RESYST Working Paper 8: Uptake of public sector sessional contracts by private general practitioners in South Africa
In South Africa a policy initiative aims to persuade private sector general practitioners (GPs) to work for a number of hours each month in public sector clinics.
GPs that agree to a contract with the National Department of Health are reimbursed through fixed sessional payments. Public sector rates are significantly lower than potential earnings in private practices, so the uptake of contracts depends on the extent of their altruism in benefiting public sector patients.
This paper reports on a pilot study which used a discreet choice experiment (DCE) to evaluate the level of interest to take up these sessional contracts, among a random national sample of GPs.
The study shows that the overall uptake of public sector work among private GPs was likely to be low under the contract conditions being offered by government. The results indicate that GPs were generally more motivated by their own personal welfare than the potential benefit to public sector patients.
Private GPs are not, however, a homogenous group and a small but significant group showed more pro-social tendencies and were relatively enthusiastic about contributing to the public sector.
The study presents the following policy implications:
- significantly higher rates of remuneration are required to get GPs to accept sessional work
- framing of different financial incentives made little difference to contract uptake
- there was less opposition to performance monitoring than expected
- performance monitoring should be introduced early so that improvements in clinical care for public sector patients are realised, and potential abuse prevented
- policy initiative should target the small proportion of GPs who are enthusiastic about contributing to the public sector