Strategies to Save Healthcare Costs and Reduce Hospital Overuse under the National Health Insurance in South Africa

Introduction

Addressing healthcare challenges: saving costs & reducing overuse of hospitals

As South Africa gears up for the implementation of the National Health Insurance (NHI), it is important to devise effective strategies that tackle the rising costs of healthcare and address the overuse of hospitals. By prioritising preventive measures, implementing efficient screening processes in conjunction with the Community Health Workers (CHWs), emphasising the use of Primary Healthcare (PHC) as the first point of entry in healthcare, and integrating telemedicine services, the healthcare system can achieve long-term sustainability and enhanced accessibility for all citizens.

The need for a culture shift

Transforming healthcare to shift from curative to proactive, preventive care

To overcome the challenges faced by the healthcare system, a cultural transformation is necessary. Communities must adopt a proactive approach to healthcare, transitioning from a curative and reactive treatment seeking behaviours to a more preventive approach for early interventions. This change in mind-set can result in improved health outcomes, reduced burden on hospitals, and significant cost savings.

With the NHI in force, this will mean that although access to both public and private health facilities will improve, for all citizens, facilities will not be overwhelmed with demand that exceeds supply. 

Efforts should be focused on educating communities about the importance of leading a healthy lifestyle, engaging in regular exercise, maintaining balanced diets, and receiving timely immunisations. By emphasising preventive measures such as regular health check-ups and screenings, the occurrence of chronic diseases can be reduced, resulting in fewer hospitalisations and overall cost savings.

The role of Community Health Workers (CHWs) in managing healthcare costs

The NHI must leverage innovative cost-containment approaches such as the use of CHWs in the delivery of healthcare services at the grassroots level. The CHWs are dedicated individuals trained to provide essential healthcare, offer health education, and extend support within their communities.

By involving CHWs in screening programs, such as conducting blood pressure checks, diabetes screenings, and other preventive measures, early detection of health issues can be achieved. This proactive approach helps identify potential health risks promptly, offering an opportunity for timely interventions and reducing the need for hospitalisation.

Learning from the Role of CHWs in Brazil

Brazil successfully implemented a robust Community Health Worker program that has demonstrated positive outcomes in healthcare delivery. CHWs in Brazil are community members who are trained and employed to provide healthcare services within their communities. They play a crucial role in health promotion, disease prevention, and early intervention. 

Through an intervention named Family Health Strategy, Brazil was able to deploy CHW covering 63% of the population and providing  systems support by serving as a link between healthcare providers and households. This innovative approach helped to address the health-seeking behaviour of patients by providing home-based, early support for minor health issues leading to a reduction in hospitalisation rates and thus reducing the cost burden in the healthcare system. 

Other notable achievements from the CHWs program in Brazil include:

Improved access to healthcare

CHWs serve as a link between the community and healthcare facilities, ensuring that healthcare services reach those who need them the most. They facilitate the identification of health risks, provide health education, and encourage timely healthcare seeking.

Empowerment of communities

CHWs empower communities by equipping them with knowledge and skills to effectively manage their health. They engage in community-based health education campaigns, addressing specific health concerns and promoting healthy behaviours.

Enhanced Disease Surveillance

CHWs can actively participate in disease surveillance activities, such as monitoring outbreaks, identifying potential health threats, and facilitating timely interventions. Their close connection with the community enables them to detect health issues early and prevent their escalation.

Strengthened Primary Healthcare

CHWs play a pivotal role in strengthening primary healthcare services. They assist in routine check-ups, immunisations, family planning, and maternal and child health services. By providing these services at the community level, they reduce the burden on hospitals and improve healthcare efficiency.

South Africa, in preparing for the NHI, can draw valuable lessons from this experience and adapt similar strategies to maximise the impact of CHWs in the local context.

Encouraging PHC use as an effective cost-containment strategy

Another cost-saving intervention could be through encouraging individuals to prioritise PHC consultations before resorting to hospital visits. This is an effective, proven strategy to reduce healthcare costs and minimise hospital overuse.

The PHC ecosystem within the NHI will be clinics, community health centres (CHCs) and networks of General Practitioners (private and public) accredited with the NHI Fund.

These facilities are well-equipped to handle common illnesses, minor injuries, and routine healthcare needs. Where necessary, the NHI will fund the referral of patients through referral pathways to higher levels of care such as regional, provincial and tertiary hospitals depending on need. 

By promoting PHC consultations as the initial point of contact, unnecessary hospital visits will be minimised, thereby relieving the burden on hospitals and reducing overall healthcare costs under the NHI.

The role of telemedicine in revolutionising healthcare access and reducing hospital visits

Telemedicine involves the use of technology to provide remote healthcare services. It offers a promising solution to enhance healthcare access while minimising hospital visits. By integrating telemedicine platforms with the support of CHWs, individuals can consult healthcare professionals remotely, receive medical advice, and access necessary prescriptions without physically visiting healthcare facilities. 

This approach is particularly advantageous for individuals in remote areas or those with limited mobility. Telemedicine not only reduces the strain on hospitals but also enhances convenience and accessibility for patients, leading to improved healthcare outcomes and cost savings.

Conclusion

In preparation for the implementation of the national health insurance in South Africa, it is necessary to start prioritising strategies that promote a culture shift in healthcare. By emphasising preventive measures, leveraging the expertise of CHWs, prioritising primary healthcare consultations, and integrating telemedicine, the country can reduce healthcare costs, alleviate the burden on hospitals, and improve overall healthcare outcomes. 

Learning and implementing innovative cost-containment strategies from countries such as Brazil, South Africa can, through the NHI, build a sustainable and patient-centred healthcare system that addresses the needs of its population by improving access without compromising quality care.