M. Tech. Organisational Leadership / The objective of this research is to assess the perceptions held by the medical aid schemes and the general public on the National Health Insurance (NHI). It also identifies areas that need attention to improve service delivery through the National Health Insurance model.

Thesis (MTech (Public Management)--Cape Peninsula University of Technology, 2011 / In South Africa’s two-tiered health system, some enjoy health care based on ability to pay and others utilize services in an under-funded sector. The rift in the two, public and private sectors, primarily exists because income categories either curb or allow the necessary contributions. This thesis reports on the various contributing mechanisms, through which health care can be ensured universally, without causing impoverishment. The framework or criteria selected for this study includes feasibility, equity, efficiency and sustainability of a contributing mechanism. Furthermore, the contributing mechanisms – tax-funded, NHI, voluntary health insurance and out-ofpocket – are resident within four health care models namely, Beveridge, Bismarck, NHI and Out-of-pocket. These models are discussed as well as relevant country examples are provided. In the pursuit of answering whether the NHI scheme is suitable for South Africa, the study shows that government or tax-funding and NHI provides the contributing mechanisms that are applicable to the South African situation within the context of different challenges. It is recommended that, in the government’s discussions about health care reform, prepayment, universalism and health care expenditure, amongst others, be considered.

M.Com. (Business Management) / Please refer to full text to view abstract

M.A. (Public Management and Governance) / The study deals with the nature and problems of the proposed National Health Insurance system in South Africa in order to develop a management and governance model to promote universal healthcare in South Africa. The general aim of the study is, therefore, to analyse the concepts and policy initiatives related to the resolution on the National Health Insurance (NHI) scheme being passed at the ANC’s 52nd National Conference in Polokwane in 2009. Calls for a NHI together with relevant legislation and programmes, have consistently formed an integral part of Government’s national effort to build a united national health system in which the public health sector plays a dominant role as provider of first choice. The proposed NHI is a state-mandated and state-administered health insurance scheme that provides universal and comprehensive cover to all South Africans in spite of their financial status. In essence therefore, the vision of the NHI system is to be inclusive of the unemployed and the indigent who will also be afforded the opportunity to receive healthcare which is on par with everyone else’s and not based on what they can or cannot afford. This enquiry is premised on the variables that have influenced the development of South Africa’s healthcare system, the implementation challenges of the proposed NHI, according to the National Health Insurance Policy Paper of 2011, and the lessons that South Africa can derive from the implementation of the national health insurance schemes of Brazil and Ghana. The dissertation concludes that there are certain challenges in the current NHI debate in terms of the lack of technical details on the proposed NHI system, a lack of transparency in terms of the process, as well as problems related to the exclusion of the main stakeholders in the public and private health sector.

M.Com. (Business Management) / The success of National Health Insurance (NHI) according to literature depends on a number of factors; this includes awareness and knowledge of the benefit of the policy by the public, and the increase and equitable utilisation of the healthcare facilities once the policy is promulgated into a law. The aim of this study is to provide insight into what the effect of government communication and public debate has been on creating awareness and building knowledge on the NHI subject amongst university students, and to establish the attitude and readiness status of students to utilize the NHI platform to access healthcare service. A cross-sectional, descriptive, empirical survey was conducted amongst a sample of one hundred and thirteen (n=113) students at the University of Johannesburg to address the research questions. The survey used self-administered questionnaires to gather primary quantitative data. This study deployed rigorous statistical analysis that included both descriptive and inferential statistical analyses methods. Findings from this study revealed that the majority of the students are aware of NHI; albeit possess a low level of functional knowledge on the subject. The majority of the students prospectively show less preference to use NHI to access health compared to using medical aids, and this is more apparent amongst the male students. From this study, undergraduates show more preference to use NHI over medical aids to access healthcare than postgraduate students. This insight about university students will inform policy makers and businesses on how to develop communication and engagement strategies geared at achieving success on NHI development and healthcare access. The study acknowledges the limitations of a small sample size, and the influence of the respondents’ family socio-economic standing on their attitude to NHI as a healthcare access platform.

