Exploring the beliefs and attitudes of private general practitioners towards national health insurance in Cape Town, South Africa.

Sheena Mathew,Robert Mash

doi:10.4102/phcfm.v11i1.2189

Sheena Mathew, Robert Mash

Open Access

https://doi.org/10.4102/phcfm.v11i1.2189

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Abstract

BackgroundPrivate general practitioner (GP) participation in the national health insurance (NHI) is necessary to address doctor shortages and achieve universal health coverage. An in-depth understanding of GP’s views on the NHI is needed to inform implementation strategies.AimTo explore the beliefs and attitudes of GPs towards the proposed NHI system.SettingCape Town, South Africa.MethodsThis was a descriptive, exploratory, qualitative study using semi-structured interviews. Eleven GPs were recruited using purposeful snowball sampling from different practices and communities. Thematic data analysis was conducted using the framework approach and Atlas.ti software.ResultsAlthough GPs saw the need for NHI, they felt that the government was antagonistic towards the private sector and had not engaged in a dialogue. They were wary of integration into a nurse-led primary care system and of being coerced. They felt that the public sector lacked the necessary financial and administrative capacity, and were concerned about the level, efficiency and sustainability of reimbursement, and the criteria to be used to accredit practices. General practitioners anticipated that the NHI would favour multidisciplinary teams and group practices. They also had mixed ideas about the impact on practice with some expecting higher workloads, stress and costs with reduced quality of care, while others saw more comprehensive care, better incomes and increased patient satisfaction.ConclusionsWhile GPs are essential for the success of the NHI, there are many concerns regarding government policy, plans for implementation and the consequences for GP practice. Many of the concerns expressed could be tackled by greater policy dialogue and clarification.

Highlights

Private general practitioner (GP) participation in the national health insurance (NHI) is necessary to address doctor shortages and achieve universal health coverage
In 2005, all World Health Organization (WHO) member states made a commitment towards achieving universal health coverage.[1]
The different political environments, cultures and inherited legacies of countries have resulted in diverse reforms,[5] evidence suggests that the following reforms are effective: shifting high hospital spending towards primary care, increasing government expenditure on primary care and introducing public–private partnerships to expand health coverage.[6,7]

Summary

Introduction

Research plays a vital role in generating evidence to reform health systems in order to achieve universal health coverage.[2,4] The different political environments, cultures and inherited legacies of countries have resulted in diverse reforms,[5] evidence suggests that the following reforms are effective: shifting high hospital spending towards primary care, increasing government expenditure on primary care and introducing public–private partnerships to expand health coverage.[6,7]. In Africa, countries such as Ghana, Nigeria, Rwanda, Kenya and Mali have commenced with national health insurance (NHI) as a key strategy. Health reforms in these countries have led to increased government spending on health, with taxation as a key source of revenue; increased coverage of primary health care; and decreased out-of-pocket spending.[5]

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