The establishment of a Ministerial Advisory Committee on Health Technology Assessment (HTA) as proposed in the National Health Insurance (NHI Bill) now before parliament, will serve as a precursor to what will ultimately become an independent HTA agency.

“There is therefore clear intent in the legislation that HTA is not a once-off or temporary intervention for us to be able to create a benefit for NHI,” Dr Nicholas Crisp (above), Deputy Director-General NHI, told attendees during an ISPOR webinar late last week.

“This legislation is merely a starting point going forward as we know it’s going to be more and more complex and difficult to evaluate HTA,” Crisp acknowledged, explaining the need for a permanent structure initially for HTA capacity in the NHI fund itself and later in an agency on its own.*

“This agency and precursor must be able to ensure cost effective, allocative, productive and technical efficiency. That is what the Bill is requiring. Once we get beyond the first stepping stone, we will get more sophisticated legislation.”

The Deputy D-G went on to remind his audience that in terms of the Bill, the NHI fund must establish an Office of Health Products Procurement responsible for identifying all elements of the prescribed fund formulary that will be paid for in providing benefits.

The onus will then be on suppliers to deliver direct to accredited and contracted NHI providers: “The NHI will buy or own nothing. It is merely a financial vehicle to enable providers to purchase goods which will include the technical assessment of those goods,” said Crisp.

Providers, he reiterated, must then procure from suppliers at prices determined to deliver care to patients in terms of the benefits prescribed and claim from the fund. If the fund identifies providers using or trying to claim benefit for, for example, an HTA item not covered by the fund, the claim will be rejected.

“The bottom line,” he concluded,” HTA is not a flash in the pan for the future of health care in South Africa, but a major corner stone of ensuring that we have proper efficiencies and use the goods and services to the best of our abilities.”

*In its presentation to the Parliamentary Portfolio Committee on Health on the NHI Bill last month, the South African Medical Technology Industry Association (SAMED) made the following statement: “Medtech has a complex supply chain and many medtech suppliers are SMMEs that lack a national footprint. As a result, central procurement of medical technology poses significant disadvantages.”