Research – Insight

31 Aug

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

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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 [...]

04 Aug

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Magical mommy kisses and the meaning effect

Having a seven-year old son means an almost endless series of grazes, knocks and bruises. My go-to response is to kiss it better. Even though he is rapidly shrugging off believing in Santa Claus and the tooth fairy (“it’s a tooth mouse mom, fairies don’t exist”), both he and I happily participate in the illusion of magical mommy kisses. But is it an illusion? For most of these minor injuries mommy kisses do seem to help. The explanation that makes the most sense to me is what researchers refer to as the meaning effect or meaning response: “We define the meaning [...]

11 Jul

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The Signal Model: Throwing Light into Dark Corners

Murky territory Have you ever tried to compare the value-for-money that you get from two different medical scheme options? Whether you’re a consumer trying to choose an option, a broker advising clients or a technical marketing actuary, you will know that it is impossible to come to an objective conclusion by simply studying the benefit brochures. Simply tallying which benefit option offers richer benefits is insufficient, particularly since you need to make a comparison on multiple benefits. The question that needs to be asked is “what is the value of those additional benefits and how does it compare to the [...]

16 May

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Why Actuaries Need “Street View”

I remember playing with Google Maps for the first time. It was startling to get a zoomed-out view of your neighbourhood, your city, your country. In business-school speak this is the view from 30 000 feet. And this is the view that being an actuary affords you. We have the ability to look at the patterns formed by data, to join the dots in unexpected ways, to rise above the detail. Working in healthcare this means thinking about questions like how to allocate resources across provinces, or figuring out ways of measuring healthcare quality, or using statistical methods to benchmark [...]

19 Apr

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It’s Complicated

The first round of public hearings held by the Health Market Inquiry during February and March of this year have, at the same time, been both fascinating and frustrating to watch. I certainly don’t envy the panel members. There is an enormous amount of information to process. This includes thousands of pages of written submissions, presentations and transcripts. It is the task of the inquiry to process all of this information, distil it down to the facts and then make recommendations. This is by no means an easy task: not all of the information provided by stakeholders is relevant to [...]

15 Jul

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Supporting NHI in South Africa

This report reviews health system benefits policy and purchasing mechanisms in Chile to inform the development of National Health Insurance policy in South Africa. It has been prepared by R4D in consultation with South Africa’s National Treasury and with financial support from The Atlantic Philanthropies.

15 Jul

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Last Year of Life

The aim of this paper is to highlight the key methodological considerations in an investigation into the costs incurred by health insurers arising from the provision of benefits during the 12 months preceding a beneficiary’s death. A South African dataset is used to illustrate the suggested methodology. Download the paper to read more

15 Jul

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HASA – Intl utilisation benchmarking

This project was commissioned by the Hospital Association of South Africa (HASA). The aim of the project is to compare the hospital-inpatient admission rates and length of stay of the South African medical scheme population with a set of international comparators. Download the paper to read more

15 Jul

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Comparing the cost of hospitalisation across private and public sectors

The South African private healthcare industry faces significant changes in national health policy which most notably include the likely introduction of National Health Insurance (NHI). The possibility exists that the NHI agency will seek to contract with both public and private healthcare providers (referred to as plurality of provision). This raises questions of relative pricing between the two sectors. The concept of “price” from a consumer or funder perspective is complicated because services in the public sector are frequently not sold, and where prices do exist (for those above the means test) they are not determined by the existence [...]