Chief Directorate: User and Service Provider Management


The Bill describes the ‘Users’ of the health system. The issues of who may access services to be paid for from the Fund and how to identify them, where they reside, and the necessary biometrics that the health system must, or may, keep to ensure provision of health care will need to be regulated within the parameters of other existing laws. The public has a right to know what the health system and the Fund know about them and why their data is kept.

There is also a need for processes to manage the relevant data, to update it as people are born or die and to link each user’s identity to the Department of Home Affairs official register. Users are cared for by public and private ‘Providers’, and in primary health care services as well as hospitals and other specialized services. The law (National Health Act) defines ‘health establishments’ where individual professionals attend to patients, or from where they operate to provide outreach services to ‘users’.

The NHI Bill requires both establishments and individual providers to be accredited to provide services that the Fund will pay for. This starts with a standards compliance certification issued by the Office of Health Standards Compliance (OHSC). Thereafter, the provider must participate in the standard treatment guidelines, may procure form the Fund’s Formulary, and must be connected through an interoperable digital system to the Fund for records, reporting, and payment. Once those are in place, the provider will enter into a contract with the Fund as an ‘accredited provider’. This compliance and accreditation process is likely to take years. The intention is that the Fund will publish regulations describing the multi-year phasing in the accreditation process. The processes for managing accreditation will be digitised and outcomes will be transparent on the Fund’s website so that users understand the accreditation status of their selected providers.