The impact of changes to healthcare payment arrangements on private healthcare in South Africa

Abstract

Alternative healthcare reimbursement models (ARMs) have been implemented around the world in order to ensure that quality, evidence-based medicine remains affordable and accessible as health service delivery costs continue to rise. The South African private healthcare system has traditionally relied on a fee-for-service (FFS) model, which is not sustainable within the current environment. One such model is the recent introduction of an arthroplasty bundled payment arrangement. The objective of the study is to evaluate the interpretation of the recently implemented model amongst all the relevant stakeholders involved in delivering care for their patients related to an arthroplasty procedure. Using a qualitative design, with theoretical insights from the literature, the bundled payment arrangement has been reviewed with all the relevant participants in order to assess the arrangementÕs merits within the South African private healthcare system. The findings of the study confirm many of the benefits for which the model was designed, but the research also identifies areas where the model could be modified and/or improved. In addition, cliniciansÕ concerns about the ARMs are highlighted. At the same time, the research exposes some of the positive future trends in healthcare reimbursement, and the potential role of the event-based contract (EBC). The research provides an insider view and insights that may be of immense value for those involved in designing or redesigning an ARM, specifically for the local healthcare environment. In addition, the study sheds light on possible considerations for rolling out the National Health Insurance (NHI) scheme, as the country seeks to provide improved access and quality healthcare to all citizens.