3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Regulating the employment of doctors within the private sector in South Africa: a policy analysis(2018) Mosam, AtiyaIntroduction: Submissions to the Health Market Inquiry (HMI) postulated that the Health Professions Council of South Africa (HPCSA) regulations that prevent private hospitals from employing doctors is one of the reasons for high private sector costs. This study aimed to understand the current regulatory environment surrounding the HPCSA policy on employment of doctors and the implications of such a policy in light of the current health system policy reforms in South Africa. Methodology: The study was conceptualised as a policy analysis study with qualitative and quantitative components. The qualitative component consisted of document reviews and interviews with key stakeholders in order to investigate the current regulatory environment and implications of the regulations. The 20 stakeholders interviewed represented regulatory bodies, clinician associations, hospital groups, medical schemes and universities. The quantitative component consisted of a survey of doctors in South Africa to ascertain their views on the current HPCSA policy and its implications for clinical practice. A database of 21 065 doctors was obtained from MedPages and the survey yielded a response rate of 7.7%. Results: Whilst only 5 stakeholders viewed the HPCSA policy as increasing costs of care, 20 stakeholders felt that the policy impeded quality of care provided. 46.6% of doctors surveyed did not feel that employment would lead to decreased costs but only 30.6% agreed that the HPCSA policy did impede quality of care. Both stakeholders and doctors did not feel that employment of doctors would necessarily lead to unethical practices and loss of autonomy. Stakeholders and doctors were of the opinion that other measures such as multi-disciplinary practices and clinical protocols would be more effective in reducing costs and increasing quality of care but that conditional employment should be allowed to fill service gaps. Conclusion: Whilst key stakeholders and doctors were in favour of employment, the prevailing sentiment was that the policy should allow for employment of certain types of doctors’ or for certain services. It was therefore felt that the HPCSA policy needs to be amended, not only to allow conditional employment as highlighted above but more broadly to ensure that the HPCSA regulations support more innovative, cost effective, and integrated means of delivering patient care through multi-disciplinary practices and global fees.Item Family medicine and primary health care: the role of undergraduate training on current practices and future considerations of junior doctors in South Africa(2016-02-12) Mosam, AtiyaIntroduction: The South African government recently began the implementation of the new National Health Insurance (NHI) and Re-engineering of Primary Health Care (PHC) policy proposals (green paper) in order to achieve universal health coverage and health equity. One of the vital aspects of these policy proposals is the recruitment and retention of doctors within PHC in the public sector. This study therefore aims to examine the training, current practices and future intentions of doctors completing community service in 2010, 2011 and 2012 in order to ascertain which factors may be associated with employment in PHC. Methodology: The study was designed as a cross sectional study with an analytical component. Doctors in the cohorts of interest were contacted via email and requested to fill in an anonymous self-administered online survey. Univariate analysis was done to describe socio-demographic characteristics, current employment status and future intentions. Bivariate analysis was done to examine any associations between exposure to family medicine and PHC during undergraduate training, internship and community service, and employment in PHC. Results: The database yielded a sample of 350 doctors, of which 61 responded. Of the respondents, 35.59% worked as a private general practitioner whilst 11.86% work in public PHC. The study showed no statistically significant association between exposure to family medicine and PHC and employment in PHC but female gender was the socio-demographic variable found to be associated with PHC employment (p=0.02). Factors that deterred doctors from pursuing a specialization in family medicine were related to employment conditions such as poor resources and under staffing and not to factors related to the specialty itself such as an unchallenging scope of work or poor professional perception of the specialty. Conclusion: Whilst the study showed no association between exposure to family medicine and PHC and career choices in that field, it has highlighted that the conditions within the public service are the biggest deterrent to doctors. Thus whilst medical school admissions should aim to increase the number of students with characteristics positively associated with PHC employment such as female gender, it is important that the Department of Health in South Africa aims to Mosam, Atiya. 0003032K. MPH 2015 ensure that the conditions within the public service are optimized in order to recruit and retain as many doctors as possible in light of the human resource requirements of the new policy.