Provinces, local government

Answer 4

- Disincentives to efficiency and cost-saving. -Multiple purchasers = drives up prices. -No clear package of services which the public can expect.

Answer 5

Proposed SA Health care financing model to achieve Universal Health Coverage (UHC) -Financing tool to fund health services for all South Africans -Single national fund, huge purchasing power to negotiate fair and affordable payments with healthcare providers -Financial protection in costing of healthcare

Answer 6

Publicly Administered (loosely likened to one big medical scheme for all) Mandatory Prepayment (primarily through tax) NHI fund is a Single Purchaser of defined comprehensive health services f

Answer 7

revenue collection: -Raises revenue for the health system (Tax) -Relates to fund sources, funding structures and the means by which funds are collected. pooling of funds -Accumulation & Management of revenue (Single Fund NHI Fund) -Risk for healthcare borne by all members purchasing of services -Transfer of pooled resources to health service providers by NHI Fund -Provision of appropriate and efficient services for the population DOH

Answer 8

1st phase (initiated in 2018): legislative framework / refining clinical protocols and treatment guidelines / reimbursement strategies / accreditation processes. 2nd Phase: Implementation of NHI fund with governance structures. Shifting & mobilizing revenue, expanding contracting of services from Private GP and rehab services and Private and Public Hospitals, continuing certification and accreditation. 3rd Phase: Expanding certification and Accreditation to all the remaining private and public hospitals and introduction of mandatory prepayment based on ability to pay.

Answer 9

1.National Treasury will determine the sources of funding for NHI and be approved by Cabinet. Treasury will also determine when any dedicated NHI contributions are introduced or changed in line with the fiscal and economic environment. 2. NHI will be funded through a mandatory pre-payment system and other forms of taxes collected by SARS and allocated to the Fund by Parliament. 3. Based on the NHI Bill, NHI will be predominantly funded through general revenue allocations, supplemented by: (1) a payroll tax payable by employers and employees and (2) a surcharge on individuals' taxable income. 4. The financial impact of the NHI taxation system must not create an increased burden on households compared to the current system. There will be no option for opting out of NHI for eligible people. 5. Out-of-pocket payments such as co-payments and user fees will not be used to generate additional funding for comprehensive health care services to be covered under NHI. This ensures that healthcare services are delivered free of charge at the point of service and that the most vulnerable are not denied access.

Answer 10

1. Private health care providers will continue to operate privately under the NHI dispensation. Contrary to some public narrative, the NHI is not going to abolish or do away with private health providers. 2. NHI will not allow health care providers to set their own fees for NHI funded benefits. The Fund will set the fees that it will pay to private doctors, hospitals and others on your behalf. 3. Private General Practitioners will be a part of multi-disciplinary networks in their communities and will be paid by the NHI Fund using a capitation model. 4. The private health sector providers will benefit from the opportunity to contract with NHI to provide health services to the broader public, rather than the small proportion for which they currently provide services. They will be able to provide services to patients throughout the year not worried about depletion of funds of patients at any stage. 5. Private hospitals will see patients referred by primary health care providers in both public and private sectors and the NHI Fund will settle the bill at the prescribed rates.

Answer 11

1. Every health care provider may be contracted by the NHI Fund. This will be initiated by the provider and once the provider meets the accreditation requirements they will be contracted. There will be no tenders for services. 2. Every health care provider (public and private) must be certified by the Office of Health Standards Compliance. 3. It will take some time for all health care providers to obtain certification, so the law makes provision for a transitional period of conditional accreditation by the Fund. The tools for health care provider compliance have been developed but NHI Fund accreditation and contracting requirements are still being developed. 4. The health care provider must agree to, and comply with, the requirements of the NHI Fund to be accredited and contracted with the Fund. This includes connection to the Fund digital systems and reporting. 5. A primary health care provider will be assigned a designated population that will be under their care and will be paid on a capitation basis. The details are being developed and will include a performance-based portion

Answer 12

Not at all. Contracting with NHI Fund gives the health care provider opportunity to offer health care services to a designated population (significantly more patients than currently). The provider will not have to worry about the patients’ affordability as the Fund would have paid a capitation fee for the designated population. Patients who consult with providers who are not contracted with NHI will pay cash for the providers’ services. Patients will only be able to use their medical schemes to pay for benefits not covered by the Fund with non-NHI contracted providers.

Answer 13

1. The Fund will have a Board and various governance structures as required by the PFMA and King IV that will have the responsibility of ensuring that there are institutionalised systems, policies and procedures that proactively prevent, detect, investigate and correct incidents/acts of fraud and corruption. 2. The Fund is required by law to establish and operate units that focus on fraud prevention, detection, investigation and correction of fraud and corruption. 3. All employees of the NHI Fund will be responsible for preventing and detecting fraud in the execution of their assigned roles and responsibilities. 4. The department, in collaboration with the Health Sector Anti-Corruption Forum (HSACF) and the Special Investigating Unit (SIU), is currently engaged in a process of risk identification, analysis and mitigation of all fraud and corruption risks that may affect the Fund. 5. Control measures and mitigating strategies are currently being implemented in the design and development process of the NHI Fund. 6. The public will have opportunity to anonymously report corrupt activities to law enforcement agencies and the HSACF which has been established by the President. 7. The design of the NHI is far less complicated than the present myriad of departments and medical schemes. Everything that the fund does, all the contracts with providers and suppliers, and the common set of funded benefits, will be fully transparent. Since every person will be entitled to the same benefits and treated the same way, there is far less incentive for fraud and corruption.

Answer 14

Law is a system of rules, usually enforced through a set of institutions to regulate human conduct.

Answer 15

Parliament is the national legislature (law-making body) of South Africa. As such, one of its major functions is to pass new laws, to amend existing laws, and to repeal or abolish (cancel) old laws. This function is guided by the Constitution of South Africa, which governs and applies to all law and conduct within South Africa.

Answer 16

Both Houses of Parliament, the National Assembly (NA) and the National Council of Provinces (NCOP), play a role in the process of making laws.

Answer 17

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