What are key determinants of hospital admissions, readmission rate and day case rate within the South African medical schemes population?

BACKGROUND: In South Africa, private hospitals absorb a high proportion of the total health expenditure on private health care. Between 2008-2010 private hospital expenditure which includes ward fees, theatre fees, consumables, medicines and per diem arrangements consumed between 40.5% and 40.9% of the total benefits paid by medical schemes from the risk pool, whilst in-hospital managed care fees ranged between 1.8% and 2.8% for the equivalent years.OBJECTIVE: The aim of this paper is to highlight key factors contributing to utilisation of hospital services within the medical schemes population and to recommend “appropriate” and cost effective strategies on hospital utilisation management.METHODS: A cross sectional survey informed by retrospective analysis of quantitative data was used. Researchers also triangulated quantitative data with systematic review of literature.RESULTS: The results show that demographic indicators such as age profile, dependency ratio, pensioner ratio and prevalence of chronic conditions are not the only key factors influencing hospital admissions, but rather the effectiveness of each medical scheme in containing hospital admissions is also influenced by available technical capacity on utilisation review and audit as well as the managed care methodology including the philosophy underpinning benefit option design.CONCLUSION: This study highlights the importance of “value based” managed care programs linked to benefit option design in health care utilisation management. The choice of one managed care program over the other often leads to tradeoffs whereby unintended consequences emanate. Medical schemes are therefore encouraged to continuously review their managed care programs to ensure value for money as well as better access and health outcomes

Perceived knowledge of scheme members and their satisfaction with their medical schemes : a cross-sectional study in South Africa

Additional file 1. Survey of members’ perceived knowledge and satisfaction with medical schemes.BACKGROUND : South Africa has a dual healthcare system comprising of private and public sectors covering 16% and 84% of the population, respectively. Medical schemes are the primary source of health insurance in the private sector. The aim of this study was to assess members of medical schemes’ perceived knowledge and satisfaction with their medical schemes. METHODS : A cross-sectional survey was conducted using a stratified systematic sample of members of 22 open medical schemes. Medical schemes members completed an online questionnaire on knowledge and satisfaction with their medical schemes. We calculated a composite perceived knowledge and satisfaction score. Descriptive, bivariate and multivariate analysis was conducted. RESULTS : A total of 336 members of medical schemes participated in this study. Respondents generally perceived themselves to have good knowledge of their medical schemes. Eighty-one percent of participants were satisfied with the quality of services received from their designated service providers (DSPs), however, only 9% were satisfied with accessibility of doctors under their DSP arrangement. Twenty-five percent of respondents were satisfied with scheme contributions and only 46% were satisfied with the prescribed minimum benefit package. CONCLUSION : Medical schemes remain a key element of private healthcare in South Africa. The analysis shows that medical schemes, should put more effort into the accessibility of general practitioner under their designated service providers. Furthermore, the prescribed minimum benefits should be reviewed to provide a comprehensive benefits basket without co-payment for members as recommended by the Medical Schemes Act Amendment Bill of 2018.http://www.biomedcentral.com/bmcpublichealtham2023School of Health Systems and Public Health (SHSPH

Optimising beneficiary choices : standardisation of medical scheme benefit options

Market segmentation analyses suggest that beneficiaries are confused by too many benefit options; that choice sets facing different beneficiaries are not the same; and that information is not equally accessible.http://www.journals.co.za/content/journal/healthrEconomic

The Economic Effects of Diabetes and Sugar-Sweetened Beverage Taxes

The aim of this study is to analyse the effects of diabetes and sugar-sweetened beverages on the South African economy. The study was motivated by the prevalence of diabetes in South Africa and the cost of managing diabetes. In 2016, diabetes was the second leading cause of mortality in the country. Current studies show that more than 7% of healthcare expenditure is spent on diabetes care. Sugar-sweetened beverages have been linked to the increase in the prevalence of diabetes. Three independent studies are conducted to investigate the link between diabetes, sugar-sweetened beverages (SSB) and the economy. Firstly, we study the impact of diabetes on labour market outcomes in South Africa using regression analysis. We achieve this through using probit models, propensity score matching and linear instrumental variable methods to account for endogeneity of diabetes. We find through the analysis that individuals with diabetes are less likely to be employed when compared to individuals without diabetes. Secondly, we investigate the economy-wide impact of diabetes using a computable general equilibrium model. We assessed the impact of diabetes on GDP, household welfare and sectoral outputs. We find that diabetes reduces sectoral outputs, household consumption as well as GDP. Thirdly, we investigate the effects of sugar-sweetened beverages tax on the economy. We analyse this by simulating the effects of the tax together and the envisaged health benefits from the tax. The results of the analysis show that in the short-run poor households are negatively affected. The negative effect is however reversed in the long-run when the net health benefits of the SSB tax are considered. Overall, the main finding of this research is that diabetes has a negative effect on the South African economy. This negative effect can however be offset by targeted tax policy interventions.Thesis (PhD)--University of Pretoria, 2020.EconomicsPhDUnrestricte

