DAMIAN MCHUGH | NHI and AI expected to shake up healthcare sector

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Stock photo.
Image: 123RF/HXDBZXY

Following what was a transformative 2023, bold visions from key industry players will continue to unfold, with the ultimate goal focusing on creating greater access and improved health outcomes for all South Africans.

Various trends gained significant popularity in 2023, including virtual healthcare, more intention on proactive healthcare approaches and preventative care, as well as increased awareness on mental health.

A pleasing and important trend to note was that overall wellness was a clear focus for South Africans, demonstrating a positive uptick in people taking responsibility for their health, both from a physical and mental perspective.

During the year, considerable progress was made in the framework to develop the National Health Insurance (NHI). The country’s healthcare system has been under significant strain for a long time, something that the Covid-19 pandemic further exposed.

The rollout is complex, however,and public private partnership will be key in 2024 in ensuring that the NHI positively transforms the sector. With the introduction of the NHI, worries are mounting regarding heightened risk of healthcare fraud.

Last year saw numerous allegations of fraud by major industry players coming to light. This is a crucial year for establishing policies and protocols to safeguard an already vulnerable sector from not just fraud, but also wastage and abuse.

The Fraud, Waste and Abuse Indaba1, organised by the Board of Healthcare Funders in November 2023, revealed that SA’s healthcare sector lost R30bn to fraud, wastage, and abuse.

This amount is astonishing, especially when considering the potential benefits if these funds were properly allocated and spent. Given the current socio-economic landscape, it is more important than ever to prioritise ethics and ensure major players within the healthcare sector operate in the interest of protecting their members.

While the NHI will indeed transform the sector, another key area of transformation will be the ongoing rise of artificial intelligence (AI) and its wider application in healthcare.

The 2024 World Economic Forum hosted in Davos in January, placed considerable focus on the impact that AI will have in health and the benefits of leveraging AI to enhance healthcare delivery and outcomes in complex countries such as SA.

We have already seen the positive impact that AI has had such as greater insight into our members’ overall health profiles that enables us to support them on their wellness journeys.

Looking forward, we can see how Generative AI will continue to improve efficiency when looking at administration and access to information through electronic health records. We are excited to see what is possible in 2024, not only as a business but as an industry.

From a medical scheme sector perspective, the industry will experience significant change in 2024 due to various factors, including aging membership profiles.

McHugh is executive head of marketing and distribution momentum Health Solutions


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