Insights of private general practitioners in group practice on the introduction of National Health Insurance in South Africa

Abstract

BackgroundThe South African government intends to contract with ‘accredited provider groups’ for capitated primary care under National Health Insurance (NHI). South African solo general practitioners (GPs) are unhappy with group practice. There is no clarity on the views of GPs in group practice on contracting to the NHI.ObjectivesTo describe the demographic and practice profile of GPs in group practice in South Africa, and evaluate their views on NHI, compared to solo GPs.MethodsThis was a descriptive survey. The population of 8721 private GPs in South Africa with emails available were emailed an online questionnaire. Descriptive statistical analyses and thematic content analysis were conducted.ResultsIn all, 819 GPs responded (568 solo GPs and 251 GPs in groups). The results are focused on group GPs. GPs in groups have a different demographic practice profile compared to solo GPs. GPs in groups expected R4.86 million ($0.41 million) for a hypothetical NHI proposal of comprehensive primary healthcare (excluding medicines and investigations) to a practice population of 10 000 people. GPs planned a clinical team of 8 to 12 (including nurses) and 4 to 6 administrative staff. GPs in group practices saw three major risks: patient, organisational and government, with three related risk management strategies.ConclusionsGPs can competitively contract with NHI, although there are concerns. NHI contracting should not be limited to groups. All GPs embraced strong teamwork, including using nurses more effectively. This aligns well with the emergence of family medicine in Africa.

Primary healthcare delivery models for uninsured low-income earners during the transition to National Health Insurance: Perspectives of private South African providers

“…The under-representation of GPs and the small sample size, are limitations of this study, but the perspectives of GPs on NHI contracting, as well as different contracting options, are well documented elsewhere. [13][14][15][16][17] However, what was clear was that while all other models (excluding the nurse-led model) either had a GP on site or could provide access to a GP on certain days or via telemedicine, task shifting to lower cadres of healthcare workers was an important cost-containment strategy. The current SA PHC model is based on nurse-run and led care through multidisciplinary teams in PHC clinics where access to a doctor is normally through referral.…”

Emerging role of family medicine in South Africa

“…Yet, many have no postgraduate training or formal qualifications in family medicine 18 24. So while private general practitioners in South Africa responded promisingly in 2011 to a hypothetical National Health Insurance contract for a panel or practice population of 10 000 people per private general practitioner-led team, with teamwork including nurses and other healthcare workers, at a cost almost the same as public service expenditure at the time,25 there are reservations about the ability of this workforce to deliver on aspirations 26…”

“…The legacies of colonialism-apartheid, the current state bureaucracy under post-apartheid leadership and political distrust of the mostly white private general practitioners in South Africa25 31 require transformational leadership by policy-makers and family physicians. In helping shape the contracting framework for primary healthcare service delivery under National Health Insurance, family medicine and primary health care can be strengthened in South Africa.…”

The perceptions of general practitioners on National Health Insurance in Chris Hani district, Eastern Cape, South Africa

“…The GPs in this study appeared to be more supportive of the underlying principles and need for the NHI compared with GPs interviewed from more urban areas. [7][8][9][10] This could be because they serve a poor rural community and were more conscious of the need for a radical reform of the health system, such as the implementation of NHI, that would improve health equity. Even in urban areas it was noted that GPs serving poorer communities were more positive about NHI.…”