COVID-19 has taught government valuable lessons in implementing the National Health Insurance.

This is according to National Department of Health consultant Dr Nicholas Crisp who was speaking to SAFM’s Stephen Grootes on Tuesday morning.

“What we’ve learnt during COVID-19 is that if we had one system where everyone was part of that system, and it had a logical structure, it would have been a lot easier to address the COVID-19 challenges that we face,” Crisp said.

“It’s one thing to sign a contract with a hospital but the hospitals are separate from the doctors and all the service providers who are independent practitioners and have arrangements with those hospitals to practice… so concluding those kind of arrangements have taught us a great deal about working together, the complexities of putting contracts together, how to price them and so on.
We’ve never really before had to find one kind of global tariff to deal with one kind of outcome. That is in a way what we want to do with diagnostic-related groups for outcomes in the future. This is a bit of a learning lesson…but it has taught us that we can do it.”

Asked about the levels of treatment South Africans will get under the NHI, Crisp said structural problems in our country’s healthcare system need to be fixed.
“The point about healthcare is that it’s not only about treatment. It’s about preventing people from getting to the point where they need treatment in the first place. That is part of the structural problem in our country that we want to fix with the NHI,” he said.

“When one gets to that point where you do need treatment, you want to get treatment at a place that is able to treat you, has quality of care, has competent clinicians, has all the necessary tools and consumables that are necessary to treat you. You don’t want to worry about whether you can or can’t afford to pay, whether they are going to exclude this or that.
What we have learnt is that there a huge number of resources in the private sector that could be more available and we’ve seen that now in the COVID-19 environment and can be made available if we structure the way we deliver services better.”

Crisp said COVID-19 allowed government to take decisive action fast.
“During COVID-19, we’ve used the opportunity to improve the physical environment by spending our budget on infrastructure in the places we need to, increasing the number of beds, providing oxygen and a whole lot of things that were problematic in hospitals had to be accelerated in a short space of time. We’ve also had to increase the amount of staff in hospitals. Some of the staffing is temporary because of the peak of the COVID-19 epidemic, but quite a lot of it is permanent. It has been possible to address some of the challenges that had been dragging around the registration of professionals. That has been extremely constructive,” he said.

“When we started with COVID-19, it was extremely erratic, it was very difficult to coordinate, the data systems didn’t talk to one another, it was very difficult to get information into a central point to understand where things were going wrong.
All of that has gotten systematically better using the resources of the National Health Insurance information system which has had a rapid acceleration in improvement and availability of real management dashboards.”

Concluding the interview, Crisp said he believes that COVID-19 has provided the platform for a “quite a significant kick-start” to the NHI.