While there’s no shortage of noise about the fact that National Health Insurance (NHI) is unaffordable, which is probably justifiable, there has been a silence around how it would surmount technology challenges. There has been a lack of opinion on the technological and data readiness of South Africa to deliver the NHI.
In the US, when they implemented Obamacare, they experienced serious technology challenges. Obamacare was designed to provide numerous rights and protections that made health coverage fairer and easier to understand, along with subsidies (through “premium tax credits” and “cost-sharing reductions”) to make it more affordable. The online platform was key to enabling the facilitation of information and services related to the Obamacare programme.
The online platform initially was a major failure that almost cost Obama his presidency. The problems experienced with the Obamacare online platform were due to the following reasons:
- Lack of relevant experience: The team that worked on the project had a lot of experience with private insurance markets and maintaining large government projects, but did not have required experience in technology product launches.
- Key technical positions were unfilled and project managers had little knowledge of the amount of work required and typical product development processes leaving very little time to test and troubleshoot the online platform.
- Lack of leadership: There was no formal division of responsibilities in place between the many government offices involved which caused a delay in key decision-making or a lack of communication when key decisions were made.
- Schedule pressure: Since the launch date was mandated in the Affordable Care Act, the team that worked on the platform were pressured to launch on time regardless of completion or the amount and results of testing and troubleshooting performed.
- Legacy systems: The government relied on its old technology to implement the NHI and this caused serious challenges with the functionality of the online platform.
As a result of these factors the rollout of the healthcare.gov online platform ballooned from the initial $93.7 million budget to an ultimate cost of $1.7 billion. The failure of this project was not unique to the US government. Research that was conducted in other countries working on other government projects showed that 94% of large federal information technology projects were unsuccessful, more than 50% were delayed, over budget, or didn’t meet expectations, and a total of 41.4% were judged to be complete failures.
The main contributing factor has been the fact that a large, bureaucratic organisation that has significant experience in core government policies struggles to behave like a technology start-up in successfully launching new technology. To deal with this challenge, the Obama government established a team that consisted of leading people from technology start-ups. South Africa in the process of implementing NHI is also likely to face data and information technology challenges. However, aside from technology, health data will be one of the most important aspects of the project that will need serious attention.
In order to avoid such technology challenges, South Africa will have to put technology and data standards together with other measures in the form of a blueprint. The blueprint and strategy will have to include the following:
- Establishing and managing core health data, and the infrastructure for its exchange.
- Establishing national and regional registries to create a “single source of truth”.
- Create personal health records based on international standards, which are easily accessible to citizens and services providers, based on consent.
- Promote enterprise-class health application keeping in mind sustainable development goals related to health – ensure national portability in the provision of health services, promote the use of clinical decision support systems by health professionals and practitioners, leverage health data analytics and medical research for better management of the health sector and enhance governance digital tools in the area of performance management.
Finally, health technology infrastructure will have to be built to ensure better management of health data. Finance has to be a concern for the NHI, but it should not cloud the need for other aspects such as technology to be taken care of to have a successful NHI.
Article originally published on iol.co.za. Diphoko is the editor-in-chief of The Infonomist. He also serves as the chairperson of the IEEE Open Data Initiative. You can follow him on Twitter via: @WesleyDiphoko.