Agreeing on the minimum: An 11-year review of Prescribed Minimum Benefits appeals

Background. Prescribed Minimum Benefits (PMBs) in South Africa (SA) are a set of minimum health services that all members of medical aid schemes have access to regardless of their benefit options or depleted funds. Medical aid schemes are liable to pay for these services. However, ~40% of all complaints received by the Council for Medical Schemes (CMS) are in relation to PMBs. Individuals/stakeholders who are unsatisfied with judgments on their complaints are allowed to appeal.Objectives. To determine and describe the pattern of PMB appeals from 1 January 2006 to 31 December 2016.Methods. This was a descriptive cross-sectional study that utilised the CMS Judgments on Appeals database. Data for PMBs, levels of appeal, judgments, appellants, respondents and medical scheme types were extracted. The CMS’s lists of chronic conditions, PMBs and registered schemes were used to confirm PMBs and to categorise schemes as either open (i.e. to all South Africans) or restricted (i.e. only open to members of specific organisations). Data were extracted and frequencies were calculated using Stata software, version 14.Results. All eligible appeal reports (N=340) were retrieved and 123 PMB appeals were included in the study (36.2%). The median number of PMB appeals per year was 11 (interquartile range 9 - 27). Open schemes accounted for 82.1% of all the PMB appeals. Half of the total appeals (50.4%, 62/123) were by medical aid schemes appealing their liability to pay for PMBs, and of these 69.4% (43/62) were found in favour of members. The remaining half (49.6%, 61/123) were appeals by members appealing that schemes were liable to pay, and of these 80.3% (49/61) were found in favour of the medical aid schemes. Treatment options that were scheme exclusions constituted 34.4% (21/61) of reasons why schemes were found not liable to pay. Various types of cancers and emergency conditions constituted one-quarter of all PMB appeals.Conclusions. While the pattern is unclear and the extent of the problem is masked, this study shows that a quarter of the conflict resulting in PMB appeals was due to various types of cancers and emergency conditions. Medical schemes should revise their guidelines, policies and criteria for payment of these two services and improve their communication with healthcare providers and members.

Compulsory community service for doctors in South Africa: A 15year review

Background. Compulsory community service (CS) for health professionals for 12 months was introduced in South Africa (SA) in 1998, starting with medical practitioners. Up to 2014, a total of 17 413 newly qualified doctors and ~44 000 health professionals had completed their year of service in public health facilities around the country. While a number of studies have described the experience and effects of CS qualitatively, none has looked at the programme longitudinally.Objectives. To describe the findings and analyse trends from surveys of CS doctors between 2000 and 2014, specifically with regard to their distribution, support, feedback and career plans.Methods. A consecutive cross-sectional descriptive study design was used based on annual national surveys of CS doctors. The study population of between 1 000 and 1 300 each year was surveyed with regard to their origins, allocations, experiences of the year and future career plans.Results. The total study population varied between 1 057 and 1 308 each year, with response rates of 20 - 77%. The average turn-up rate of 89% showed a decreasing tendency, while 77% of respondents were satisfied with the allocation process. Over the 15-year period, the proportion of CS doctors who were black and received a study bursary, and who were allocated to rural areas and district hospitals, increased. The great majority believed that they had made a difference (91%) and developed professionally (81%) over the course of the year, but only about half felt adequately supported clinically and administratively. The attitude towards CS of the majority of respondents shifted significantly from neutral to positive over the course of the 15 years. In terms of future career plans, 50% hoped to specialise, a decreasing minority to go overseas or into private practice, and a constant 15% to work in rural or underserved areas.Conclusions. This study is the first to track the experience of compulsory CS over time in any country in order to describe the trends once it had become institutionalised. The SA experience of CS for doctors over the first 15 years appears to have been a successively positive one, and it has largely met its original objectives of redistribution of health professionals and professional development. Greater attention needs to be given to orientation, management support and clinical supervision, and focusing professional development opportunities on the important minority who are prepared to stay on longer than their obligatory year. CS still needs to be complemented by other interventions to capitalise on its potential

Compulsory community service for doctors in South Africa: A 15-year review

Background. Compulsory community service (CS) for health professionals for 12 months was introduced in South Africa (SA) in 1998, starting with medical practitioners. Up to 2014, a total of 17 413 newly qualified doctors and ~44 000 health professionals had completed their year of service in public health facilities around the country. While a number of studies have described the experience and effects of CS qualitatively, none has looked at the programme longitudinally.Objectives. To describe the findings and analyse trends from surveys of CS doctors between 2000 and 2014, specifically with regard to their distribution, support, feedback and career plans.Methods. A consecutive cross-sectional descriptive study design was used based on annual national surveys of CS doctors. The study population of between 1 000 and 1 300 each year was surveyed with regard to their origins, allocations, experiences of the year and future career plans.Results. The total study population varied between 1 057 and 1 308 each year, with response rates of 20 - 77%. The average turn-up rate of 89% showed a decreasing tendency, while 77% of respondents were satisfied with the allocation process. Over the 15-year period, the proportion of CS doctors who were black and received a study bursary, and who were allocated to rural areas and district hospitals, increased. The great majority believed that they had made a difference (91%) and developed professionally (81%) over the course of the year, but only about half felt adequately supported clinically and administratively. The attitude towards CS of the majority of respondents shifted significantly from neutral to positive over the course of the 15 years. In terms of future career plans, 50% hoped to specialise, a decreasing minority to go overseas or into private practice, and a constant 15% to work in rural or underserved areas.Conclusions. This study is the first to track the experience of compulsory CS over time in any country in order to describe the trends once it had become institutionalised. The SA experience of CS for doctors over the first 15 years appears to have been a successively positive one, and it has largely met its original objectives of redistribution of health professionals and professional development. Greater attention needs to be given to orientation, management support and clinical supervision, and focusing professional development opportunities on the important minority who are prepared to stay on longer than their obligatory year. CS still needs to be complemented by other interventions to capitalise on its potential

