National Health Act, 2003 (Act No. 61 of 2003)

Notices

National Health Insurance Policy towards Universal Health Coverage

Chapter 8 : Purchasing of Health Services

8.2 Accreditation of Providers by NHI Fund
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279. The accreditation process will require providers to firstly meet the minimum quality norms and standards and be certified by the OHSC, and where relevant by the appropriate statutory professional council, which will continue to register and license professionals in line with national health legislation.

 

280. Accreditation by the NHI Fund will be based on the health needs of the population and will require provider compliance with specific information and performance criteria. One of the criteria for accreditation of a provider to be eligible for contracting with the NHI Fund will be the routine submission of specified information.

 

281. The information collected will be used to monitor health outcomes and should include detailed information on the demographic (age-sex) composition and epidemiological profile of the resident or catchment population in each district, and can be used to determine the global budget on a risk-adjusted capitation basis. Providers, both the public and private, will be assessed against indicators of clinical care, health outcomes and clinical governance rather than simply on perceived quality of services.

 

282. Licensing and Accreditation criteria and standards for public and private EMS will be the same and EMS providers will be required to comply with provisions contained in the EMS Regulations78 and any amendments thereof on Licensing and Inspections, as well as any provisions that may be stipulated by the Office of Health Standards Compliance (OHSC).

 

283. A key feature of the new EMS is that all medical emergency vehicles will be of a standard colour regardless of whether they are publicly or privately operated and there will be a single national emergency number to serve both public and private operators to improve services and effective response to the needs of the population.

 

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mPart of the active purchaser function requires that providers are contracted taking into account the cost of services to be rendered by a specific type of provider.