Moving from a bad to a good pricing regime: The South African private health care market

Author(s):  
Eric Picard ◽  
Alexander Zimper
Author(s):  
Miriam E. Meyer ◽  
De Wet Swanepoel ◽  
Talita Le Roux

Objective: A national survey of early hearing detection and intervention services was undertaken to describe the current status of diagnostic and intervention services in the South African private health care sector.Methods: All private hospitals with obstetric units (n = 166) were surveyed telephonically. The data was integrated with data collected from self-administered questionnaires subsequently distributed nationally to private audiology practices providing hearing screening at the respective hospitals reporting hearing screening services (n = 87). Data was analysed descriptively to yield national percentages and frequency distributions.Results: Average reported age at diagnosis was 11 months. Most participants (74%) indicated that less than 20% of infants fitted with hearing aids received amplification before the age of 6 months. Most (64%) participants indicated that the average period between confirmed diagnosis and hearing aid fitting was 1 month, on par with international benchmarks. Only 16%–23% of participants included all diagnostic procedures recommended by the Health Professions Council of South Africa’s 2007 position statement for minimum diagnostic test batteries for infants and young children.Conclusions: Diagnosis of hearing loss, hearing aid fitting and audiological intervention is delayed significantly in the South African private health care sector. Improved services should include integrated systematic hospital-based screening as part of birthing packages with diagnostic referral to specialist paediatric audiologists for accurate assessment and management of patients in a timely manner.


2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Dhokotera Tafadzwa ◽  
Riou Julien ◽  
Bartels Lina ◽  
Rohner Eliane ◽  
Chammartin Frederique ◽  
...  

Abstract Background Disparities in invasive cervical cancer (ICC) incidence exist globally, particularly in HIV positive women who are at elevated risk compared to HIV negative women. We aimed to determine the spatial, temporal, and spatiotemporal incidence of ICC and the potential risk factors among HIV positive women in South Africa. Methods We included ICC cases in women diagnosed with HIV from the South African HIV cancer match study during 2004–2014. We used the Thembisa model, a mathematical model of the South African HIV epidemic to estimate women diagnosed with HIV per municipality, age group and calendar year. We fitted Bayesian hierarchical models, using a reparameterization of the Besag-York-Mollié to capture spatial autocorrelation, to estimate the spatiotemporal distribution of ICC incidence among women diagnosed with HIV. We also examined the association of deprivation, access to health (using the number of health facilities per municipality) and urbanicity with ICC incidence. We corrected our estimates to account for ICC case underascertainment, missing data and data errors. Results We included 17,821 ICC cases and demonstrated a decreasing trend in ICC incidence, from 306 to 312 in 2004 and from 160 to 191 in 2014 per 100,000 person-years across all municipalities and corrections. The spatial relative rate (RR) ranged from 0.27 to 4.43 in the model without any covariates. In the model adjusting for covariates, the most affluent municipalities had a RR of 3.18 (95% Credible Interval 1.82, 5.57) compared to the least affluent ones, and municipalities with better access to health care had a RR of 1.52 (1.03, 2.27) compared to municipalities with worse access to health. Conclusions The results show an increased incidence of cervical cancer in affluent municipalities and in those with more health facilities. This is likely driven by better access to health care in more affluent areas. More efforts should be made to ensure equitable access to health services, including mitigating physical barriers, such as transportation to health centres and strengthening of screening programmes.


2010 ◽  
Vol 15 (1) ◽  
Author(s):  
Zelda Wasserman ◽  
Susanna C.D. Wright ◽  
Todd Mavis Maja

Literacy levels are increasingly important in health care because professional nurses and other health care professionals often use written health education materials as a major component in patient education. In South Africa, no current instrument is available to assess the literacy levels of patients in the primary health care setting, though several instruments have been developed and validated internationally. The purpose of this paper was to adapt and validate the Rapid Estimate of Adult Literacy in Medicine Revised (REALM-R) to the South African context. The REALM-R is a short instrument that is designed to rapidly screen clients in the primary health care setting for low health literacy. A modified Delphi-technique was used to measure the judgement of a group of experts for the purpose of making a decision. Eight experts in the field of Nursing Science were selected purposively to obtain the most reliable consensus. Data was collected by means of a selfreport whereby participants responded to a series of questions posed by the researcher. Descriptive statistics was used for analysing data. The REALM-R was adapted to the South African context to ensure that the literacy level of South African clients is measured with an appropriate instrument.OpsommingGeletterdheidsvlakke word toenemend belangrik in gesondheidsorg aangesien geregistreerde verpleegkundiges en ander gesondheidswerkers dikwels geskrewe gesondheidopvoedkundige materiaal gebruik. Op die oomblik in Suid-Afrika is daar geen geletterdheidsvlaksinstrument beskikbaar om pasiënte in primêre gesondheidsorg se geletterdheid te toets nie. Daar bestaan wel gevalideerde internasionale instrumente. Die doel van die studie was om die REALM-R, ‘n internasionaal gevalideerde mediese geletterdheidsinstrument, aan te pas en te valideer om in die Suid-Afrikaanse konteks gebruik te kan word. Die REALM-R is ‘n kort geletterdheidsinstrument wat ontwikkel was om primêre sorg pasiênte wat moontlik lae geletterdheidsvaardigheid het, te kansif. ‘n Aangepasde Delphi-tegniek is gebruik om die oordeel van ‘n groep kundiges in te win. Agt kundiges in verpleegwetenskappe is doelgerig gekies ten einde ‘n betroubare ooreenkoms te verkry.Data is deur middel van self-raportering ingewin deurdat die deelnemers op vrae, gestel deur die navorser, geantwoord het. Beskrywende statistiek is gebruik om die data te ontleed. Die REALM-R is aangepas vir die Suid-Afrikaanse konteks ten einde ‘n geskikte instrument beskikbaar te stel om die geletterdheidsvaardigheid van primêre sorg pasiente vinnig en akkuraat te kan meet.


2001 ◽  
Vol 57 (2) ◽  
pp. 32-40 ◽  
Author(s):  
L. A. Hale ◽  
C. J. Eales

This paper presents the opinions of expert physiotherapists on what constitutes optimal stroke rehabilitation in South Africa. Data were collected by the use of the Delphi technique. Consensus was reached after two rounds, and the respondents’ views are summarised and discussed within the framework of South African health care. Results showed that physiotherapy was felt to be very important after stroke, and the survey created a profile of the skills that physiotherapists may require in order to work in this field. However, no new or innovative methods by which appropriate rehabilitation services could be delivered in South Africa were generated by the survey.The Delphi technique is described and its use in this survey considered.


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