Thesis (MBA)--Stellenbosch University, 2014. / The South African healthcare industry has undergone numerous changes over the last two decades in both the public and private sectors. These changes have influenced the regulatory landscape of both sectors with the aim of improving accessibility to healthcare services and providers, and making healthcare more affordable for the South African public. The South African government introduced the Medical Schemes Act No. 131 of 1998, in response to issues faced in the medical scheme industry. The act allowed for a board of trustees to regulate medical schemes in their governance (McIntyre, Thiede, Nkosi, Mutyambizi, Castilo-Riquelme, Gilson, Erasmus & Goudge, 2007). The main aim was to ensure medical schemes were able to maintain solvency levels and maintain benefits offered to beneficiaries. The pharmaceutical industry saw legislative changes governing the pricing of medicines, generic substitution of medicines and open ownership of pharmacies. The researcher aimed to provide the medical scheme industry with valuable insight into the challenges experienced by pharmacists, when processing and submitting claims for medical scheme members and their beneficiaries. The intention was to enable the medical scheme industry to improve service quality and efficiency in provider relationships, and customer relationships. The research consisted of qualitative and quantitative research methods. A focus group interview consisted of the initial phase, producing qualitative data. The researcher utilised the qualitative data to construct an online questionnaire, which he then sent out through email, to a larger group of retail pharmacists in KwaZulu-Natal. The majority of retail pharmacists who participated in the research had a limited knowledge of all medical schemes and the different options available in South Africa. The majority of pharmacists in both groups were of the opinion that the redesigning and simplification of computer programmes, utilised for submitting prescriptions, would improve efficiency in service delivery. The research further found that the dissemination of information, on a variety of topics, from medical schemes to their members and service providers, should improve to increase efficiency in service delivery and foster better relationships.

A research report submitted to the Faculty of Humanities, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Arts in Applied Ethics For Professionals, July 2017 / Health and, by extension, healthcare is accepted to be a valuable and important social good that is both a good in and of itself, as well as necessary to achieve life’s goals. Its fair distribution is therefore properly the subject of ethical concern and in the era of modern medicine where costs and potentially limitless treatments exceed available resources, rationing healthcare has become an unavoidable necessity. Since such rationing implies that not everyone’s needs or preferences can be met, a fair and just way of rationing healthcare is a widely debated and controversial topic that, to date, remains unresolved. Where third-party private funding organisations are tasked with these rationing responsibilities, the ethical complexities are compounded by perceived conflicts between the ethical frameworks that govern corporate organisations versus those that govern healthcare. Given the apparent inability of normative theories to resolve the problem of how to ration healthcare fairly, there has been a shift in thinking to considerations of procedural justice and a dominant model, Accountability for Reasonableness (AFR), has emerged as the favoured procedure for healthcare decision-making. The report shows why health is an important social value and examines the key models and principles that dominate the rationing debate as well as why the conflict between healthcare ethics and organisational ethics create additional complexities that must be considered when making these funding decisions. Furthermore it explores the rationales for resorting to procedural accounts with specific emphasis on the parameters and validity of AFR. The report concludes that even though the AFR framework may be a legitimate and just process that can effectively frame decision-making and provide a platform to drive transparency and consistency, like most procedural accounts, it does not guarantee that the outcomes it produces are necessarily fair or just. Therefore a straightforward application of AFR cannot resolve the healthcare rationing debate which should, given its ethical complexity, continue to appeal to the important ethical principles that currently govern the field. / XL2018

The Department of Health (DOH) has embarked on a noble initiative to address the disproportionate distribution of resources and spending within the public and private healthcare sectors. Social Health Insurance (SHI) has thus been mooted as the vehicle to obtain a more equitable healthcare dispensation. This thesis explores the state of preparedness of the DOH, for the implementation of SHI. Ten aspects of health have been identified which will assist in determining if sufficient reforms have been implemented to facilitate the successful implementation of SHI. The prospective mechanism of financing of SHI is compared to the highly acclaimed model employed by the Australian Department of Health. Two research methodologies have been utilized viz. the case study approach and semi structured interviews, to provide comprehensive data. This enabled the researcher to adequately answer the research question. The responses from the respondents on the 10 aspects of healthcare have been arranged into themes to facilitate a greater understanding of the issues being highlighted. Established strategic management instruments have been utilized to analyze the data obtained and evaluate the preparedness of the DOH for the implementation of SHI. Following the data analysis, recommendations are proposed that would facilitate the successful implementation of SHI, thereby promoting its viability and sustainability in providing quality healthcare to all who call South Africa home. / Thesis (MBA)--University of KwaZulu-Natal, 2006.

