The issue of corruption looms large over the new National Health Insurance (NHI) and it is important that a high standard of care is held at every hospital across the country, says social policy special advisor to the president, Dr Olive Shisana, who presented to parliament’s portfolio committee on health last week.

Shisana said that the NHI would see the introduction of a national quality system improvement programme which will formally set out the standards for each facility.

“This programme will improve every single facility so that it is at a standard that had been accepted internationally before it could be labelled NHI-ready,” she said.

“The Department of Health also has to improve all facilities to reach this level – even if it’s in a rural area.”

“In this way it is almost like a McDonald’s – where one knows what one wants and what one is getting. You know the size of it, you know the price, and you know that the people who are going to be delivering it have been trained to do so.”

Medical aid claims

Shisana said that there also appears to be confusion about how claims will work under the NHI, compared to how they currently work with medical schemes.

Under the current medical aid system, people submit detailed claims which are then dealt with separately by the medical aid.

Under the NHI, doctors will submit one claim for all patients for a month, give the diagnosis for each patient and the total cost, she said.

In this way the administration will not be inundated with claims and the process will be greatly simplified.

She added that the National treasury had brought in a specialist from another country – that had been running an NHI for 30 years – to show how it should be done.

This means that South Africa will not be re-inventing the wheel, she said.

Read: Special advisor to the president answers 6 burning questions about the new NHI in South Africa