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Information asymmetry and the misalignment of incentives in the South African private healthcare sector
Thesis (PhD)--Stellenbosch University, 2023.
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| Format: | Thesis |
| Language: | en_ZA |
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Stellenbosch : Stellenbosch University
2023
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| _version_ | 1867614026235641856 |
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| access_status_str | Open Access |
| author | Vorster, Pamela Ann |
| author2 | Ronelle, Burger |
| author_browse | Ronelle, Burger Vorster, Pamela Ann |
| author_facet | Ronelle, Burger Vorster, Pamela Ann |
| author_sort | Vorster, Pamela Ann |
| collection | Thesis |
| dc_rights_str_mv | Stellenbosch University |
| description | Thesis (PhD)--Stellenbosch University, 2023. |
| format | Thesis |
| id | oai:scholar.sun.ac.za:10019.1/128999 |
| institution | Stellenbosch University (South Africa) |
| language | en_ZA |
| last_indexed | 2026-06-10T12:45:29.584Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from SUNScholar — Stellenbosch University Repository |
| publishDate | 2023 |
| publishDateRange | 2023 |
| publishDateSort | 2023 |
| publisher | Stellenbosch : Stellenbosch University |
| publisherStr | Stellenbosch : Stellenbosch University |
| record_format | dspace |
| source_str | SUNScholar — Stellenbosch University Repository |
| spelling | oai:scholar.sun.ac.za:10019.1/128999 Information asymmetry and the misalignment of incentives in the South African private healthcare sector Vorster, Pamela Ann Ronelle, Burger Lungiswa, Nkonki Helmuth, Reuter Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Economics. Health insurance -- Econometric models -- South Africa Information asymmetry -- Health -- South Africa National health insurance -- South Africa UCTD Thesis (PhD)--Stellenbosch University, 2023. ENGLISH SUMMARY: Healthcare markets are notorious for information asymmetry, which may result in the inefficient organisation of scarce resources. This dissertation examines information asymmetry occurring in both the demand for and supply of healthcare in the private sector of South Africa. This dissertation’s main contribution is of insights into inefficiencies within the private healthcare sector resulting from inherent information asymmetry in healthcare markets. These inefficiencies in the South African context make healthcare more expensive than it should be. The government has started implementing the National Health Insurance (NHI) which will require an efficient allocation of scarce resources. Research in South Africa is primarily focused on the public sector, although there are many lessons to learn from the private sector. The first essay discusses the presence of adverse selection in the market for health insurance in South Africa. It then examines individuals’ demand for insurance by identifying characteristics that influence their propensity to insure. The study found that some adverse selection may be built into the health insurance market. Individuals have a higher tendency to purchase insurance if they have a chronic condition or are pregnant. However, socio-economic factors appear to be major contributing factors to individuals’ insurance purchasing decisions. Once people join a medical scheme, they tend to maintain their membership. Therefore, measures to address wasteful healthcare spending that would decrease the overall cost of healthcare and, ultimately, the cost of insurance could sustainably increase the size of the risk pool. The second essay reports the results of a survey to investigate variations in treatment decisions among spine surgeons. It also identifies associations between surgeons’ characteristics and the treatment they select. The findings make a case for evaluating outcomes and costs to identify value-based care. Such research would assist countries seeking to contract with providers based on value. Greater uniformity in treatment and easy reporting of outcomes would provide guidance to patients. Further investment in training and participation in fellowship programmes may be necessary, along with greater dissemination of information from the literature. The third essay reports on a case study of rhizotomies to identify necessary conditions and red flags that could provide plausible signs of supplier-induced demand. A rhizotomy is a low-risk, discretionary procedure that is one of many treatments a patient can receive to address chronic back pain. The study used claims data from a large health insurer to investigate four broad themes: outcomes of the treatment, practitioner and patient characteristics, incidence and the total cost of trends, and