RESUMEN
The cost of healthcare is an issue of concern for both consumers and funders of healthcare in South Africa. The country spends approximately 8% of GDP on health care. Health care is financed through the public sector which covers 86% of the population and the private sector which covers 14% of the population. Medical schemes are the main source of healthcare financing in the private sector. Services covered by medical schemes include chronic diseases, emergencies, diagnosis, and treatment of a selected number of diseases. Primary health care services such as screening are limited. The aim of this study was to assess factors associated with members of medical schemes' willingness to pay for a primary health care package in the private sector. A cross-sectional survey was conducted amongst principal members of medical schemes between July and September 2020. All principal members with access to an online questionnaire were eligible to participate in this study. Logistic regression was used to identify factors associated with willingness to pay for primary health care services. A total of 6512 members of medical schemes participated in the study. Thirty-five percent of the participants were willing to pay for the primary health care package. Factors influencing willingness to pay included marital status, employment status, income and household size. The study highlights the need for policymakers to consider socioeconomic factors when designing health care policies.
RESUMEN
South Africa has embarked on major health policy reform to deliver universal health coverage through the establishment of National Health Insurance (NHI). The aim is to improve access, remove financial barriers to care, and enhance care quality. Health technology assessment (HTA) is explicitly identified in the proposed NHI legislation and will have a prominent role in informing decisions about adoption and access to health interventions and technologies. The specific arrangements and approach to HTA in support of this legislation are yet to be determined. Although there is currently no formal national HTA institution in South Africa, there are several processes in both the public and private healthcare sectors that use elements of HTA to varying extents to inform access and resource allocation decisions. Institutions performing HTAs or related activities in South Africa include the National and Provincial Departments of Health, National Treasury, National Health Laboratory Service, Council for Medical Schemes, medical scheme administrators, managed care organizations, academic or research institutions, clinical societies and associations, pharmaceutical and devices companies, private consultancies, and private sector hospital groups. Existing fragmented HTA processes should coordinate and conform to a standardized, fit-for-purpose process and structure that can usefully inform priority setting under NHI and for other decision makers. This transformation will require comprehensive and inclusive planning with dedicated funding and regulation, and provision of strong oversight mechanisms and leadership.