Private medical aid membership: What is the impact on health care use and out-of-pocket payments in South Africa?
Document type: Joint Policy Brief:Health Economics Unit, UCT and Centre for Health Policy, Wits
Author/s: John E Ataguba and Jane Goudge
Production Year: 2013
Citation: Ataguba, J.E., Goudge, J. The impact of health insurance on healthcare utilisation and out-of-pocket payments in South Africa. Geneva Papers on Risk and Insurance: Issues and Practice (2012) 37, 633-654.
Summary: In South Africa, medical scheme membership does not guarantee lower out-of-pocket payments. Fees charged by private health care providers have increased and generally exceed the amounts that medical schemes are willing to pay for. Scheme members have to make substantial co-payments. A form of insurance that ensures adequate use of health services is needed. Ideally, this should be a form that ensures universal access to health care, for example, the proposed National Health Insurance. Policy recommendations include the need to move away from fee-for-service payments, and that health insurance should not only ensure adequate use of health services, but also provide financial protection to the insured. The NHI should ensure that out-of-pocket payments are limited.
Human Resources for Health: Summaries
Can we encourage the devotion of nurses? An experimental investigation of the effects of various incentives
Document Type: Report
Creator: Lagarde, M.; Blaauw, D.
Production Year: 2011
Citation: Lagarde, M.; Blaauw, D. Can we encourage the devotion of nurses? An experimental investigation of the effects of various incentives. (2011) 23 pp.
Summary: The existence and the role of social preferences in influencing individual decisions have been widely described. Research has also underlined how critical it is to take into account social preferences when designing incentives to influence individual choices. Social preferences are potentially very relevant to the analysis of decisions made by health care workers. Governments in developed and developing countries have tried to create incentives to shape health workers? behaviours in various areas, and in particular to encourage them to take up posts in under-served areas.
We designed a within-subject lab experiment to test the impact of various incentives designed to encourage decisions that benefit patients and are costly to health workers. We played the experiment with 1,064 nursing students: 377 from South Africa; 342 from Kenya; and 345 from Thailand. Each participant in our experiment had to make a series of allocation decisions which differed in the distribution of payoffs between themselves and a patient, in five different treatments. The design of treatments was guided by considering their relevance to potential regulations that could be enforced to alter job choices made by nurses, and their relevance to contextual factors that are more likely to affect nurses’ choices.
The results showed a large variation in the extent to which the four types of incentives could encourage the devotion of nursing students, in their willingness to accept a reduction in their benefits to yield greater welfare for patients. The prospect of delayed rewards was only effective in Thailand, but even there it was much less persuasive than incentives that used information, either to convey indirectly the deservingness of patients, or to encourage generosity through indirect peer-pressure. Interestingly, an arbitrarily unfair environment where some participants were offered less favourable benefits than the others had the cumulative effect of crowding out the altruistic motives of the victims of the unfair decisions, as well as the others.
These findings provide interesting elements for policy-makers to design measures to increase the devotion of nurses, and caution them to avoid creating an institutional environment that could be perceived as unfair.
Differential calculus: the impact of group norms, social values and identity on altruism
Document Type: Report
Creator: Lagarde, M.; Blaauw, D.; Smith, R.
Production Year: 2011
Citation: Lagarde, M.; Blaauw, D.; Smith, R. Differential calculus: the impact of group norms, social values and identity on altruism. (2011) 30 pp.
Summary: In this study, we played the dictator game with more than 1,200 nursing students and economics students in three low- and middle-income countries: Kenya, South Africa and Thailand.
We found significant differences in altruistic behaviours between subject pools, with nursing students being more altruistic dictators than economics students, and systematic differences across countries. Dictators’ generosity increased with the perceived deservingness of the recipient, but the sense of moral obligation varied across subject pools in unexpected ways. Our results caution against generalising experimental results based on standard subject pools, and originating from specific contexts.
Policy interventions to improve health worker retention in rural areas: Results from the CREHS Cohort Study in South Africa
Document Type: Report
Creator: Erasmus, E.; Blaauw, D.
Production Year: 2011
Citation: Erasmus, E.; Blaauw, D. Policy interventions to improve health worker retention in rural areas: Results from the CREHS Cohort Study in South Africa. (2011)
Summary: Over the years, various initiatives have been implemented to attract health workers and retain them in rural areas, including the employment of foreign doctors in rural areas, community service and the payment of rural allowances. This report asks what policy interventions are most likely to be effective in improving the recruitment and retention of health workers in rural areas. A research project was initiated with a group of final-year nursing students about to graduate in South Africa and the idea is to keep collecting data from them for as long as possible in order to track their career decisions and progression over time.
CREHS Policy Briefing
Influencing health systems policy and practice: Experiences from the Consortium for Research on Equitable Health Systems
There is a growing interest in the role of research in policymaking processes. This has been driven by an evidence-based policy movement which advocates the use of evidence to strengthen policy and practice. At the same time leading research funders, in particular those working in international health and development, are increasingly concerned about the practical implications of research and how these can be used to save lives and reduce poverty. Download the document
Nurses attitudes towards working and living in rural areas, November 2009
The cohort study began in 2008 when 377 final-year nursing students were recruited to be part of the research. The objective is to track the cohort members, most of whom are currently doing community service, over a number of years to understand where they end up working and how and why they decide to take certain jobs in certain places, and not others. Download the document.
The need for the active and strategic management of local-level policy implementation, October 2009
Policies are not implemented just because they exist on paper. When implemented, they often confound the expectations of policy makers and take forms different from the visions outlined in policy documents. This is because policy implementation processes are dynamic. Download the document.
Equity Briefings September 2007
Are South Africa?s new health policies making a difference?
Since 1994 the South African government has placed equity at the heart of its health policy goals. Yet, how successful have the policies been in reducing inequity? This study provides some answers, based on evidence from household studies carried out between 1992 and 2003. Download the document.
Commercialisation and extreme inequality in the South African health system
A case study of the South African health system shows that, despite new policies promoting equity, the divisions within the health sector between rich and poor, black and white, insured and uninsured have deepened since 1994. The paper presents evidence to show that tackling this apartheid legacy requires controlling the forces driving commercialisation in the public sector and integrated regulation of the private sector. In addition, a coherent vision that defines the roles of both public and private agents within a health system that promotes equity is essential. Download the document
Embrace the change: how local accountability mechanisms can improve primary health care services
Greater community participation in health care is a key principle of South Africa?s health policy. To facilitate such participation and improve service delivery, there are mechanisms that help to make service providers accountable to the communities they serve. Yet such mechanisms are not working effectively. This investigative study calls for a shake up of the old form of state?society relations that undermine accountability mechanisms. Download the document.
Improve health service delivery through building trust
New research shows that a lack of trust lies at the heart of current weaknesses in local service delivery. Mechanisms that develop relationships based on trust are needed to improve accountability between citizens, service providers and policy-makers. This study identifies factors that help to strengthen such relationships. Download the document.
Cost still a barrier to primary health care for rural poor in South Africa
Since 1994, South African health polices have sought to reduce inequity within the health system. User fees for primary health care services for low-income households were removed in 1994. Yet data collected during 2003 ? 2004 from a rural household survey indicate that low-income households still face greater barriers to accessing health care than higher income households. Download the document.