Contracting of private medical practitioners in a National Health Insurance pilot district: What has been the effect on primary healthcare utilisation indicators?
National Health Insurance pilot project
medical practitioners contracting
Journal
African journal of primary health care & family medicine
ISSN: 2071-2936
Titre abrégé: Afr J Prim Health Care Fam Med
Pays: South Africa
ID NLM: 101520860
Informations de publication
Date de publication:
28 Oct 2020
28 Oct 2020
Historique:
received:
21
05
2020
accepted:
29
07
2020
revised:
23
07
2020
entrez:
13
11
2020
pubmed:
14
11
2020
medline:
19
8
2021
Statut:
epublish
Résumé
In 2012, the National Department of Health in South Africa started contracting of private medical practitioners (MPs) as part of the first phase of National Health Insurance (NHI) in 11 pilot districts to improve access to healthcare. The aim of this study was to describe the effect of contracting private MPs on the utilisation of primary healthcare (PHC) services in public healthcare facilities. A National Health Insurance pilot district compared to a non-pilot district. A quasi-experimental ecological study design was used to compare selected PHC utilisation indicators in the District Health Management Information System from June 2010 to May 2014 between a pilot and a non-pilot district. Both single and controlled interrupted time series analyses were used for comparing before and after implementation of the intervention. Single interrupted time series analysis showed an increase in adults remaining on anti-retroviral therapy, clients seen by a nurse practitioner and clients 5 years of age and older in both districts. However, controlled interrupted time series analysis found no difference in all parametres. Despite a decrease in total headcounts in both districts using single interrupted time series analysis, controlled interrupted time series analysis found no differences in all parameters before and after the intervention. The increase in utilisation of PHC services in the pilot district may not be attributable to the implementation of contracting private MPs, but likely the result of other healthcare reforms and transitions taking place in both districts around the same time.
Sections du résumé
BACKGROUND
BACKGROUND
In 2012, the National Department of Health in South Africa started contracting of private medical practitioners (MPs) as part of the first phase of National Health Insurance (NHI) in 11 pilot districts to improve access to healthcare.
AIM
OBJECTIVE
The aim of this study was to describe the effect of contracting private MPs on the utilisation of primary healthcare (PHC) services in public healthcare facilities.
SETTING
METHODS
A National Health Insurance pilot district compared to a non-pilot district.
METHODS
METHODS
A quasi-experimental ecological study design was used to compare selected PHC utilisation indicators in the District Health Management Information System from June 2010 to May 2014 between a pilot and a non-pilot district. Both single and controlled interrupted time series analyses were used for comparing before and after implementation of the intervention.
FINDINGS
RESULTS
Single interrupted time series analysis showed an increase in adults remaining on anti-retroviral therapy, clients seen by a nurse practitioner and clients 5 years of age and older in both districts. However, controlled interrupted time series analysis found no difference in all parametres. Despite a decrease in total headcounts in both districts using single interrupted time series analysis, controlled interrupted time series analysis found no differences in all parameters before and after the intervention.
CONCLUSIONS
CONCLUSIONS
The increase in utilisation of PHC services in the pilot district may not be attributable to the implementation of contracting private MPs, but likely the result of other healthcare reforms and transitions taking place in both districts around the same time.
Identifiants
pubmed: 33181881
doi: 10.4102/phcfm.v12i1.2563
pmc: PMC7670007
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e1-e10Références
N Engl J Med. 2013 Oct 10;369(15):1385-7
pubmed: 24106930
Afr J Prim Health Care Fam Med. 2015 Jun 19;7(1):
pubmed: 26245611
Eur J Health Econ. 2010 Oct;11(5):437-47
pubmed: 19756796
Bull World Health Organ. 2008 Jan;86(1):46-51
pubmed: 18235889
Curationis. 2016 May 13;39(1):1545
pubmed: 27246793
Hum Resour Health. 2009 Feb 20;7:15
pubmed: 19232120
Int J Med Inform. 2016 Nov;95:60-70
pubmed: 27697233
PLoS One. 2012;7(6):e39282
pubmed: 22723985
Int J Equity Health. 2013 Feb 27;12:16
pubmed: 23446355
Fam Pract. 1985 Jun;2(2):122-3
pubmed: 4007314
S Afr Med J. 2018 Mar 28;108(4):329-335
pubmed: 29629685
Int J Epidemiol. 2017 Feb 1;46(1):348-355
pubmed: 27283160
Health Policy. 2009 May;90(2-3):214-22
pubmed: 19036467
BMJ. 2015 Jun 09;350:h2750
pubmed: 26058820
J Health Econ. 2009 Jan;28(1):1-19
pubmed: 19058865
N Engl J Med. 2014 Oct 2;371(14):1344-53
pubmed: 25265493
Acad Pediatr. 2013 Nov-Dec;13(6 Suppl):S38-44
pubmed: 24268083
Bull World Health Organ. 2005 Apr;83(4):274-9
pubmed: 15868018
BMC Int Health Hum Rights. 2016 Aug 30;16(1):21
pubmed: 27576456
Foot Ankle Int. 2018 Mar;39(3):387
pubmed: 29406785
Lancet. 2008 Sep 13;372(9642):893-901
pubmed: 18790312
S Afr Med J. 2014 Mar;104(3 Suppl 1):249-51
pubmed: 24893502
Health Econ Rev. 2012 Jul 23;2(1):13
pubmed: 22828034
Soc Sci Med. 2016 Feb;151:157-66
pubmed: 26803656