Mukudu Hillary, Otwombe Kennedy, Moloto Caiphus, Fusheini Adam, Igumbor Jude
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Health SA. 2021 May 31;26:1580. doi: 10.4102/hsag.v26i0.1580. eCollection 2021.
Contracting private medical practitioners for the National Health Insurance pilot project in 2012 by the National Department of Health in South Africa was envisaged to reduce workload at referral district hospitals by reducing self-referral by clients as the perceived quality of care at the primary healthcare level improves.
To describe the effect of contracting private medical practitioners at primary healthcare facilities on the self-referral rate of clients at district hospitals as a proxy for perceived quality of care in a National Health Insurance pilot district.
The study was set in Tshwane National Health Insurance pilot district compared to Ekurhuleni district.
We compared findings before and after implementing the National Health Insurance private medical practitioners contracting between a pilot and a non-pilot district. A quasi-experimental ecological study design was used to compare district hospital outpatient department indicators of clients follow-up, self-referral, self-referral rate and referred in the two districts from June 2012 to May 2014 using single and controlled interrupted time-series analyses.
Controlled interrupted time series analysis found decreases in self-referral rate (-1.8 [-2.2, -1.1] [ < 0.0001]) and the initial trend of headcounts of self-referral (-516 [-969, -66] [ = 0.0260]), but an increase in headcounts of referred clients (1293 [77, 2508] [ = 0.0376]) in the pilot compared with the non-pilot district.
We concluded that the implementation of contracting private medical practitioners in primary healthcare facilities might have resulted in an improved perceived quality of care at primary health care facilities. However, the higher number of outpatient department headcounts for follow-up and the increase in referred cases in the pilot district would need to be investigated.
南非国家卫生部在2012年为国家医疗保险试点项目签约私人执业医生，旨在随着初级卫生保健层面的医疗服务质量提升，减少患者的自我转诊，从而减轻转诊地区医院的工作量。
描述在初级卫生保健机构签约私人执业医生对地区医院患者自我转诊率的影响，以此作为国家医疗保险试点地区医疗服务质量感知的一个指标。
该研究以茨瓦内国家医疗保险试点地区与埃库鲁莱尼地区进行对比。
我们比较了试点地区和非试点地区实施国家医疗保险私人执业医生签约前后的结果。采用准实验性生态研究设计，通过单组和对照中断时间序列分析，比较2012年6月至2014年5月期间两个地区医院门诊部患者随访、自我转诊、自我转诊率和转诊的指标。
对照中断时间序列分析发现，与非试点地区相比，试点地区的自我转诊率下降（-1.8 [-2.2, -1.1] [P < 0.0001]），自我转诊人数的初始趋势下降（-516 [-969, -66] [P = 0.0260]），但转诊患者人数增加（1293 [77, 2508] [P = 0.0376]）。
我们得出结论，在初级卫生保健机构签约私人执业医生的做法可能提高了初级卫生保健机构的医疗服务质量感知。然而，试点地区门诊部随访人数较多以及转诊病例增加的情况需要进一步调查。
