Strategic purchasing for Universal Health Coverage: Medical schemes in South Africa
This research brief provides an overview of how health service purchasing functions in South African medical schemes, which provide private health insurance. It examines the medical schemes as purchaser and how they interact with three key groups: health service providers, the national government and their members. It compares actual purchasing practices with ideal strategic purchasing actions to identify design and implementation gaps and the factors that influence effective purchasing. Finally, it draws policy implications for what needs be done to produce the desired actions by groups involved in purchasing.
The RESYST Consortium, in collaboration with the Asia Pacific Observatory on Health Systems and Policies, has critically examined how health care purchasing functions in ten low and middle-income countries to identify factors that influence the ability of health care purchasers and other key actors to take strategic actions.