Cochlear implants and the NHI: Dani Schlesinger Chris Hani Baragwanath Academic Hospital Cochlear Implant Programme READY OR NOT…. NHI IS COMING The background National Rehab Task Team Meeting 2013 Query - Will CIs will be covered by NHI? Response – They have not been given consideration Taken to National ST&A Forum Suggestion - Prepare a motivation to submit to National Rehab Directorate Goal - Get CIs incorporated into rehab plan, allowing them to be considered in NHI planning and costing Request for SACIG to look at this What will NHI mean? What will NHI mean? The NHI promises to… ‘ensure that everyone has access to appropriate, efficient and quality health services…This will entail major changes in the service delivery structures, administrative and management systems’ (Government Gazette, 2011) Implementation of NHI will require Transformation of the healthcare financing model Better regulation of healthcare pricing Improvement in quality of healthcare Strengthening of the planning, information management, service provision Overhauling of management systems (Government Gazette, 2011) Public vs Private sector 8.3% of GDP spent on health Private sector Public sector 4.1% of GDP 4.2% of GDP 8.2 million people 42 million people Fragmented, underresourced Unsustainable for schemes Impoverishing healthcare costs NHI intends to ensure that everyone has access to a defined comprehensive package of healthcare services via accredited and contracted public and private providers (National Treasury: Intergovernmental Fiscal Review, 2011) Objectives of NHI Provide improved access to quality health services for all South Africans To pool risks and funds for equity and social solidarity To procure services on behalf of the entire population and efficiently mobilize and control key financial resources To strengthen the under-resourced and strained public sector so as to improve health systems performance Why this matters to SACIG Impact on all sectors ◦ Public CI programmes may be funded by NHI ◦ Private CI programmes may See a reduction in medical aid patients Select to be contracted to provide services to NHI The possibility of future universal screening ◦ Increased numbers referred for diagnosis, CI assessment and intervention Need to give input into standards for protocols, minimum standards and financial requirements Costing ◦ Realigning budgets ◦ Costs of services and costs to patient Principles of NHI Principles of NHI Application to CI The right to access • CI as standard of care • Hearing as a human right Social solidarity • Cross-subsidisation Effectiveness • CI as an evidence-based intervention • Positive health outcomes Appropriateness • Adoption of new and innovative health service delivery models • Responsive to local needs • Who should be a candidate in NHI? • Local access? • Distance support / telehealth Equity • Those with greatest need; timely access Affordability • Commodity vs public good • Cost effectiveness • Repairs, upgrades, consumables, school Efficiency • Clear criteria, protocols & team function • Referral systems • Tender process; value for money Quadruple Burden of Disease 1. HIV/AIDS and TB SA - 0.7% of world population but 17% of HIV-infected 23 times the global average prevalence TB infection rate is among the highest in the world TB and HIV/AIDS co-infection rate is 73% 2. Maternal, infant and child mortality 3. Non-communicable diseases 4. Injury and violence (Lancet Report, Coovadia et al, 2009) Relevance: Rationale – Right to access hearing for those affected Logistical - Dramatic increase in candidates Strategic – Align services with HIV/ TB packages of care Dimensions to consider The 3 Dimensions of Universal Coverage ◦ Considerations for Cis Population Coverage What numbers would Refers to the proportion of the population that we hypothesise? has access to needed health services Service Coverage It refers to the extent to which a range of services necessary to address health needs of the entire population are covered What is the package of services required? SACIG guidelines? Financial Risk Protection It refers to the extent to which the population is protected from catastrophic health expenditure Catastrohpic costs Impact of HL & CIs FM systems Consumables Schooling (WHO, 2010) Benefit packages Must be ‘fair and rational’ Defines services considered as achievable for SA commensurate with its resources Different levels of care within public sector Propose how to reduce barriers to access Demonstrate health system performance Norms and standards of care Cost-efficiency according to international benchmarking from countries of similar economic development that have successfully implemented such processes Comprehensive evidence-based packages of care for each level of service delivery Accreditation Office of Health Standards Compliance ◦ Inspection ◦ Norms and standards ◦ Office of the ombudsperson All health establishments (public and private) to meet standards of quality Adherence to referral procedures Accreditation standards specify minimum range of services to be provided at different levels of care Reimbursement Initial phase - global budgets Gradual migration towards diagnosis related groups (DRGs) with a strong emphasis on performance management Preparation for contracting with private providers Medical schemes will coexist ◦ No more tax subsidies Information required going forward ◦ Incidence of severeprofound SNHL ◦ Impact of hearing loss ◦ Candidacy criteria and protocols ◦ Norms and standards for CI programmes ◦ Minimum range of services ◦ Referral pathways ◦ Cost:benefit for pts ◦ Population size – Entire EHDI pathway ◦ Human resources ◦ Additional elements – early intervention, FM systems (educ. support?) ◦ Costing - to NHI; procurement of devices ◦ Relation to HIV and TB burden of disease End product? Proposal to combine CI document with HPCSA task team outputs: ◦ EHDI ◦ School-based hearing screening ◦ Ototoxicity Integrated package of care for individuals with hearing loss within NHI
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