GP preferences for contracting with the public health sector

Abstract

The report investigates the parameters of a suitable contract regime between government and general practitioners (GPs) that will help to ensure the successful implementation of the National Health Insurance (NHI) plan. The study gauges a suitable fee and determines the criteria that should be used to determine a fee to contract GPs to the public sector. It also examines the potential contract approaches to ensure that the barriers to the large-scale strategic use of public sector GP contracting can be overcome. Finally, the study uses demographic data to establish which GPs will accept low rates and agree to contract with the government. Subsequently, the government will be able to use available resources to target only suitable doctors to contract with the public sector. The results show that GPs in South Africa believe that an appropriate take-home income should be higher than there international peers. The preferred method of remuneration is an hourly fee and with the majority of GPs willing to discount their fees, an hourly fee of R520-R540 is proposed to be tested in NHI pilot districts. The results also provided evidence that GPs would prefer a contract approach that allows all GPs to contract with the public sector, and that GPs should not be limited to either public or private sector patients. There was also evidence that strongly suggests that GPs preferred working at their own facilities rather than at public facilities. Lastly, a target group comprising people of African, Indian or coloured origin, and with nine years of experience or fewer, would contract at a suitable fee of less than R700 per hour. Resources should be aimed at targeting this demographic group to increase the rate of contracting.