Doctors and hospitals won't be able to charge what they like under NHI
Health workers, nurses, doctors, dentists, specialists, physiotherapists, paramedics and hospitals will be subject to price control and guidelines if the NHI bill is passed.
Theses prices will be set by a pricing committee.
TimesLIVE has had sight of the bill, which health minister Zweli Mkhize is releasing publicly on Thursday. It has been sent to parliament.
The NHI aims to provide high-quality free healthcare to all and will only pay hospitals, doctors and other staff who provide quality service and meet standards.
The NHI Fund can refuse to work with doctors and hospitals that do not adhere to a "national pricing regimen".
The bill states the fund can refuse to work with establishments or workers that:
- Have failed to or are unable to adhere to treatment protocol and guidelines;
- Fail to adhere to national pricing regimen for services delivered; or
- Deliver services that are not acceptable to the fund.
Various committees and teams, with medical professors, will decide what protocols doctors can follow, what treatments they can administer and what lists of drugs and technology can be used.
Health workers and hospitals will have to be accredited and meet quality standards every year to be paid by the NHI Fund.
Medical aids will not exist as we know them. They will only be allowed to pay for services not paid for by the fund when NHI is in full force.
More than 10 different acts need to be amended to allow the bill to be passed.
The bill also gives the minister and provincial MECs huge powers.
They can make regulations on:
- All the medical practices and procedures followed by health workers (which include doctors, nurses, dentists, dieticians, and so on) and hospitals or clinics paid for by the fund;
- The relationship between medical aids, insurance policies and the fund;
- The development of the formulary of approved treatments and medicines;
- The monitoring of the fund;
- Fees payable to the fund;
- The levels of reserves kept in the fund for stability;
- How the extra NHI funds must be invested;
- How doctors and hospitals bill/invoice the fund, and what medical codes they use on invoices;
- How the state buys private health services from private hospitals and private doctors' practices;
- How doctors, therapists, health workers and hospitals are paid;
- The accreditation of doctors, hospitals and health workers, like optometrists and speech therapists, by the Office of Health Standards Compliance;
- The budget of the fund;
- The information that must be provided to the fund by the national database and by doctors and hospitals; and
- The registration of every user (every citizen and legal immigrant) of the fund.
The bill will be debated in parliament after its public release.