Service delivery
• Care is provided through integrated practice units, leading to greater health outcomes as there is a more holistic approach to care • Care is value-oriented and the data is used to make evidence-based decisions about how to get the most value • Public and private providers are held to account based on value metrics, and they influence where purchasers will purchase from • Value performance metrics are made publicly available for both providers and purchasers • Primary care is the focus leading to higher primary care usage and lower hospitalisations than in other scenarios
Cost drivers
Differences in cost are driven by the following factors: • Largely the same cost drivers as the Power to the People scenario, with the additional ones listed below • Clear focus on value could reduce inclinations to push volume and lead to less wastage – Lower unnecessary volumes of care provided may mean lower overall costs • Continuous improvement in value monitoring may require additional research costs • Facilities need to be improved, but accreditation is no longer necessary as accountability is built into the system • Measurement reform – Tracking the cost and outcome information for each patient may require data-system related costs – Strong HIS system will be in place and there may be maintenance costs • Payment – Bundled payments per condition or user will limit unfruitful expenditure and possibly decrease costs • Delivery – Integrated practice units need to be maintained, which may have an administrative cost – The team integrations may lead to synergies and lower the costs of care • A population health perspective is taken, possibly leading to declining burdens of disease and therefore lower costs in the long run; – This could also accelerate the increase in life expectancy and lead to a greater proportion of the elderly – there is an uncertain overall impact on total cost
NHI as Described in the Bill: the policy proposal currently on the table Summary NHI is rolled out as proposed in the Bill. The Bill is silent on many details, such as the basic benefit package and how hospital services, for example, will be funded. This lack of detail in the implementation plan is assumed and built on in the financing model. The process is swift, medical schemes are closed as proposed in the Bill (quicker than in other scenarios) and the population is served by the new NHI Fund. Medical schemes are only allowed to fund health services not covered by the NHI Fund. The NHI Fund is the single purchaser. The Fund purchases from provincial and local departments as well as private providers. The quick implementation without a slow and gradual reform process to prepare the system for the changes that will follow leads to a less robust system
19 | TRADE-OFFS ON THE ROAD TO UHC: A QUANTITATIVE ASSESSMENT OF ALTERNATIVE PATHWAYS FOR SOUTH AFRICA
