Implementation of National Health Insurance in South Africa: views of healthcare managers in a private healthcare institution
- Authors: Grewar, David Alan
- Date: 2017
- Subjects: National health insurance -- South Africa , Health care reform -- South Africa , Medical personnel -- South Africa
- Language: English
- Type: Thesis , Masters , MA
- Identifier: http://hdl.handle.net/10948/7503 , vital:21789
- Description: South Africa is in the process of reforming its healthcare system by implementing universal health coverage for its citizens. Universal health coverage is defined as the access of all people to comprehensive health services at an affordable cost with protection against catastrophic health expenditures leading to financial hardship. The system being implemented in South Africa is known as National Health Insurance (NHI) and is seen by the South African government as the key to addressing the shortcomings and disparities in the current public and private healthcare sectors. Healthcare managers have a crucial role to play in health reform yet are often overlooked in debate over health reform. The primary aim of this study was to better understand the views of healthcare managers, working in a private healthcare institution in South Africa, towards the implementation of the NHI. The purpose of this was to make recommendations that would assist the private healthcare institution under investigation to optimise the implementation of the NHI. A quantitative research design was used to explore and describe the views of healthcare managers. Firstly, a literature review was conducted to gain international as well as local perspectives of healthcare practitioners on universal health coverage. Secondly, a census survey in the form of an online questionnaire was developed and distributed to 193 healthcare managers representing different managerial and medical disciplines in a private healthcare institution with facilities nation-wide. A total of 63 questionnaires were returned for analysis. Quantitative data were analysed using Microsoft Excel, Statistica and SPSS Statistics. Qualitative data in the form of written comments by the participants were analysed using interpretive analysis that involved sequential steps of familiarisation and immersion, development of themes, coding, elaboration and interpretation and checking. The qualitative element of the study was limited in nature and was used merely to enrich the quantitative findings. The study found that there was a lack of knowledge amongst private healthcare managers concerning the NHI, poor communication from the government regarding the proposed NHI and high levels of negativity towards the ability of the government to successfully implement the NHI. However it was found that despite concerns regarding the NHI, the private healthcare managers surveyed showed a willingness to actively participate in its implementation. Recommendations regarding policy and practise were made for private healthcare institutions as well as for the South African government in order to assist with the implementation of the NHI.
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- Date Issued: 2017
Servant and ethical leadership of self-employed healthcare practitioners in the Eastern Cape and Western Cape
- Authors: Hlongwane, Nomasonto Sophie , Farrington, Shelley
- Date: 2016
- Subjects: Health facilities -- Administration , Leadership -- South Africa , Medical personnel -- South Africa
- Language: English
- Type: Thesis , Masters , MCom
- Identifier: http://hdl.handle.net/10948/6969 , vital:21180
- Description: Healthcare is the main contributor to the well-being of the population and the country. Healthcare services ensure that the country has a healthy and productive workforce which influences economic growth. Self-employed healthcare practitioners are key role players in the healthcare system in South Africa. However they are faced with several challenges that affect their relationship with their employees and the service offered in their practises. A lack of leadership skills, professionalism, budget constraints, corruption, increased legislation, medical negligence, poor human resources and poor management are mentioned in this study as part of the challenges facing self-employed healthcare practitioners. Against this background, the primary objective of this study was to establish the level of Servant and Ethical leadership displayed by self-employed healthcare practitioners in both the Eastern Cape and Western Cape, and to investigate whether the dimensions of these leadership styles influence Job satisfaction and Perceived financial performance. In this study a quantitative approach was adopted. A form of purposive sampling called criterion sampling was used to draw the sample for this study. The sample consisted of self-employed healthcare practitioners and their employees in the Eastern and Western Cape Provinces. The survey methodology was implemented using self-administered structured questionnaires. A total of 241 questionnaires were deemed usable, and were subjected to statistical analysis. Factor analysis was used to assess the validity of the independent (dimensions of Servant and Ethical leadership) and dependent variables (Job satisfaction and Perceived financial performance). More specifically, factor analysis was utilised to conduct tests of uni-dimensionality and principal components were used as the extraction method to produce an unrotated factor matrix. Concerning validity assessments, only factors with two or more items loading on them were included for further analysis. Items that did not load were discarded and were subsequently excluded from further statistical analysis. In this study, four items intended to measure Job satisfaction all loaded together as expected. Of