Thesis submitted in fulfillment of the requirements for the degree Master Technologiae: Biomedical Technology In the Faculty of Health and Wellness Sciences At the CAPE PENINSULA UNIVERSITY OF TECHNOLOGY 2014 / Over the past few decades, it has been shown that various critical diseases including heart disease, cancer, and diabetes associated with free radical generation and low endogenous antioxidant capacity, lead to oxidative stress and cell injury. In recent years, numerous studies have also reported that antioxidants, present in various beverages, vegetables and some foods have attracted a significant research interest due to their potential benefits to human health. However, epidemiological evidence shows a correlation between the intake of food rich in antioxidants and the reduced incidence of some mortality of chronic diseases, certain cancers and coronary heart disease. The aims of this study were to determine the effects of rooibos teas (fermented and unfermented) and green tea as a comparison on the biochemical parameters and the trace element absorption in a rat model. In this study 4 groups of experimental animals were used. All groups had ad libitum access to standard rat chow. Group A, the controls (11 animals), were fed with tap water; group B (11 animals) were fed with the liquid extract of fermented rooibos tea; group C (9 animals) were fed with the liquid extracts of unfermented rooibos and group D (9 animals) were fed with the liquid extract of green tea. All groups were fed for a period of 10 weeks. After the feeding period, the animals were sacrificed by euthanization with intraperitoneal injections of pentobarbital. Blood was sampled by cardiac puncture and centrifuged to obtain the serum. Some elemental analyses were performed with X-ray emission and backscattering. ICP-OES was used to determine the magnesium content. For X-ray emission, backscattering and ICP-OES analyses, 100 μL of each serum sample in a group were added to 2 mL freeze-drying tube. Of the combined specimen, 100 μL was used for the magnesium determination by ICP-OES. The remainder of the combined serum specimens for each group were freeze-dried at -80 ºC and then pressed into a pellet. The pellet was coated with carbon and analyzed using X-ray emission and backscattering. The elemental X-rays of P, S, Ca, Mn, Fe, Cu, Co, Zn, Mo, Ca and Se emitted were quantified to obtain the respective concentrations. Biochemical chemistry analyses were performed on each serum sample of each animal. The biochemical parameters tested for were total protein, albumin, globulin, total bilirubin, lactate dehydrogenase, blood urea nitrogen, uric acid, total cholesterol, aspartate aminotransferase, alanine aminotransferase, creatine phosphokinase and creatinine. The P concentration increased (p=0.028) when fed with the fermented rooibos tea liquid extract and S content increased when fed with the - the unfermented tea liquid extract (p=0.041). The concentrations of Cl and Cr were not affected (p>0.05) by any of tea liquid extracts. The unfermented rooibos tea liquid extract and the green tea indicated a decrease in the concentrations of Fe (p=0.031 and p=0.032, respectively) and Mn (p=0.041 and p=0.034, respectively). The concentrations of Fe, Zn and Cu in the serum increased when feeding with fermented rooibos tea liquid extract (p=0.024; p=0.030 and p=0.015, respectively) while Se, Mo and Mg concentrations were decreased by the liquid extracts of the fermented, unfermented and green teas (p=0.014, p=0.017 and p=0.011; p=0.024, p=0.026 and p=0.019; p=0.031, p=0.034 and p=0.025, respectively). Concerning the biochemical parameters, the total protein, globulin and the uric acid contents in the serum sample were slightly affected with the green tea extract (p=0.041, p=0.039 and p=0.047 respectively). The albumin, lactate dehydrogenase, blood urea nitrogen, the total cholesterol, the alanine aminotransferase and the aspartate aminotransferase concentrations were not affected (p>0) by any of the tea liquid extracts. However, the total bilirubin content was decreased (p=0.012) when feeding with the fermented rooibos group while the creatine phosphokinase and the creatinine contents were decreased (p=0.042 and p=0.033, respectively) when feeding with the unfermented rooibos tea liquid extract.

South Africa possesses a highly fragmented health system with wide disparities in health spending and inequitable distribution of both health care professionals and resources. The national health system (NHI) of South Africa consists of a large public sector and small private sectors which are overused and under resourced and a smaller private sector which is underused and over resourced. In broad terms, the NHI promises a health care system in which everyone, regardless of income level, can access decent health services at a cost that is affordable to them and to the country as a whole. The relevance of this study is to contribute to the NHI debate while simultaneously providing insights from other countries which have implemented national health care systems. As such, the South African government can then appropriately implement as well as finance the new NHI system specific to South Africa’s current socio-economic status. The objective of this study was to examine health care financing models in different countries in order to draw lessons for South Africa when implementing the NHI. A case study was conducted by examining ten countries with a national health insurance system, in order to evaluate the health financing models in each country. The following specific objectives are pursued: firstly, to review the current health management system and the policy proposed for NHI; secondly, to examine health financing models in a selected number of countries around the world and lastly to draw lessons to inform the South African NHI policy debate. The main findings were firstly, wealthier nations tend to have a much healthier population; this is the result of these developed countries investing significantly in their public health sectors. Secondly, the governments in developing nations allocate a smaller percentage of their GDP and government expenditure on health care. Lastly, South Africa is classified as an upper middle income developing country; however, the health status of South Africans mirrors that of countries which perform worse than South Africa on health matters. In other words the health care in South Africa is not operating at the standard it should be given the resources South Africa possesses. The cause of this may be attributed to South Africa being stuck in what is referred to as the “middle income trap” amongst other reasons.