practitioner landscape. This study found that some practitioners are likely to induce demand for rhizotomies. It illustrates how analysing claims data could assist in detecting supplier-induced demand. It indicates the need to pool claims data across the industry to provide funders with a useful tool to address such demand and overservicing, and to develop benefit options based on high-value treatment. AFRIKAANSE OPSOMMING: Gesondheidsorgmarkte is berug vir inligting-asimmetrie, wat tot die ondoeltreffende organisasie van skaars hulpbronne kan lei. Hierdie proefskrif ondersoek inligting-asimmetrie wat voorkom in beide die vraag na en aanbod van gesondheidsorg in die private sektor van Suid-Afrika. Hierdie dissertasie se hoofbydrae is 'n aantal insigte rakende die ondoeltreffendheid binne die private gesondheidsorgsektor as gevolg van inherente inligting-asimmetrie in gesondheidsorgmarkte. Hierdie ondoeltreffendheid in die Suid-Afrikaanse konteks maak gesondheidsorg duurder as wat dit behoort te wees. Die regering is in die proses om die Nasionale Gesondheidsversekering (NGV) te implementeer, wat 'n doeltreffende toewysing van skaars hulpbronne sal vereis. Navorsing in Suid-Afrika is hoofsaaklik gefokus op die openbare sektor, hoewel daar baie lesse is om uit die private sektor te leer. Die eerste artikel ondersoek die teenwoordigheid van ongunstige seleksie in die mark vir gesondheidsversekering in Suid-Afrika. Tweedens ondersoek dit individue se vraag na versekering deur eienskappe te identifiseer wat hul geneigdheid om te verseker beinvloed. Die studie het bevind dat 'n mate van ongunstige keuse in die gesondheidsversekeringsmark ingebou kan word. Individue het 'n groter neiging om versekering te koop as hulle 'n chroniese toestand het of swanger is. Sosio-ekonomiese faktore blyk egter groot bydraende faktore tot individue se versekeringsaankoopbesluite te wees. Wanneer mense by 'n mediese fonds aangesluit het, is hulle geneig om hul lidmaatskap te behou. Maatreels moet ingestel word om verkwistende gesondheidsorgbesteding aan te spreek, wat die algehele koste van gesondheidsorg sal verlaag, en dus uiteindelik die koste van versekering, en sodoende die risikopoel volhoubaar vergroot. Die tweede artikel rapporteer die resultate van 'n opname om variasies in behandelingsbesluite onder ruggraatchirurge te ondersoek. Dit identifiseer ook assosiasies tussen chirurge se eienskappe en die behandeling wat hulle kies. Die bevindinge maak 'n saak vir die evaluering van uitkomste en koste om waardegebaseerde sorg te identifiseer. Sulke navorsing sal lande help wat op grond van waarde met verskaffers wil kontrakteer. Groter eenvormigheid in behandeling en maklik toeganklike verslagdoening oor uitkomste sal leiding aan pasiente verskaf. Verdere belegging in opleiding en deelname aan gemeenskapsprogramme mag nodig wees, tesame met groter verspreiding van inligting uit die literatuur. Die derde artikel gebruik verslae oor 'n gevallestudie oor risotomiee om nodige toestande en rooi vlae te identifiseer wat op tekens van verskaffer-geinduseerde vraag kan dui. 'n Risotomie is 'n lae-risiko, Doctorate 2023-11-13T14:15:31Z 2024-01-08T18:43:47Z 2023-11-13T14:15:31Z 2024-01-08T18:43:47Z 2023-12 Thesis https://scholar.sun.ac.za/handle/10019.1/128999 en_ZA Stellenbosch University xiv, 150 pages : illustrations, includes annexures application/pdf Stellenbosch : Stellenbosch University |
| spellingShingle | Health insurance -- Econometric models -- South Africa Information asymmetry -- Health -- South Africa National health insurance -- South Africa UCTD Vorster, Pamela Ann Information asymmetry and the misalignment of incentives in the South African private healthcare sector |
| title | Information asymmetry and the misalignment of incentives in the South African private healthcare sector |
| title_full | Information asymmetry and the misalignment of incentives in the South African private healthcare sector |
| title_fullStr | Information asymmetry and the misalignment of incentives in the South African private healthcare sector |
| title_full_unstemmed | Information asymmetry and the misalignment of incentives in the South African private healthcare sector |
| title_short | Information asymmetry and the misalignment of incentives in the South African private healthcare sector |
| title_sort | information asymmetry and the misalignment of incentives in the south african private healthcare sector |
| topic | Health insurance -- Econometric models -- South Africa Information asymmetry -- Health -- South Africa National health insurance -- South Africa UCTD |
| url | https://scholar.sun.ac.za/handle/10019.1/128999 |
| work_keys_str_mv | AT vorsterpamelaann informationasymmetryandthemisalignmentofincentivesinthesouthafricanprivatehealthcaresector |