Pharmacists' perception of the implementation of the national health insurance in South Africa

Abstract

South Africa is currently in the process of implementing the National Health Insurance (NHI). The aim of this study was to determine pharmacists‘ perception of the implementation of the NHI. A quantitative design was followed by utilising an online, structured questionnaire as the data collection method. The questionnaire was sent to 122 respondents that are pharmacists and hold managerial positions in different pharmaceutical societies and associations, as well as in corporate community pharmacies. The response rate was 18.2%. The data were captured by using Excel® and subsequently analysed using descriptive statistics such as frequencies, percentages, means and standard deviations. In order to establish the opinions and attitudes of the respondents, a Likert scale that offered respondents six pre-coded responses that ranged from one (1) being ―completely disagree‖ to six (6) being ―completely agree‖, was used. The study found that 72.7% of the respondents were of the opinion that the NHI is not the appropriate solution to rectify the inadequate public health system. The respondents were, however, divided on whether the problems the health system is facing can be improved without the implementation of the NHI, but they agreed that targeted action should be taken to deal with current issues (4.81±1.25). In the opinion of the respondents, South Africa does not have the know-how, expertise and knowledge to reform the health system (2.64±1.14) and in addition they indicated that the South African economy cannot afford the implementation of the NHI (1.86±1.32). Furthermore, the respondents felt that should the NHI not be implemented in a proper manner, it will possibly put even more strain on the health system (5.36±1.14) that could lead to further inequalities in healthcare (4.91±1.19). The respondents also suggested that co-payments for medicines and service delivery should be included in the NHI policy as it will prevent the over-use of the healthcare service and thereby reduce moral hazard (66.7%). The study revealed that pharmacists‘ are underutilised in the current health system. According to the respondents the implementation of the NHI creates the opportunity to utilise the pharmacists‘ scarce skills more effectively (72.7%). The respondents were also of the opinion that the pharmacy profession could contribute to the reform of the health system by means of disease management programmes, medicines information services and patient compliance initiatives (5.68±0.48). With the implementation of the NHI, pharmacists‘ primary dispensing role will be minimised and the main focus will be on preventative and curative patient care. A worrying factor is the fact that 68.2% of the respondents indicated that with the implementation of the NHI, the monetary input from the remainder of the population that chooses to continue to use private medical schemes will not be sufficient to support community pharmacies. The respondents, however, felt that community pharmacies should be included as additional medicine distribution points in the NHI system (4.95±1.21) and that this inclusion will promote equity (4.86±0.99). Furthermore, 72.7% of the respondents concluded that it would be financially beneficial for community pharmacies to contract with the NHI. There was consensus (95.5%) that scarce pharmaceutical services should be provided in a Primary Health Care clinic of a community pharmacy as this could lead to better preventative disease management and for the greater part lessen the quadruple burden of disease that South Africa is facing. The respondents also concluded that pharmacists‘ practising in community pharmacies could expand their scope of practice by completing the Primary Care Drug Therapy qualification (81.1%), which will enable them to diagnose and prescribe treatment for all patients of the NHI and private medical aids. It is the opinion of the respondents that this could, in-turn, provide community pharmacies with the human resources required to run a Primary Health Care clinic which could provide scarce pharmaceutical services to all patients (86.4%). The strain that will be put on the NHI facilities by the massive amounts of patients that will be dependent on these facilities will also be lessened (77.3%). In conclusion, it is clear that the respondents did not agree that the NHI is necessarily the best option to reform the healthcare system, but they do, however, feel optimistic that it will create the opportunity to utilise pharmacists‘ scarce skills more effectively