Exact non-equilibrium solutions of the Einstein-Boltzmann equations. II

We find exact solutions of the Einstein-Boltzmann equations with relaxational collision term in FRW and Bianchi I spacetimes. The kinematic and thermodynamic properties of the solutions are investigated. We give an exact expression for the bulk viscous pressure of an FRW distribution that relaxes towards collision-dominated equilibrium. If the relaxation is toward collision-free equilibrium, the bulk viscosity vanishes - but there is still entropy production. The Bianchi I solutions have zero heat flux and bulk viscosity, but nonzero shear viscosity. The solutions are used to construct a realisation of the Weyl Curvature Hypothesis.Comment: 16 pages LaTex, CQG documentstyle (ioplppt

The birth of an association : creating African leaders in health professions education

No abstract available.http://www.ajhpe.org.zadm2022Pharmacolog

Medical Students’ and Trainees’ Country-By-Gender Profiles: Hofstede’s Cultural Dimensions Across Sixteen Diverse Countries

Purpose: The global mobility of medical student and trainee populations has drawn researchers’ attention to consider internationalization in medical education. Recently, researchers have focused on cultural diversity, predominately drawing on Hofstede’s cross-cultural analysis of cultural dimensions from general population data to explain their findings. However, to date no research has been specifically undertaken to examine cultural dimensions within a medical student or trainee population. This is problematic as within-country differences between gender and professional groups have been identified within these dimensions. We address this gap by drawing on the theoretical concept of national context effects: specifically Hofstede’s six-dimensional perspective. In doing so we examine medical students’ and trainees’ country profiles across dimensions, country-by-gender clustering, and differences between our data and Hofstede’s general population data. Methods: We undertook a cross-cultural online questionnaire study (eight languages) containing Hofstede’s 2013 Values Survey. Our questionnaire was live between 1st March to 19th Aug 2018, and December 2018 to mitigate country holiday periods. We recruited undergraduate medical students and trainees with at least 6-months’ clinical training using school-specific methods including emails, announcements, and snowballing. Results: We received 2,529 responses. Sixteen countries were retained for analyses (n = 2,307, 91%): Australia, Chile, China, Hong Kong, India, Indonesia, Ireland, Israel, Japan, Malaysia, New Zealand, Pakistan, South Africa, South Korea, Sri-Lanka, Taiwan. Power distance and masculinity are homogenous across countries. Uncertainty avoidance shows the greatest diversity. We identified four country clusters. Masculinity and uncertainty are uncorrelated with Hofstede’s general population data. Conclusions: Our medical student and trainee data provides medical education researchers with more appropriate cultural dimension profiles than those from general population data. Country cluster profiles stimulate useful hypotheses for further research, especially as patterning between clusters cuts across traditional Eastern-Western divides with national culture being stronger than gendered influences. The Uncertainty dimension with its complex pattern across clusters is a particularly fruitful avenue for further investigation.We would like to acknowledge our funders, Ministry of Science and Technology, Taiwan (Grant No. MOST 106-2511-S-182-012-MY2)

A global experience‐sampling method study of well‐being during times of crisis: The CoCo project

We present a global experience-sampling method (ESM) study aimed at describing, predicting, and understanding individual differences in well-being during times of crisis such as the COVID-19 pandemic. This international ESM study is a collaborative effort of over 60 interdisciplinary researchers from around the world in the “Coping with Corona” (CoCo) project. The study comprises trait-, state-, and daily-level data of 7490 participants from over 20 countries (total ESM measurements = 207,263; total daily measurements = 73,295) collected between October 2021 and August 2022. We provide a brief overview of the theoretical background and aims of the study, present the applied methods (including a description of the study design, data collection procedures, data cleaning, and final sample), and discuss exemplary research questions to which these data can be applied. We end by inviting collaborations on the CoCo dataset

A blank page: feedback from first referral hospitals to primary health care clinics

Background: Primary care practitioners depend on the feedback from hospitals in order to care for returning patients effectively. Lack of such feedback from the hospitals leads to frustration, poor efficiency and care that it is not cost effective. This study examined the presence and adequacy of written feedback from first referral hospitals to primary health clinics (PHC) in the Metsweding district, Tshwane, South Africa.Methods: A retrospective descriptive stratified cluster study was done by reviewing 863 patient records selected randomly from referred patients between 1 January 2010 and 31 December 2011 in 6 of the 11 clinics. The clinics were stratified according to type of setting and 6 clinics sampled proportionately.Results: Of the 858 referrals only 5.4% (n = 46) had feedback letters. Details of the patient were listed in 35 (76.0%) of the feed - back letters. There were no contact details for the referring institution or practitioner in almost half of the feedback letters (41.8%; n = 19). Most did not mention the symptoms (87%; n = 40) or signs (89.2%; n = 41) but the majority (58.6%; n = 27) recorded the condition or diagnosis of the patient. The follow-up instructions were documented in 30 letters (65.2%).Conclusions: The low rate of return feedback letters appears to be a commonplace experience and this study both quantifies the extent of this problem and highlights the weaknesses in the letters themselves. The findings reinforce the experiences of practitioners in PHCs and have practical implications for hospital doctors and district hospital managers who wish to strengthen the health system