Introducing a national health insurance system in South Africa: A general practitioner’s bottom-up approach to costing

Moosa, Shabir; Luiz, John; Carmichael, Teresa

doi:10.7196/samj.6072

Cited by 17 publications

(21 citation statements)

References 6 publications

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“…A well structured, team-based health system can deliver accountable, population-based care. 14 However, an intern's remark, previously mentioned, seems to be prescient:…”

Section: Resultsmentioning

confidence: 99%

A focus group study on primary health care in Johannesburg Health District: “We are just pushing numbers”

Moosa

Gibbs

2014

South African Family Practice

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Objectives: South Africa is striving towards a strong primary healthcare system. Since 2007, departments of family medicine have been established in Gauteng to improve quality of care through improved access to doctors, the coordination of health services and better referrals. There have been anecdotal difficulties around clinical quality, the role of the increasing number of doctors and the value of family medicine as a new speciality in Johannesburg since these changes. This study aimed to explore Johannesburg stakeholder views on clinical priorities, the role of doctors and family medicine in primary care.Design: The study design comprised qualitative focus group discussions.Setting and subjects: Groups of nurse clinicians, clinic managers, senior managers, doctors and interns within the Johannesburg Health District.Outcome measures: The content was thematically analysed and a model developed.Results: There were nine focus groups, with 6-13 participants per group. Addressing staff burnout and poor management were viewed as clinical priorities in primary care. Discussing the role of doctors reflected deep conflict between doctors and nurses. Nurses and managers expected doctors to help to "push the queues". It took some time for further roles, such as helping with referrals, training, research and administration, to emerge. There was initial confusion and tension when participants were asked about family medicine. However, its role was seen as useful.Conclusion: Nurses appeared to suffer from burnout and resented the increasing burden placed on them with regard to primary care in Johannesburg. There appeared to be confusion with respect to the role of doctors, with doctor-nurse conflict and poor teamwork. This may threaten attempts to re-engineer primary health care in order to increase the presence of doctors at clinic level. The discipline of family medicine can make a difference, but reorganisation of the system is required.Peer reviewed.

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“…A well structured, team-based health system can deliver accountable, population-based care. 14 However, an intern's remark, previously mentioned, seems to be prescient:…”

Section: Resultsmentioning

confidence: 99%

A focus group study on primary health care in Johannesburg Health District: “We are just pushing numbers”

Moosa

Gibbs

2014

South African Family Practice

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“…including the large number of general practitioners (GPs) from the current private sector into a strongly regulated capitated public primary care system) can reduce the shortage of doctors in the public service [21] but team-based primary health care will still remain an important consideration. Family physicians need to be proactive in defining primary care service packages for primary care, staffing mixes and skills, including the range of members of the Primary Health Care (PHC) team.…”

Section: Discussionmentioning

confidence: 99%

The views of key leaders in South Africa on implementation of family medicine: critical role in the district health system

et al. 2014

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BackgroundIntegrated team-based primary care is an international imperative. This is required more so in Africa, where fragmented verticalised care dominates. South Africa is trying to address this with health reforms, including Primary Health Care Re-engineering. Family physicians are already contributing to primary care despite family medicine being only fully registered as a full specialty in South Africa in 2008. However the views of leaders on family medicine and the role of family physicians is not clear, especially with recent health reforms. The aim of this study was to understand the views of key government and academic leaders in South Africa on family medicine, roles of family physicians and human resource issues.MethodsThis was a qualitative study with academic and government leaders across South Africa. In-depth interviews were conducted with sixteen purposively selected leaders using an interview guide. Thematic content analysis was based on the framework method.ResultsWhilst family physicians were seen as critical to the district health system there was ambivalence on their leadership role and ‘specialist’ status. National health reforms were creating both threats and opportunities for family medicine. Three key roles for family physicians emerged: supporting referrals; clinical governance/quality improvement; and providing support to community-oriented care. Respondents’ urged family physicians to consolidate the development and training of family physicians, and shape human resource policy to include family physicians.ConclusionsFamily physicians were seen as critical to the district health system in South Africa despite difficulties around their precise role. Whilst their role was dominated by filling gaps at district hospitals to reduce referrals it extended to clinical governance and developing community-oriented primary care - a tall order, requiring strong teamwork. Innovative team-based service delivery is possible despite human resource challenges, but requires family physicians to proactively develop team-based models of care, reform education and advocate for clearer policy, based on the views of these respondents.

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“…Equally, if as seems likely, there will be a flat single rate regardless of the patient's presenting problem, many predict doctors will not be incentivized to take on high cost or high risk patients. (Fin24 2013b; Moosa et al 2012).…”

Section: Role Of Private Sectormentioning

confidence: 99%

The Drivers of Universal Health Care in South Africa: The Role of Ideas, Actors and Institutions

Surender

2017

Towards Universal Health Care in Emerging Economies

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Introducing a national health insurance system in South Africa: A general practitioner’s bottom-up approach to costing

Cited by 17 publications

References 6 publications

A focus group study on primary health care in Johannesburg Health District: “We are just pushing numbers”

A focus group study on primary health care in Johannesburg Health District: “We are just pushing numbers”

The views of key leaders in South Africa on implementation of family medicine: critical role in the district health system

The Drivers of Universal Health Care in South Africa: The Role of Ideas, Actors and Institutions

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