An investigation into pharmacists perceptions of the South African medical scheme industry

Pillay, Yogindren (2014-12)

Thesis (MBA)--Stellenbosch University, 2014.


The South African healthcare industry has undergone numerous changes over the last two decades in both the public and private sectors. These changes have influenced the regulatory landscape of both sectors with the aim of improving accessibility to healthcare services and providers, and making healthcare more affordable for the South African public. The South African government introduced the Medical Schemes Act No. 131 of 1998, in response to issues faced in the medical scheme industry. The act allowed for a board of trustees to regulate medical schemes in their governance (McIntyre, Thiede, