Over-the-Counter Medicine Utilization by Beneficiaries Under Medical Schemes in South Africa.

BACKGROUND: South African medical insurance schemes (known as medical schemes) cover about 17% of the population. Within these schemes, access to medicines for a defined set of chronic diseases is mandated by legislation. However, much of the responsibility for treatment of minor conditions with non-prescription over-the-counter (OTC) medicines has been transferred to the individuals within the medical schemes. The overall expenditure on pharmacist-assisted therapy (PAT)/OTC medicines in South Africa is considerable and medical schemes endeavor to limit amounts paid out by devising strategies that will limit their financial exposure. AIM: To investigate how benefit design and other factors within two medical schemes influenced access to and payment for OTC medicines and to explore whether access to OTC medicines by individuals impacted on utilization of other health-care services. METHODS: Medical scheme data were obtained from a leading administrator for two health plans: one with comprehensive benefits covering 4593 beneficiaries (designated HI) and the other with lower benefits covering 54,374 beneficiaries (LO). Extracted data included beneficiary demographics, OTC medicines prescribed by doctors and/or dispensed by pharmacists, and monetary amounts claimed by individuals and paid by the medical schemes. Doctor consultations, costs and payments were also extracted, as were beneficiaries' records of their chronic disease(s) and any episode(s) requiring hospitalization. RESULTS: Some 60-70% of beneficiaries submitted claims for OTC medicines accessed directly or recommended by a pharmacist, and 80-90% claimed OTC medicines that were prescribed by a doctor during a consultation. Amounts claimed and percentages of original products prescribed were substantially higher when accessed directly by beneficiaries or recommended by pharmacists than when doctors prescribed the medicines. In multivariate analysis, there was no clear advantage of offering access to OTC medicines in order to reduce visits to general practitioners, although in the LO plan it appeared that beneficiaries with chronic diseases made less use of the OTC benefit and more use of medical specialists. CONCLUSION: Within these two plans, there were higher costs and greater use of original products when beneficiaries or pharmacies accessed OTC medicines than when these medicines were prescribed by doctors. A key question is whether access to these medicines and the costs thereof would be managed better if paid for directly by individuals and not as insured benefits through the medical scheme.

Multivariate models for compliance with phase 3 cardiac rehabilitation services in Johannesburg.

The efficacy of an exercise cardiac rehabilitation programme depends on an adequate compliance of its participants. A 50% dropout rate after 12 months has been reported by most rehabilitation programmes. Compliance with attendance and the exercise prescription are monitored daily at the Johannesburg Cardiac Rehabilitation Centre. This study evaluated the attendance of 711 patients admitted to the programme between June 1986 and March 1990 and looked at possible differences in attendance and intensity rates of compliers and dropouts prior to dropout. Multiple regression analyses were performed on all patients using different measures of exercise compliance as dependent variables and patient characteristics on admission as explanatory variables in order to establish possible associations which could identify potential dropouts at an early stage. We found that 36% of patients dropped out by 12 months and that 50% managed to complete our 18 month programme. Dropouts complied less than compliers in terms of attendance and intensity before dropping out. Significant associations were found between the measures of compliance and patient characteristics. Age, smoking, peak oxygen uptake and a measure of hostility were identified as predictive factors. With the exception of the energy expended per session the variation in the other measures of compliance was poorly explained by the explanatory variables suggesting that other factors could be related to compliance at the Johannesburg Cardiac Rehabilitation Centre and need to be further evaluated.

A stochastic model for medium-term estimation of the prevalence of HIV infection in a South African heterosexual population.

This paper describes the development of a micro-simulation model to estimate the extent of HIV infection among black heterosexual South Africans and attempts to predict the number of newly acquired cases of HIV infection for the period 1985-2000. Owing to the lack of key data inputs, many assumptions are made. The inputs used are estimated demographic transition, HIV-positive immigrants, probability of being HIV-positive, probability of acquisition of infection upon at-risk contact by gender, time to AIDS distribution, average number of new sexual partners over time by age and gender, average number of sexual contacts per partner by gender and age group, and probability of sexual contact by age group between genders. Paediatric, homosexual and intravenous HIV cases are excluded from the model. The results indicate a fairly rapid increase in HIV infection from 1988 until the year 2000, when 5,664,487 adults, i.e. approximately 27% of the total adult (15-60 years) black population, could have become HIV-positive. This first phase of the model does not include the effect of a change in behaviour or the possible effect of effective drugs or vaccines and is therefore a worst-case scenario, maximum-potential estimate. The results are very similar to previously published South African actuarial and macro-simulation models.

Birth to ten: child health in South Africa in the 1990s. Rationale and methods of a birth cohort study.

Birth to Ten is a longitudinal birth cohort study which began in April 1990 in the Johannesburg/Soweto area of Transvaal, South Africa. In this paper, the reason for the initiation of the study and its location in the current sociopolitical context is discussed. The health status of South Africa children in terms of infant mortality, morbidity (notifiable diseases) and nutritional status is described and mention is made of measures of psychological health and the importance of environmental pollution on health. The existing health service infrastructure in the study area is described and the fragmentation of health services between races, between preventive and curative services and on a geographical basis is highlighted. The study objectives, design, population, inclusion and exclusion criteria, methods of measurement and logistics are described.