Email this article 
Hide
Show all
Original Research
Exploring the beliefs and attitudes of private general practitioners towards national health insurance in Cape Town, South Africa
Submitted: 01 July 2019 | Published: 17 October 2019
About the author(s)
Sheena Mathew, Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South AfricaRobert Mash, Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Abstract
Background: Private general practitioner (GP) participation in the national health insurance (NHI) is necessary to address doctor shortages and achieve universal health coverage. An in-depth understanding of GP’s views on the NHI is needed to inform implementation strategies.
Aim: To explore the beliefs and attitudes of GPs towards the proposed NHI system.
Setting: Cape Town, South Africa.
Methods: This was a descriptive, exploratory, qualitative study using semi-structured interviews. Eleven GPs were recruited using purposeful snowball sampling from different practices and communities. Thematic data analysis was conducted using the framework approach and Atlas.ti software.
Results: Although GPs saw the need for NHI, they felt that the government was antagonistic towards the private sector and had not engaged in a dialogue. They were wary of integration into a nurse-led primary care system and of being coerced. They felt that the public sector lacked the necessary financial and administrative capacity, and were concerned about the level, efficiency and sustainability of reimbursement, and the criteria to be used to accredit practices. General practitioners anticipated that the NHI would favour multidisciplinary teams and group practices. They also had mixed ideas about the impact on practice with some expecting higher workloads, stress and costs with reduced quality of care, while others saw more comprehensive care, better incomes and increased patient satisfaction.
Conclusions: While GPs are essential for the success of the NHI, there are many concerns regarding government policy, plans for implementation and the consequences for GP practice. Many of the concerns expressed could be tackled by greater policy dialogue and clarification.
Keywords
Metrics
Total abstract views: 4480Total article views: 5759
Crossref Citations
1. Spatial distribution and factors associated with health insurance subscription among women in Ghana
Richard Gyan Aboagye, Ebenezer N K Boateng, Yaw Marfo Okyere, Joshua Okyere, Kwamena Sekyi Dickson, Abdul-Aziz Seidu, Bright Opoku Ahinkorah
International Health vol: 16 issue: 6 first page: 610 year: 2024
doi: 10.1093/inthealth/ihad092
2. Perceptions of healthcare practitioners about NHI implementation in the public sector in Sedibeng district, Gauteng province
Aluwani Delila Mudzweda, Thembi Violet Simbeni, Ntlogeleng Mabina Mogale
BMC Health Services Research vol: 25 issue: 1 year: 2025
doi: 10.1186/s12913-025-13409-x
3. The views of family physicians on National Health Insurance in Gauteng Province, South Africa
Shane D. Murphy, Klaus von Pressentin, Shabir A. Moosa
South African Family Practice vol: 66 issue: 1 year: 2024
doi: 10.4102/safp.v66i1.5831
4. Climate change, global health and the post-COVID world. Comments on Benatar (S Afr J Sci. 2022;118(11/12))
Robert Mash
South African Journal of Science vol: 119 issue: 3/4 year: 2023
doi: 10.17159/sajs.2023/15658
5. Self-reported practices and learning needs of private general practitioners during the pandemic in South Africa
JM Musonda, JS Musonda
South African General Practitioner vol: 5 issue: 2 first page: 86 year: 2024
doi: 10.36303/SAGP.0432
6. An enterprise technical architecture for the implementation of the South African National Health Insurance
Tiko Iyamu, Farirai Chitsa
THE ELECTRONIC JOURNAL OF INFORMATION SYSTEMS IN DEVELOPING COUNTRIES vol: 91 issue: 2 year: 2025
doi: 10.1002/isd2.12352
7. Regulation and participation of the private sector in the pursuit of universal health coverage: Challenges and strategies for health systems
Rosendo Zanga
Journal of Family Medicine and Primary Care vol: 13 issue: 5 first page: 2123 year: 2024
doi: 10.4103/jfmpc.jfmpc_1697_23
8. State of readiness: National health insurance implementation in hospitals, Gauteng province
Aluwani D. Mudzweda, Thembi V. Simbeni, Ntlogeleng M. Mogale
Curationis vol: 48 issue: 1 year: 2025
doi: 10.4102/curationis.v48i1.2689
9. Prevalence, perceptions and associated factors of health insurance enrollment among older persons in selected cash grant communities in Ghana: a cross-sectional mixed method
Doris Ottie-Boakye, Ayagah Agula Bawah, Naa Dodua Dodoo, J. K. Anarfi
BMC Geriatrics vol: 24 issue: 1 year: 2024
doi: 10.1186/s12877-024-05037-7
10. Mistrust in government and National Health Insurance: A qualitative study of solo private practitioners in Cape Town
Bridget L. Perrow, Helen Schneider
South African Family Practice vol: 65 issue: 1 year: 2023
doi: 10.4102/safp.v65i1.5768
11. National health insurance in the face of COVID-19: urban tendencies in South Africa
Gina Weir-Smith, Tholang Mokhele, Simangele Dlamini
South African Geographical Journal vol: 104 issue: 3 first page: 276 year: 2022
doi: 10.1080/03736245.2021.2020585
12. Health insurance non-enrollment among women in Sierra Leone: A cross-sectional analysis of the 2019 Demographic and Health Survey
Augustus Osborne, Mainprice Akuoko Essuman, Peter Bai James, Camilla Bangura, Richard Gyan Aboagye, Comfort Z. Olorunsaiye, Abdul-Aziz Seidu, Bright Opoku Ahinkorah, Emmanuel O Adewuyi
PLOS One vol: 20 issue: 7 first page: e0323538 year: 2025
doi: 10.1371/journal.pone.0323538
13. Prevalence and factors associated with health insurance coverage in urban sub-Saharan Africa: Multilevel analyses of demographic and health survey data
Hubert Amu, Kwamena Sekyi Dickson, Kenneth Setorwu Adde, Kwaku Kissah-Korsah, Eugene Kofuor Maafo Darteh, Akwasi Kumi-Kyereme, Gopal Ashish Sharma
PLOS ONE vol: 17 issue: 3 first page: e0264162 year: 2022
doi: 10.1371/journal.pone.0264162
14. Exploring stakeholders’ experiences on implementing family medicine in urban South Africa
John M. Musonda, Shabir Moosa
African Journal of Primary Health Care & Family Medicine vol: 17 issue: 1 year: 2025
doi: 10.4102/phcfm.v17i1.4675
15. National Health Insurance unpacked: Part 1
Bob Mash
South African Family Practice vol: 62 issue: 1 year: 2020
doi: 10.4102/safp.v62i1.5094