Browsing by Author "Ramjee, Shivani"
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- ItemOpen AccessAnalysing the structure and nature of medical scheme benefit design in South Africa(2015) Kaplan, Josh Tana; Ramjee, ShivaniThis dissertation intends to shed light on open-membership medical scheme benefit design in South Africa. This will be done by analysing the benefit design of 118 benefit options, so as to provide an overview of the structure and nature of the benefit offerings available in the market in 2014. In addition, affordability of these benefit options was analysed in order to identify whether or not there exist connections between the benefits on offer and the price of cover. This paper will argue that at present, the large number of benefit options available in the market, the lack of standardisation between benefit options, together with the mosaic of confusing terminology employed in scheme brochures, creates a highly complex environment that hampers consumer decision making. However, this implicit complexity was found to be necessary owing to the incomplete regulatory environment surrounding medical schemes. The findings of this investigation show that benefit design requires significant attention in order to facilitate equitable access to cover in South Africa.
- ItemOpen AccessThe construction of a price index for the South African Medical Scheme Industry(2010) Ramjee, Shivani; Dorrington, RobA methodology is proposed for constructing a price index that reflects the change in the prices of the goods and services purchased by medical schemes in South Africa. The methodological choices were made taking cognisance of the unique characteristics of the South African medical scheme environment, both in terms of the factors influencing the mix of goods and services purchased by medical schemes, as well as the factors affecting price determination. An example of a pharmaceutical price index was constructed to illustrate the proposed methodology, the results of which are presented. Whilst the proposed methodology provides a base for creating a meaningful and useful medical scheme price index there is considerable further work that needs to be done to refine the methodology.
- ItemOpen AccessThe evaluation of case-mix adjusted efficiency scores the case of the South African private hospital industry(2013) Dreyer, Kathryn Ann; Ramjee, ShivaniThere is little existing South African literature relating to hospital efficiency that allows for differences in case mix across hospitals. One of the primary motivations for this dissertation is to help fill this gap in the literature by examining the impact that adjusting for differences in case mix has on efficiency scores. Data Envelopment Analysis (DEA) is chosen as the efficiency measurement method because of its exibility and ease of handling multiple inputs and outputs. A number of DEA models are applied to a sample of South African private hospitals for the years 2008 to 2011 inclusive. Three different case-mix adjustment techniques are investigated and their ability to capture differences in case mix is assessed. The three techniques investigated are: a case-mix adjustment factor (constructed using Diagnosis-Related Groups (DRGs)) to adjust outputs; including the case-mix adjustment factor as an additional output; and disaggregating hospital admissions into broad categories which are used as outputs. A comparison of the unadjusted model with the case-mix adjusted model reveals that omitting the adjustment can have a considerable impact on efficiency scores. Whilst little difference is noted in average efficiency scores for the group of hospitals, 90% for the unadjusted model and 92% for the adjusted model in 2011, there are substantial differences between the adjusted and unadjusted efficiency scores of individual hospitals. On comparison of the three different techniques investigated, it is evident that if there is sufficient data to construct a case-mix adjustment factor, case-mix adjusted admissions should be used, rather than using the factor as an additional output variable. In the case where insufficient data is available, disaggregating admissions does capture some of the differences in case mix but a substantial amount of power is lost as a result of increasing the number of output variables.
- ItemOpen AccessThe profile and cost of end-of-life care in South Africa - the medical schemes' experience(University of Cape Town, 2020) Botha, Pieter; Ramjee, ShivaniSouth 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.
- ItemOpen AccessUsing DEA to profile in-hospital surgeon services: A South African funder perspective(2014) Abraham, Matan; Ramjee, Shivani; Dreyer, Kathryn AnnThe comparative assessment of physician performance, also known as ‘physician profiling’ is frequently used by healthcare funders. It aims to identify and improve the resource efficiency and quality of physician care. South African private healthcare funders use a wide range of profiling techniques; however, currently the use of frontier analysis is absent. This study explores the use of the non - parametric frontier analysis technique called Data Envelopment Analysis (DEA) for the profiling of physicians in South Africa. This is investigated by following a DEA profiling approach to evaluate the performance of 403 general/ paediatric surgeons in providing in - hospital services in 2012. A 7 - input 1 - output VRS DEA model is used to determine the efficiency of the surgeons. The profiling results are then analysed to determine their usefulness. It results reveal that 58 surgeons are efficient, representing only 14.4% of surgeons profiled. Therefore, the DEA approach reveals a large potential for efficiency improvements. The average efficiency score of inefficient surgeons is found to be 0.68. This means that, on average, inefficient surgeons have to decrease resource utilisation by 32% to achieve efficiency. The DEA approach is also found to be proficient at identifying the physicians presenting the most severe levels of inefficiency. 37 surgeons are found to be significantly inefficient. The approach also allows for the identification of peers against which inefficient surgeons are able to directly compare their practices. These results are determined to be of significant potential use to South African private healthcare funders. It is, however, noted that the analysis and results obtained was solely of a statistical nature. Closer consideration of the clinical appropriateness of the results is essential. In any case, this study concludes that a DEA profiling approach can be considered a useful technique in the comparison of physician performance in South Africa.