Browsing by Author "Botha, Pieter"

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    The profile and cost of end-of-life care in South Africa - the medical schemes' experience
    (University of Cape Town, 2020) Botha, Pieter; Ramjee, Shivani
    South African medical schemes spend billions of Rands each year on medical care costs for their beneficiaries near their end of life. Hospi-centric benefit design, fee-for-service reimbursement arrangements and fragmented, silo-based delivery of care result in high, often unnecessary spending near the end of life. Factors including an ageing population, increasing incidence rates of cancer and other non-communicable diseases, and high levels of multi-morbidity among beneficiaries near their end of life further drive end-of-life care costs. Low levels of hospice or palliative care utilisation, a high proportion of deaths in-hospital and chemotherapy use in the last weeks of life point to potentially poor-quality care near the end of life. The usual care pathway for serious illness near the end of life acts like a funnel into private hospitals. This often entails resource intensive care that includes aggressive care interventions right up until death. The result is potentially sub-optimal care and poor healthcare outcomes for many scheme beneficiaries and their surviving relatives. Understanding the complex nature of the end of life, the different care pathways, the available insurance benefits, the interactions between key stakeholders and the multitude of factors that drive end-of-life care costs are vital to setting end-of-life care reform in motion. In order to increase value at the end of life, i.e. to increase quality and/or to reduce costs, benefit design reform, alternative reimbursement strategies, effective communication and multi-stakeholder buy-in is key.
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    Using survey data to estimate the prevalence of Diabetes in South Africa - from risk factor analysis to action
    (2024) Klein, Murray; Botha, Pieter
    South Africa is a developing country which has in the last decades experienced a sharp rise in the number of diagnosed diabetes cases. Significant uncertainty exists about the true prevalence of diabetes in South Africa, since many of those suffering from diabetes remain undiagnosed. The large financial burden imposed by diabetes on the public health sector places significant pressure on its ability to effectively deliver quality healthcare to all who rely on it. The Indian Diabetes Risk Score (IDRS) was developed as a low-cost screening tool to assess the potential undiagnosed case prevalence of type 2 diabetes using analysis of risk factors and their association to diabetes. The South African General Household Survey (SAGHS) (StatsSA, 2021a) is used to analyse the risk factors of diabetes on a population through a generalised linear regression model. A synthetic IDRS was calculated from the available population trends and an illustrative prediction of the diabetes prevalence rate was performed using this score. The IDRS could be modified and used in South Africa to model undiagnosed cases of diabetes. Furthermore, the IDRS would allow for government screening to be targeted, thereby allowing for the potential healthcare cost savings.