BETTER TOGETHER
how collaboration can fast-track alternative reimbursement AUTHORS Kelly Chennells Shivani Ranchod Anja Smith
PEER REVIEWER: Graham Hukins
EXECUTIVE SUMMARY The need for alternative reimbursement approaches in South Africa has become increasingly urgent in the face of rising healthcare costs, linked to increases in utilisation in the private sector, and insufficient access to quality care in the public sector. The draft National Health Insurance (NHI) Bill raises the possibility of alternative reimbursement methods in a universal healthcare system: capitation for primary healthcare (PHC) and reimbursement based on diagnostic-related groups (DRGs) for hospital-based care. The NHI Bill also alludes to payment based on quality of care, pointing towards value-based contracting (VBC). In this paper, we provide context on the slow adoption of alternative methods of reimbursement in South Africa and consider the ways in which adoption could be accelerated through collaboration. The main impediments to widespread adoption of alternative reimbursement approaches, with nuances across both sectors, include the lack of consolidated patient-level cost and quality data, the lack of agreed-upon metrics, insufficient technical expertise, behavioural and organisational impediments and the costs of reorganisation. We argue that coordinated collaboration can be used to overcome all these impediments – and in some respects, it is near impossible to meaningfully achieve the objectives without a substantial reorientation of funding flows. Concerted collaborative efforts require trust, engagement and communication, as well as a supportive regulatory structure. This applies both within and across the public and private sectors in the South African health system. The impetus for change may come through policy reform, through innovation and disruption of existing market structures and/or through the concerted efforts of non-commercial industry bodies.
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2 0 2 0 SOU T H ERN AFRICAN H E A LT H JO UR N A L P U B L I S H E D B Y T H E B O A R D O F H E A LT H C A R E F U N D E R S
