Cost drivers
Differences in cost are driven by the following factors: • Data and information systems improvement: – Requires technical maintenance costs and teams to monitor and improve the system which adds to the cost – The need to train relevant staff to use the systems may have cost implications – Data supports better strategic purchasing and therefore supports value (better outcomes/less cost) – PERSAL system improves HR management process and leads to more efficient staffing – Patient records help target resources and reduce LTFU, reducing the long-term cost of care – Linking patient-level data (for example, DHIS2) to outcomes may lead to better outcomes-based financing and value measurement ○ Creating a public domain where data is available to citizens, clients, researchers and more may improve accountability • Improved healthcare quality: – Certification of facilities may lead to greater maintenance costs and frequent assessment costs – Setting up structures to publicly share information gathered from quality assessments may have cost implications – Funds may be more easily directed towards providers who are better/more efficient, leading to overall greater system efficiency – Health outcomes data is linked to the facility to promote the continuous prioritisation of quality, as opposed to only meeting the minimum requirements for certification • Improved budget processes: – Transparent budgeting leads to more accountability and less misuse of funds or corruption – Transparent budgeting helps with resource allocation – leading to greater efficiency – The system to publicise budgets may require maintenance costs – A greater budgeting skillset and/or time allocation may be needed for more agile budgeting, which may have a cost implication • Lack of competition in the purchaser space may result in sluggishness and sub-optimal performance – costs may then not be as low as possible • Likely working on a more constrained budget compared to other scenarios, since none of the private sector expenditure is captured by the public sector, unless mechanisms are put in place to meaningfully increase revenue
NHI Rejigged: NHI, but sequenced differently Summary NHI is eventually implemented as envisaged in the NHI Bill, but it occurs more gradually. Medical schemes are phased out and the public sector serves the entire population through the NHI Fund. While still relevant, the private sector is regulated, largely in line with the main recommendations of the Competition Commission’s Health Market Inquiry 17. The public sector is improved as outlined in Status Quo Gold Standard and develops the capacity to contract from private providers. The process to achieve NHI is incremental and by the
TRADE-OFFS ON THE ROAD TO UHC: A QUANTITATIVE ASSESSMENT OF ALTERNATIVE PATHWAYS FOR SOUTH AFRICA | 14
