Dr Nicholas Crisp (left) with IHPs Oscar de Weijer (centre) and Dr Hlombe Makuluma

Practitioners
will be paid in real time, no real need for a Certificate of Need, and services
will have to push ahead without a patient records system in place for the time
being, more than 50 Pretoria doctors were told in an NHI Forum discussion convened
by the Institute for Health Professional in Tshwane last Wednesday.

Discussing
many of the practical issues facing basic systems development in the implementation
of the proposed insurance fund, Dr Nicholas Crisp, Department of
Health-appointed NHI administration and operations consultant, stressed that
getting rid of all the inefficiencies prevalent in both the public and private
sectors had to be prioritised for the health reforms to succeed: “Many of
these, such as over-servicing, anti-competitive behaviour, poor and
undocumented health care outcomes, transfer of costs and poor accountability,
were clearly identified in the Health Market Inquiry report on private
healthcare costs but I have no doubt also apply in the public sector.

“What
I have to remind you is that, contrary to what many still believe,” Crisp
continued, “NHI is not a health system. It’s purely and simply a funding
mechanism.” It was the department’s role, he intimated, to create efficiencies
in healthcare services delivery to be funded accordingly in line with the NHI benefit
designs.

One
of the cases in point prompted by a question from the floor was the matter of
practitioners “being paid on time”. Responding, Crisp explained that the system
has been designed in such a way that all practitioners have to register the
services they offer, are accredited accordingly, will be provided with a
benefit code which will in turn be recognised by NHI immediately on claim
submission “and the practitioner will therefore be paid in real time”.

Obviously,
he warned, this won’t happen if a practitioner claims for a service for which
he or she is not accredited.

On
the issue of the Certificate of Need as proposed in the 2003 National Health
Act, Crisp felt implementing this – certainly in the earlier stages of the fund
coverage – wouldn’t be necessary. He intimated that where doctors chose to
practice and what services they chose to provide would determine their
remuneration in terms of their NHI accreditation: “Providing this service at
that place and going to be paid this,” he noted, would prompt decisions as to
where people will want to practice.

Probably
the biggest challenge facing all involved in healthcare services is that of
patient records: “It’s actually a nightmare,” Crisp acknowledged, reminding his
audience that South Africa has had nine separate provincial health departments
with what amounted to 47 different record systems!

“This
is a serious problem and extremely difficult to sort out particularly for NHI. But
it is not an NHI problem, it’s a Department of Health problem.”

He
concluded that the state had to press ahead with NHI without a national patient
records system: “If we had to wait for that, we’d never get going,” he said.