the six items intended to measure Perceived financial performance, five items loaded together. Only one item did not load onto this factor and was excluded from further analysis. The items measuring the dimensions of Servant leadership, namely Humility, Servanthood, Caring for others and Developing others, loaded onto the respective factors as expected. All items measuring the dimensions of Ethical leadership, namely Integrity, Ethical commitment, Ethical guidance, Fairness and Sustainability, also loaded as expected. The Cronbach‟s alpha coefficients for all variables were greater than 0.7 which provided sufficient evidence of reliability of the scales. Statistical techniques used to analyse the empirical data, which included the descriptive statistics, Pearson product moment correlations and multiple regression (MRA). T-tests were explained as the method used to determine whether significant differences existed in the mean scores of self-employed healthcare practitioners and their employees for the leadership styles (Servant and Ethical leadership) under investigation. The results of the study show that for the dimensions of Servant leadership, both the healthcare practitioners and their employees returned the highest mean for Caring for others. The majority of self-employed healthcare practitioners agreed that they adopted these dimensions. The majority of employees also agreed that the self-employed healthcare practitioners use these dimensions. Statistically significant differences were found in terms of the mean scores returned for the level of Humility and Caring for others displayed by the self-employed healthcare practitioners. No significant differences were found between the mean scores returned for Servanthood and Developing others for the two sample groups. A significant difference was reported for mean scores returned for the levels of Integrity, Ethical commitment, Ethical guidance, and Fairness. No, significant difference was reported for Sustainability for the two sample groups. The multiple regression analysis (MRA) shows that the dimensions of Servant leadership Developing others and Caring for others had a significant positive influence on Job satisfaction. The MRA results also show a significant positive influence between Fairness, Ethical guidance and Ethical commitment and Job satisfaction. Based on the findings of the study several recommendations were put forward to ensure a Servant and Ethical behaviour among self-employed healthcare practitioners.
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- Date Issued: 2016
Identifying and evaluating risk factors that predict traumatic stress severity in South Africa
- Authors: Van Wyk, Rozelle
- Date: 2013
- Subjects: Post-traumatic stress disorder -- Risk factors , Medical personnel -- South Africa
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:9968 , http://hdl.handle.net/10948/d1020937
- Description: Background: This study identified, addressed and validated risk factors that can be measured in the peri-traumatic period which may eventually be used in predicting the development of traumatic stress. Many people in South Africa possibly suffer from Posttraumatic Stress Disorder (PTSD) if we consider the extent of trauma exposures that is apparent within the South African population. Traumatised individuals are at risk but may remain undiagnosed and untreated. It makes sense for first line and primary health care practitioners (i.e., not highly qualified psychological practitioners) to screen for risk since they have the initial contact with trauma individuals. A relatively easy screening instrument that can be administered time efficiently would be useful in this regard. The principles of this instrument are that it needs to be objectively measurable, quick and easy to administer. No consistent measure geared towards identifying risk factors in such a manner immediately post trauma currently exists in South Africa. Objectives: The overall aim was to start a process of designing a psychometric instrument that is valid in predicting the development of traumatic stress. Since this is the initial stage of constructing a new measure, content validity was of utmost importance. It became imperative to ensure that items were not only relevant and appropriate, but also accurate and capable in identifying at-risk individuals. The proposed end goal is to develop effective identification strategies in South Africa geared towards helping victims of traumatic events. Method: A pilot psychometric questionnaire was compiled using three major international reviews, South African research on known risk factors, and literature on PTSD risk assessment considerations. This preliminary assembled item pool was used as a departure point and evaluated quantitatively as well as qualitatively by expert reviewers who have research and/or clinical experience with PTSD in a South African context. Their feedback resulted in either the omission or the modification of certain items; for some items, further exploration was recommended. The questionnaire was further scrutinised and modified accordingly after qualitative interviews with and critical feedback from the intended administrators or primary health care professionals, namely Registered Counsellors (RCs) and/or nursing staff from a participating general government hospital and a non-government organisation. Findings: Expert reviewers did not agree consistently across all the items. At times they rated certain items as relevant according to the necessity of the information rather than with regards to the relevance of the content of the item – in terms of prediction of PTSD. It was also observed that intended administrators did not always agree with expert reviewers.
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- Date Issued: 2013