Abstract
The research report reviews the financial controls that the National Health Insurance
(NHI) would be subjected to as a mitigating factor to the risk of fraud within the
expenses cycle of the NHI.
A review is performed on the World Health Organisation’s framework for a successful
healthcare system, and it is then benchmarked against the NHI. A review of other
countries with similar universal healthcare systems to the NHI is also performed to
determine any key success factors and challenges that were faced by those countries
in their healthcare system. Lastly, a review is performed on the financial reporting
framework and any other regulatory frameworks that the NHI would be subjected to
once its roll out as mitigating factors for the risk of fraud within the expenses cycle if
the NHI.
The research findings indicate that there are factors to consider in ensuring the
successful implementation of a universal healthcare system in South Africa and based
on those success factors and challenges noted by other countries with a similar
universal healthcare system to South Africa, it became evident that it is possible for
South Africa to successfully implement the NHI if it will operate within a strong control
environment with rigorous financial reporting on its activities.
The NHI was designed in line with the four pillars of implementing a successful
healthcare system according to the World Health Organisation. Based on the reviews
performed on other countries’ healthcare systems, South Africa can implement a
successful universal healthcare system but there are some challenges that can be
anticipated. The South African reporting and regulatory framework adequately
addresses the risk of fraud in the expenses cycle of the Fund and, therefore, could be
applied as a mitigating factor for fraud.
Key words: National Health Insurance, Universal Health Insurance, Financial
controls, Procurements, expenses cycle, Risk of Fraud.