Views of private general practitioners on capitation in a National Health Insurance system in South Africa
Date
2012-11-21
Authors
Moosa, Shabir Ahmed Hassim
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
National Health Insurance (NHI) is an important debate in South Africa.
Affordability appears to be a key issue. Yet NHI costing is dominated by medical
aid schemes with exorbitant cost estimates. Capitation is not only a different
payment system but also a different service delivery model. There are
opportunities, in the light of this, for risk management and efficiencies at a
micro- and meso-economic level. This study explores how private general
practitioners may choose to embrace these service delivery concepts to meet
National Health Insurance requirements. Data was collected from 598 solo
private general practitioners through a self-administered online questionnaire
survey of general practitioners across South Africa.
The key findings are that, in the main, general practitioners are young, fairly
experienced, diverse and moving to areas of need. They are optimistic on
practice growth, with medical aid schemes dominating their practice and with
fair experience in capitation. Despite being ambivalent about the NHI they seem
capable of engaging with capitation by using computer technology and
reviewing practice data. Furthermore, in spite of poor engagement with the
public sector, and some challenges in costing and organisation, it was found
that general practitioners had an affordable and pro-active response to NHI
capitation-costing and fee-setting. On average, they would accept a minimum
global fee of R 4.03 million to look after a population of 10 000 people for
personal curative and preventive-promotive healthcare services (excluding
medicines). Notwithstanding their concerns regarding high utilisation and
contractual risk their responses offered possible solutions such as
strengthening management and staffing, building a healthy population and
strengthening the contractual arrangements. At a total cost to country of R16.9
billion, government could affordably launch the Primary Health Care (PHC) part
of the NHI with 4200 general practitioners to cover the entire South African uninsured
population. Their cost projections are similar to current public service
PHC costs. This finding behoves government to engage with general
practitioners urgently.
Description
MBA thesis - WBS
Keywords
National Health Insurance - South Africa, Health