IMPROVING DISTRIBUTION OF THE HEALTH WORK FORCE – ACHIEVING EQUITY An analysis of the distribution of general practitioners paid by medical schemes across district level healthcare markets AUTHORS Phakamile Nkomo Mondi Govuzela
PEER REVIEWER: Laetitia Rispel
EXECUTIVE SUMMARY There are important reasons to enquire into whether access to healthcare is equally distributed and accessible in the private healthcare industry. One of these is the need to coordinate access through a supply-side regulator to reduce market concentration of healthcare delivery. The second is so that mandatory cover can be achieved, and adverse selection (anti-selection) in the medical schemes industry can thus be curtailed through accessible networks. The third is that the primary care prescribed minimum benefits (PMBs) require access to general practitioners (GPs) for all beneficiaries. We calculated equality indices using density ratios, patient loads, Gini coefficients and Hoover indices. The overall access to GPs is also illustrated using Lorenz curves. We then evaluated access to GPs relative to efficiency ratios by employing data envelopment optimisation techniques. We then used quantile regression to compare the impact of GP supply and the number beneficiaries on the whole distribution of healthcare utilisation across districts in Gauteng. We found that districts with relatively higher density ratios (a high concentration of GPs): i) enjoy large shares of healthcare utilisation, and ii) that adding additional GPs will diminish returns from utilisation at an increasing rate. In the districts with relatively lower density ratios (a low concentration of GPs), the opposite effects apply. It was observed from the Lorenz curves and Gini coefficients that access to GP services is extremely unequal. The findings drawn from quantile regressions show differences in accessing healthcare across districts, although these are not significantly different from the mean estimate derived from ordinary least squares. The policy implications are that a concerted effort should be made to rationalise the distribution of healthcare providers to achieve equal access to primary care.
20 2 0 S O UT H E R N A FR IC A N H E A LT H JO UR N A L P U B L I S H E D B Y T H E B O A R D O F H E A LT H C A R E F U N D E R S
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