Abstract
The National Department of Health aims to provide good quality healthcare to all citizens and especially those who cannot afford proper healthcare through the implementation of the National Health Insurance (NHI). This will be done by pooling funds to establish a social solidarity fund for all citizens in need of healthcare regardless of their socio-economic status. The South African healthcare sector currently makes use of skewed healthcare financing systems, which makes it difficult to have a convergent healthcare scheme such as the NHI. Therefore, it is proposed that for the implementation of the NHI in South Africa, a new healthcare financing system, is developed based on artificial intelligence (AI) and blockchain algorithms with embedded deep learning capabilities. It is anticipated that the proposed healthcare financing system will help build resilience in South Africa's healthcare financing system.
TopOverview Of The South Africa’S Healthcare Financing System
Healthcare financing system is the basis upon which health insurance is provided with adequate management of financial resources. In South Africa, due to most of the healthcare funding coming from the private sector, many medical schemes offer health insurance that is mainly accessible to only the higher income group earners in the country. This leaves the lower-income group within South Africa exposed to poor quality of healthcare due to limited access to the necessary healthcare funding, which is normally provided by the medical schemes. This is because the lower-income group cannot afford health insurance premiums offered by current medical schemes. Therefore, South Africa’s skewed healthcare financing systems need to be revised to allow lower-income families in the country access to proper health insurance, that provides a good standard of quality healthcare. Health insurances can be made accessible to lower-income families if the health financing systems are adjusted, so that resources are distributed more evenly throughout the country (Department of Health, 2017; Department of Planning, 2017).
Providing health insurance to all South Africans requires medical schemes in the private sector to become deprivatized to work towards a universal healthcare system for all. The two-tiered South Africa’s healthcare system (private and public healthcare) will need to become cohesive to achieve the NHI implementation effectively; as well as more community healthcare workers need to be in place to serve the lower-income group of the population (Department of Health, 2019). According to Smith (2016), South Africa’s private health insurance sector spends the most financial resources on healthcare in the world amounting to 44% of the total expenditure of health financing in the country. The public healthcare financing systems are of poor quality which could be caused by inefficient use and misdistribution of funds and resources within the sector (Manyazewal, 2017).
Key Terms in this Chapter
National Health Insurance (NHI): The NHI serves as a basis for providing standardized equitable, affordable, accessible, and quality-based healthcare to all citizens of the country regardless of their socio-economic status by unifying the two-tiered healthcare system (public and private) within the country.
Healthcare: This refers to the healthcare industry as a whole, including all technical implications on a broad scale.
Electronic Medical Record (EMR): EMRs can be described as patient’s portfolios in which they describe a patient’s medical history, prognosis, and diagnosis. These records are extremely confidential as they incorporate each individual patient’s personal details which if stolen, can be used to facilitate fraud or impersonation.
Health Data: Patient’s medical data such as diagnosis from the information make-up of a health system. Therefore, health data implies any and all information pertaining to an individual’s medical history, records, and other personal information.
Data Security: Data such as patient’s medical records possess confidential information and thus requires protection in form of system security to ensure that only authorized personnel (such as doctors) may be granted access to such information.
Blockchain: Blockchain is a distributed ledger technology which promotes data transparency, validity, security, and accessibility by storing network information within individual nodes across the network.
Data Transparency: All transactions/processes need to be clearly visible within a healthcare system so that in the event of malpractice, all actions can be traced back to the source and held accountable thereof. Data transparency refers to having the ability to access all the transactions and/or processes that are conducted across the network to ensure proper management of the healthcare system.
Healthcare Financing Systems: The basis upon which healthcare systems are operated is based on the healthcare financing systems that are utilized. An efficient, reliable healthcare financing system drives the facilitation of good healthcare service delivery and fundamentally eliminates or reduces many risks currently faced in the industry such as corruption.