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

Girdwood, Sarah; Govender, Kerensa; Long, Lawrence; Miot, Jacqui; Meyer‐Rath, Gesine

doi:10.7196/samj.2019.v109i10.13930

Cited by 13 publications

(23 citation statements)

References 10 publications

(10 reference statements)

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“…Os autores concluíram que a região de localização normatizada pela Agencia Nacional foi a principal variável determinante para a distribuição de resultados de organizações classificadas como Medicina de Grupo. Girdwood et al (2019) consideram que a presença de um quadro regulamentar claro, em um ambiente de inovação, seria um catalisador para a mediação entre planos públicos e privados de saúde, de modo a garantir uma maior eficiência para o setor e oferecer serviços de menor custo à população.…”

Section: Estudos Anterioresunclassified

A eficiência econômico-financeira de operadoras de planos de saúde: a influência da modalidade

Xavier

Souza

2020

ForScience

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Diante de um grande mercado que movimenta milhões anualmente e atende a mais de 20% da população brasileira quanto à saúde, fazem-se necessários estudos relacionados à eficiência econômico-financeira das Operadoras de Planos de Saúde (OPS). Soma-se a isso o fato que o mercado de saúde suplementar vem diminuindo ao longo dos últimos 15 anos. Dessa maneira, o estudo dessa eficiência mostra-se importante para a manutenção dessas empresas no mercado. Uma das formas de se analisar a situação financeira dessas organizações é por meio da utilização dos benchmarks de mercado. Para tanto, foram calculados alguns indicadores econômico-financeiros e realizados testes de Kruskal-Wallis e Análise Envoltória de Dados (DEA). Conclui-se que a modalidade a qual opera a OPS pode ser determinante para a sua eficiência e que alguns indicadores apresentam possibilidades de melhoria em grande parte das empresas, independente da modalidade. Palavras-chave: Operadoras de planos de saúde. Eficiência econômico-financeira. Análise envoltória de dados (DEA). Determinants of the economic and financial efficiency of health plan operators: the influence of the modality Abstract Faced with a large market that moves billions of people and serves more than 20% of the Brazilian population regarding health, these studies may be related to the economic economy of the Health Plan Operators (OPS). This means that the supplemental healthcare market has been shrinking over the last 15 years. Thus, the study of this efficiency is important for the maintenance of these companies in the market. One way to analyze the financial situation in these situations is the average use of market benchmarks. For this, some economic and financial indicators were calculated and performed by Kruskal-Wallis and Data Envelopment Analysis (DEA). Conclude that a form of OPS quality operation can be decisive for its efficiency and that some indicators show possibilities for improvement in most companies, regardless of the modality. Keywords: Health plan operators. Economic and financial efficiency. Data envelopment analysis (DEA).

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Section: Estudos Anterioresunclassified

A eficiência econômico-financeira de operadoras de planos de saúde: a influência da modalidade

Xavier

Souza

2020

ForScience

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“…With debilitating or persistent symptoms, women eventually presented to a private or public clinic for advice (where we met them). Choice of clinic depended on income and whether or not they had private health insurance, the latter factor determining the quality of care in the private sector that was available to employed middle class patients, compared with resort to the public sector by the majority of the population, most on a low income or unemployed (Ataguba & Goudge, 2012;Fusheini et al, 2018;Girdwood et al, 2019). Those without health insurance or sufficient money to pay out-of-pocket presented to a community health clinic or hospital outpatient department, often leaving home early in the morning to be in a queue by eight am with hope of being seen by midday (see, for example, Sastry et al, 2015).…”