The impact of diabetes on labour market outcomes

This study estimates the effect of diabetes on labour market outcomes (employment, unemployment and labour force participation) in South Africa using data from the South African General Household Survey (2018). We first examine the possibility that diabetes status is endogenous through the application of heteroscedasticity-based instruments. Internal instruments meet the underlying diagnostic expectations, but do not consistently accept the endogeneity hypothesis. Thus we turn to multinomial logit models, ignoring endogeneity, to estimate the effect of diabetes. Our findings indicate that diabetes has differential effects for men and women, where the magnitude of the effect tends to be larger (in absolute value) for women.http://www.tandfonline.com/loi/cdsa202023-08-01hj2023Economic

The Impact of COVID-19 Lockdown on Service Utilization Among Chronic Disease Patients in South Africa

Introduction: Globally, the COVID-19 pandemic has brought many disruptions in health service delivery. Evidence show that the pandemic has negatively affected routine healthcare utilization such as maternal and child health services, but the literature on the effect on non-communicable diseases (NCDs) is scant in South Africa. These disruptions can have long-term health and economic implications for patients. Objective: To estimate the impact of COVID-19 lockdown on service utilization among chronic disease patients in South Africa using administrative data. Methods: Using monthly data from the Centralized Chronic Medication Dispensing and Distribution (CCMDD) program database covering November 2018 to October 2021, we examined the effects of COVID-19 lockdown on utilization among patients receiving antiretroviral therapy (ART) medication only (ART-only), patients receiving both ART and NCD medication (ART + NCD), and patients receiving NCD medications only (NCD-only). We employed segmented interrupted time series approach to examine the changes. We stratified the analysis by socioeconomic status. Results: We found that, overall, the lockdown was associated with increased utilization of CCMDD services by 10.8% (95% CI: 3.3%-19%) for ART-only and 10.3% (95% CI: 3.3%-17.7%) for NCD-only patients. The increase in utilization was not different across socioeconomic groups. For patients receiving ART + NCD medications, utilization declined by 56.6% (95% CI: 47.6%-64.1%), and higher reductions occurred in low SES districts. Conclusion: Patients should be educated about the need to continue with utilization of disease programs during a pandemic and beyond. More efforts are needed to improve service use among patients with multi-morbidities

Estimating the healthcare cost of overweight and obesity in South Africa

Background Overweight and obesity are major risk factors for noncommunicable diseases. This presents a major burden to health systems and to society in South Africa. Collectively, these conditions are overwhelming public healthcare. This is happening when the country has embarked on a journey to universal health coverage, hence the need to estimate the cost of overweight and obesity. Objective Our objective was to estimate the healthcare cost associated with treatment of weight-related conditions from the perspective of the South African public sector payer. Methods Using a bottom-up gross costing approach, this study draws data from multiple sources to estimate the direct healthcare cost of overweight and obesity in South Africa. Population Attributable Fractions (PAF) were calculated and multiplied by each disease’s total treatment cost to apportion costs to overweight and obesity. Annual costs were estimated for 2020. Results The total cost of overweight and obesity is estimated to be ZAR33,194 million in 2020. This represents 15.38% of government health expenditure and is equivalent to 0.67% of GDP. Annual per person cost of overweight and obesity is ZAR2,769. The overweight and obesity cost is disaggregated as follows: cancers (ZAR352 million), cardiovascular diseases (ZAR8,874 million), diabetes (ZAR19,861 million), musculoskeletal disorders (ZAR3,353 million), respiratory diseases (ZAR360 million) and digestive diseases (ZAR395 million). Sensitivity analyses show that the total overweight and obesity cost is between ZAR30,369 million and ZAR36,207 million. Conclusion This analysis has demonstrated that overweight and obesity impose a huge financial burden on the public health care system in South Africa. It suggests an urgent need for preventive, population-level interventions to reduce overweight and obesity rates. The reduction will lower the incidence, prevalence, and healthcare spending on noncommunicable diseases

A cost-effectiveness analysis of a South African pregnancy support grant.

Poverty among expectant mothers often results in sub-optimal maternal nutrition and inadequate antenatal care, with negative consequences on child health outcomes. South Africa has a child support grant that is available from birth to those in need. This study aims to determine whether a pregnancy support grant, administered through the extension of the child support grant, would be cost-effective compared to the existing child support grant alone. A cost-utility analysis was performed using a decision-tree model to predict the incremental costs (ZAR) and disability-adjusted life years (DALYs) averted by the pregnancy support grant over a 2-year time horizon. An ingredients-based approach to costing was completed from a governmental perspective. The primary outcome was the incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses were performed. The intervention resulted in a cost saving of R13.8 billion ($930 million, 95$1.57 billion - $264 million) and averted 59,000 DALYs (95$2,149) per pregnancy. Mortality contributed most significantly to the DALYs accrued in the comparator (0.68 DALYs). The intervention remained the dominant strategy in the sensitivity analyses. The pregnancy support grant is a highly cost-effective solution for supporting expecting mothers and ensuring healthy pregnancies. With its positive impact on child health outcomes, there is a clear imperative for government to implement this grant. By investing in this program, cost savings could be leveraged. The implementation of this grant should be given high priority in public health and social policies