Roles and reimbursement of pharmacists as South Africa transitions towards Universal Health Coverage (UHC): An online survey-based study

Abstract

Background The implementation of Universal Health Coverage in SA has sought to focus on promoting affordable health care services that are accessible to all citizens. In this regard, pharmacists are expected to play a pivotal function in the revitalization of primary health care (PHC) during this transition by the expansion of their practice roles. Objectives To assess the readiness and perceptions of pharmacists to expand their roles in an integrated health care system. To determine the availability and pricing of primary health care services currently provided within a community pharmacy environment and to evaluate suitable reimbursement for the provision of such services by a community pharmacist. Methods Community pharmacists’ across SA were invited to participate in an online survey-based study. The survey consisted of both open- and closed-ended questions. Descriptive statistics for closed-ended questions were generated and analysed using Microsoft Excel® and Survey Monkey®. Responses for the open-ended questions were transcribed, analysed, and reported as emerging themes. Results Six hundred and sixty-four pharmacists’ responded to the online survey. Seventy-five percent of pharmacists’ reported that with appropriate training, a transition into a more patient-centered role might be beneficial in the re-engineering of the PHC system. However, in order to adopt these new roles, appropriate reimbursement structures are required. The current fee levied by pharmacists in community pharmacies that offered these PHC services was found to be lower to that recommended by the South African Pharmacy Council; this disparity is primarily due to a lack of information and policy standardisation. Therefore, in order to ensure that fees levied are fair, comprehensive service package guidelines are required. Conclusions This study provides baseline data for policy makers on pharmacists’ readiness to transition into expanded roles. Furthermore, it can be used as a foundation to establish appropriate reimbursement frameworks for pharmacists providing PHC services.

Policy developer’s perceptions on the implementation of National Health Insurance in South Africa: a qualitative study

“…Therefore, the responsibility for appropriate healthcare system management is shared [ 17 ]. This strategy for development should take into consideration the different values and perspectives that have to be integrated within the structure [ 8 , 25 ]. Similarly, a study based on the district healthcare system in South Africa found that there is a pressing need to bridge the health inequities at a district health level prior to NHI implementation [ 1 ].…”

“…A recurring theme seen in this study is the concern of lack of reimbursement mechanisms for private healthcare providers [ 8 ]. Participants felt that there is insufficient information on the reimbursement processes within NHI.…”

“…Participants felt that there is insufficient information on the reimbursement processes within NHI. Similarly, in other studies conducted by researchers, a common theme documented is the concern that there is a lack of information on reimbursement mechanisms for healthcare providers expected to render services within NHI [ 8 ]. It is also important to note that participants had mixed feelings about the potential mechanisms of reimbursement, i.e., capitation, fee-for-service, outcome-based and a hybrid system.…”

“…A common opinion expressed is that the role of a pharmacist has been minimized to pill dispensers and further limited by other administrative duties [ 8 ]. “They're nothing more than pill dispensers broadly speaking.” [Participant 8] “Unfortunately, from my perspective it’s kind of just becoming dishing out medicines and there's a lot more that pharmacists could be doing.…”

“…Furthermore, the objective of PHC re-engineering is to regulate gatekeeping (access and entry into the healthcare system) and support an efficient referral pathway [ 2 ]. Therefore, pharmacists are expected to play a crucial role as they are generally viewed as a first point of access to care [ 8 , 9 ].…”