4. Electronic Theses and Dissertations (ETDs) - Faculties submissions

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    Perceived impact of reimbursement policies on accessibility to PCSK9 inhibitors in the South African private healthcare sector
    (University of the Witwatersrand, Johannesburg, 2024) Ngobeni, Plossie; Totowa, Jacques
    The South African private healthcare sector is confronted with the challenge of the limitation of adoption and access to proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i), a cholesterol-lowering medicine. At the heart of this is the complex nature of the reimbursement policies that are failing to yield favourable outcomes for patients, investors and practitioners alike. The long-term implications of these current medical reimbursement policies include resistance to medical cover, a decline in innovative drug adoption, a decline in optimal medical outcomes, decline in human capital development, loss in productivity, global drug companies pulling out of the South African market, and an extra financial burden to the patients. This study, employing a qualitative approach, aims to investigates barriers limiting adoption and access to PCSK9i in the South African private healthcare sector with a focal focus on reimbursement policies implemented by medical funders and insurances. The study also explores the market access and commercial success of PCSK9i hindered by reimbursement policies. Through semi-structured interviews as the main method of primary data collection, and using a thematic analysis, the explores the barriers, challenges and burdens that impede market access and entry for the PCSK9i and how this affects the economy, commercial success and stakeholders involved. The findings of this study indicate that reimbursement policies can have far-reaching impacts on businesses and the economy, affecting everything from cost management and innovation to employee satisfaction and market dynamics. Businesses must carefully navigate these policies to optimize their operations and remain competitive in the marketplace. Finally, the study proposes evidence-based recommendations for broadening accessibility to PSCK9i. These include encouraging medical funders to adopt a “risk-sharing” concept, value-based healthcare, patient advocacy groups, and review single exit pricing regulations. The significance of these recommendations is their potential to aid policy makers and other important stakeholders in decision making and ensuring access to the most deserving hypercholesteremia population.
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    Investigating the reasons for the differences in the accessibility of renal replacement therapy in the public and private healthcare sectors in South Africa
    (University of the Witwatersrand, Johannesburg, 2022) Asmal, Zubair Mahomed; Ameyibor, Leeford
    The number of patients with kidney failure is increasing. This increase is secondary to an increase in the risk factors resulting in kidney disease, and will result in an increase in the number of patients requiring renal replacement therapy (RRT). South Africa has a two-tiered healthcare system, a public and a private sector. At present, there is a significant disparity in the number of patients receiving RRT in the two sectors with more in the private sector. This disparity has been attributed anecdotally to a lack of resources in the public sector and specific legislation, although no research have been done to confirm this. Health disparity in general is complex and involves an interplay between multiple factors, including historical, political, economic, legislative and environmental factors. The hypothesis is that the disparity in RRT is complex, based on multiple factors, and cannot be ascribed to only two factors. To test the hypothesis, we interviewed the stakeholders in the RRT industry regarding their perspectives of the causative factors. In total, 33 interviews were conducted, recorded, transcribed and analysed using the grounded theory from a constructivist angle. The objective of the analysis was to determine which factors contributed to t he number of patients receiving RRT in the public sector, compared with the private sector. As the renal transplantation programme is managed collectively by the two sectors, it was considered separately. Based on the interviews, five themes were extracted to explain the disparity. These themes follow the journey of a kidney failure patient from the factors that contributed to the condition, to being diagnosed and ultimately treated. The themes are the prevalence of kidney disease in the two populations, the decision-making process of who receives RRT, the accessibility of receiving RRT, the resources available for RRT and the impact of the transplantation. Each theme has subthemes and combined they form a holistic explanation to account for the disparity. This study identified possible causative mechanisms to explain the disparity. It is hoped that by uncovering these mechanisms, corrective Page 5 of 15 measures can be implemented, a more equitable and just healthcare service can be offered to all citizens and in the process save a multitude of lives