Is the routine health information system ready to support the planned national health insurance scheme in South Africa?
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Oxford University Press
Abstract
Implementation of a National Health Insurance (NHI) in South Africa requires a reliable, standardized health information system that supports Diagnosis-Related Groupers for reimbursements
and resource management. We assessed the quality of inpatient health records, the availability of
standard discharge summaries and coded clinical data and the congruence between inpatient
health records and discharge summaries in public-sector hospitals to support the NHI implementation in terms of reimbursement and resource management. We undertook a cross-sectional healthrecords review from 45 representative public hospitals consisting of seven tertiary, 10 regional and
28 district hospitals in 10 NHI pilot districts representing all nine provinces. Data were abstracted
from a randomly selected sample of 5795 inpatient health records from the surgical, medical,
obstetrics and gynaecology, paediatrics and psychiatry departments. Quality was assessed for 10
pre-defined data elements relevant to NHI reimbursements, by comparing information in source
registers, patient folders and discharge summaries for patients admitted in March and July 2015.
Description
Keywords
National Health Insurance (NHI), Routine health information system (RHIS), Insurance claims, Clinical coding, South Africa
Citation
Nicol, E. et al. (2021). Is the routine health information system ready to support the planned national health insurance scheme in South Africa?. Health Policy and Planning, 36(5), 639–650. 10.1093/heapol/czab008