Insight – Insight

11 Mar

Give patients a voice.

By Gareth Kantor. In South Africa, “ask a friend” or a family member is often how we choose a doctor and judge a hospital. This is because we usually trust our friends and family, share personal values and appreciate their perspective. Is there a way to more systematically obtain and reliably distil the “wisdom of crowds” to assess health care? Increasingly, the answer is yes. Although asking a friend isn’t always best, the measurement of patient experience and patient-reported outcomes is a valid method for assessing the performance of health care systems and is becoming the norm around the world. Asking patients doesn’t [...]

12 Aug

All, OpinionsLike: 4

Covid-19 conundrums and considerations.

By Insight Actuaries & Consultants Adapted from an article written for the SA Actuary magazine Written in June, published in July and updated for this blog dated 10 August 2020 The novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) which is the causative agent of Coronavirus Disease 2019 (Covid-19) has been a pandemic of several kinds. First the epidemiological kind, as declared by the WHO on 11 March 2020, but also a pandemic of data visualisation dashboards, projection models, sensational news and strong opinions. It has been a polarising wedge in politics, society, and even the actuarial profession where we are not shy [...]

29 Apr

All, ResearchLike: 3

Global reactions to Covid-19, a brief overview.

By Insight Actuaries & Consultants As Covid-19 has spread around the world countries have adopted a wide range of varying mitigation policies for the pandemic. Country performance in dealing with the spread and resulting mortality from the disease varies widely, and so lessons can be learned from considering the different policy choices made. What seems clear is that acting early and strongly makes a difference, as does the ability to rapidly scale health system and surveillance capabilities. These short country specific discussions will be updated from time to time as the pandemic matures and more countries will be added for additional [...]

20 Apr

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Medical scheme healthcare utilisation during lockdown.

By Craig Getz With the COVID-19 crisis looming, many are concerned by the likelihood of overwhelmed and overcrowded hospitals. This is of course a valid concern. For now, as at the time of publishing, the number of hospitalised COVID-19 patients remains low. There has been a proliferation of models which predict hospital admission rates when the COVID-19 infection rate accelerates. There has though been very little focus on what is happening our hospitals right now. COVID-19 and the interventions aimed at mitigating its impact have already had a dramatic effect on hospital admission rates. These effects can change the way medical schemes approach [...]

31 Aug

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The Diagnostic Mortality Audit Process (DMAP)™

By Dr Gareth Kantor & Dr Michele Youngleson No hospital in the world provides perfect care. We believe the best hospitals are those that strive continuously to improve and to make care safer. The management of a large client South African hospital embraced this challenge. They agreed to work with us to develop better systems for learning about, and improving, patient safety in their facility. Our initial focus was on preventable mortality using what we call a Diagnostic Mortality Audit Process (DMAP)™. The Stratification Matrix Not all deaths in hospital are unexpected. Many are the predictable outcome of serious illness and/or occur at the [...]

27 Jun

All, ResearchLike: 2

The Era of Behavioural Economics

By Barry Childs 2017 saw the Nobel prize in Economics awarded to Richard H. Thaler for his wide ranging work in the area of behavioural economics. While he is not the first to receive the award for work in this field, his writings and contribution to making behavioural economics more accessible have done us all a great service. We had the pleasure of hosting our third Foresight dialougues event a few weeks back with Behaviour as the theme. Topics included the impact of behaviour on fraud and fraud mitigation, what influences our medical scheme purchasing choices, addictive behaviour, anti-selective behaviour [...]

29 Aug

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Closer to Home: The Affordable Care Act and NHI

By Gary Kantor The battle between Democrats and Republicans over the Affordable Care Act (ACA) - Obamacare - is of interest to observers worldwide. Despite obvious differences between South African and US health care systems, the unfolding drama there may be relevant to health care policy makers locally as we consider our own high stakes health reform initiative, NHI - National Health Insurance. The failure to achieve universal health coverage in the United States despite the country’s wealth and its enormous total national spend on health care, (around 18% of GDP - over $3 trillion) marks it out as different from [...]

17 May

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Understanding Public Health: Exploratory notes

Understanding Public Health: Exploratory Notes Note 1: Public Health Budget and Expenditure Trends Public health Funding Background 30.3.17

13 Feb

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Policy and its (failed) implementation

Jodi Wishnia February 2017 South Africa, like many middle income countries, has robust and technically sound policies but struggles with their implementation. In my opinion, the first step to understanding how the Life Esidimeni crisis and many other similar incidents happened, is to understand the disjuncture between policy and its implementation. Using the Life Esidimeni (LE) case as an example, we can look at South Africa’s Mental Health Care Act, 2004 and its strategic plan, relevant from 2013 to 2020[1]. The strategic plan places a heavy focus on the concept of deinstitutionalisation. This means that there is a push to reintegrate mentally [...]

13 Feb

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Bad Apples and a Just Culture

Gary Kantor February 2017 It’s tempting to conclude that MEC Mahlangu, Dr Selebano and Dr Manamela are the sole culprits in this distressing affair. After all, to quote Professor Makgoba, their “fingerprints” are “peppered throughout the project”. This would be comforting, for if we simply get rid of the culprits – those who are to blame - the problem is solved, and a tragedy like this will never recur. Unfortunately, even if the three officials are permanently removed from their positions, patients in the Gauteng public health system are unlikely to be safer the next day and thereafter. Let’s explore why. In health [...]