Medical Schemes

Background on health systems.

Kutzin framework showing the four functions of a health system: revenue collection, pooling, purchasing and delivery. Illustrated below for current situation in South Africa.

Download Kutzin frameworks for envisaged stages of reform in South Africa

Purchasing is the process by which pooled funds are paid to providers in order to deliver a specified or unspecified set of health interventions. Purchasing uses different instruments for paying providers, from fee-for-service to budgeting.

The WHO argues that there is a need to move from passive purchasing to strategic purchasing:

* Passive purchasing implies following a predetermined budget or simply paying bills when presented.

* Strategic purchasing involves a continuous search for the best ways to maximize health system performance by deciding which interventions should be purchased, how, and from whom. It involves the use of selective contracting and incentive schemes.

Presentation on the problems at the interface between purchasing and delivery.

Should there be an NHRPL process for administration and managed healthcare costs?

BHF Southern African Conference, Durban, 13-16 July 2008 [slides 722 Kb]

 

Papers referred to in the presentation:

Papers by Prof Nicholas Barr from the London School of Economics.

Investigation into a Procedural Coding System for South Africa, prepared for Deloitte and BHF (not available on either web-site). [Document 995Kb]

Regulating Entrepreneurial Behaviour in European Healthcare Systems.

Richard B. Saltman, Reinhard Busse and Elias Mossialos (ed.) European Observatory.

Purchasing to improve health systems performance  

Josep Figueras, Ray Robinson and Elke Jakubowski (eds.) European Observatory.

Payment-for-Performance (P4P): International Experience ...

Alan Maynard (2008) World Health Organisation Europe

Demutualisation of health insurers in Australia 

Changing Ownership in Australian Private Health Insurance Market. Connelly, ACERH.