NHI to have built-in fraud detection

2010-10-18 07:40

The ANC’s national health insurance (NHI) task team chairperson, Olive Shisana, said government will hire people to monitor fraud in the functioning of the mooted ­public health scheme to prevent its abuse.

The implementation of the NHI, which was unveiled in ANC documents at the ­ruling party’s National General Council late last month, will be phased in over 14 years, starting in 2012. The scheme is ­expected to have initial funding of R128?billion per year, which will increase to R376?billion per year once it is running at full steam in 2025.

The public health budget is currently R101?billion, and is projected to grow to R117?billion in the 2012/13 financial year.

This means the NHI would need an extra R11?billion per year after it becomes operational. The discussion paper said the reason for introducing the NHI was to get those with means to subsidise those without means. ­Contributions will depend on an individual’s income, while access to services will depend on the need for healthcare. The NHI is also one of government’s ­10 public health priorities.

Shisana told a conference of the SA ­Medical Association (Sama) on Friday that work on a “risk engine” had begun.

“Let us accept that any time you have a fund like this you’ll have fraud. It’s already happening with medical aids,” she said.

According to Shisana, it was important to monitor transactions as they happened in ­order to prevent fraud. “In that way you don’t wait for problems to happen. You act as and when they ­happen,” she said.

The state would have to finance the ­R11?billion shortfall, she said. “It may be that the economy will grow or there could be other sources. If at all there will be a tax levied, its timing will be in the legislation and will be announced by government.”

But critics have questioned the accuracy of the cost of the scheme in the ANC ­document. Both DA shadow health minister Mike ­Waters and Cape Town-based economist Alex van der Heever have cast doubt on whether the costs of administering the NHI could be capped at 2.8%, as the ANC document suggests.

Van der Heever said the scheme was likely to cost about R18?billion to run per year by 2017 – as opposed to the ANC’s projection of about R6.4?billion in the same period.

He based his forecast on the cost of ­managing the SA Social Security Agency.

A report on alternative healthcare ­reforms, released by Di McIntyre of the ­University of Cape Town’s Health ­Economics Unit, projected that healthcare could become cheaper over the next 15 years in an ­NHI-type scenario.

The report modelled a status quo option; mandatory medical aid for all employees and universal cover. Under the status quo expenditure would grow to 9.5% of Gross Domestic Product (GDP), while medical scheme would come to about 13% of GDP.

Healthcare expenditure could increase from 8% of national gross domestic product (GDP) to 8.6% under universal cover.

“This means the resource requirements for universal coverage will grow in line with GDP growth,” the report said, which is cheaper than the other two options.

Speaking to City Press earlier, Sama chair Norman Mabasa said while his ­organisation supported the NHI, its ­effectiveness depended on the existence of adequate homegrown health professionals.

“You must train and rely on your own ­people. If you can’t, wait until you have enough,” he said.

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