Section: Methodsmentioning

confidence: 99%

Prescribing, care and resistance: antibiotic use in urban South Africa

Manderson

2020

Humanit Soc Sci Commun

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patients' and providers' expectations of transactions in health services converge in consultations for acute respiratory tract infections with the prescription of antibiotics. To explore this, a qualitative study was undertaken at community health centres and private general practice surgeries in four areas of metropolitan South Africa, selected purposively to allow for wide variability in terms of socioeconomic status and ethnicities/race of patient populations. With permission, clinic waiting rooms and patient/provider consultations were observed, and 65 in-depth interviews were undertaken with patients or parents or guardians presenting with children. These interviews were complemented by interviews with health providers (26) and key informants (12). All interviews were recorded, transcribed and imported into NVivo 12 for management. Data were open coded, with individual interviews and observational data compared and contrasted to highlight understandings and practices of care, antibiotic precription and use. In this article, I illustrate how the social context of patient and provider interactions in primary care settings influenced treatment. Community health centres and clinics were (and are) stretched for resources, and there were long wait times before patients can be seen; consultations were brief, with relatively little verbal exchange on the management of coughs and colds. Providers' decisions of treatment were informed by clinical assessment, concern about the risks of bacterial infection, and perceptions of patient ability to seek further care and advice-a mix of clinical and social considerations. While patients did not always request antibiotics and were willing to discuss how to manage acute conditions without them, doctors in private practice still often provided a prescription, sometimes postdated to discourage use but with the option for medication if needed. In the public sector, the provision of a prescription also reflected clinicans' appreciation of economic constraint and vulnerability. As described, patients understood principles of the appropriate use and storage of antibiotics, in contrast to other medications, and they were largely open to discussions with their providers about whether or not to use an antibiotic. However, their own and their prescribing providers had varied understandings of the mechanisms of resistance to antibiotics and so the need for antibiotic stewardship.

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“…The population for this study included all patients, aged 18 years and older (adults), who presented for PHC services at seven selected private PHC organisations (primarily providing services to the low-income uninsured patient population) and their matched public sector PHC clinic counterpart (seven facilities) between May 2018 and January 2019, as previously described (10). Only patients able to communicate in English, willing to provide written informed consent, and be physically present for an interview during our site visit were eligible for inclusion in the nal random study sample.…”

Section: Samplingmentioning

confidence: 99%

Primary Healthcare Seeking Behaviour of Low-income, Uninsured Patients Across the Public and Private Health Sectors in South Africa

Govender¹,

Girdwood²,

Letswalo³

et al. 2020

Preprint

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Background: The proposed National Health Insurance (NHI) system aims to re-engineer primary healthcare (PHC) in South Africa, envisioning both private sector providers and public sector clinics as independent contracting units to the NHI Fund. In 2017, 16% of the South African population had private medical insurance and predominately utilised private providers. However, it is estimated that up to 28% of the population access private PHC services, with a meaningful segment of the low-income, uninsured population paying for these services out-of-pocket. The study objective was to characterise the health seeking behaviour of low-income, uninsured patients accessing PHC services in both the public and private sectors, patient movement between sectors, and factors influencing their facility choice. Methods: We conducted once-off patient interviews on a random sample of 153 patients at 7 private PHC providers (primarily providing services to the low-income uninsured patient population) and their matched public PHC clinic (7 facilities). Results: The majority of participants were economically active (96/153, 63%), 139/153 (91%) did not have health insurance, and 104/153 (68%) earned up to $621/month. A multiple response question found affordability (67%) and convenience (60%) were ranked as the most important reasons for choosing to usually access care at public clinics (48%); whilst convenience (71%) and quality of care (59%) were key reasons for choosing the private sector (32%). There is movement between sectors: 23/76 (30%) of those interviewed at a private facility and 8/77 (10%) of those interviewed at a public facility indicated usually accessing PHC services at a mix of private and public facilities. Results indicate cycling between the private and public sectors with different factors influencing facility choice. Conclusions: It is imperative to understand the potential impact on where PHC services are accessed once affordability is mitigated through the NHI as this has implications on planning and contracting of services under the NHI.

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

Abstract: This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Cited by 13 publications

References 10 publications

A eficiência econômico-financeira de operadoras de planos de saúde: a influência da modalidade

A eficiência econômico-financeira de operadoras de planos de saúde: a influência da modalidade

Prescribing, care and resistance: antibiotic use in urban South Africa

Primary Healthcare Seeking Behaviour of Low-income, Uninsured Patients Across the Public and Private Health Sectors in South Africa

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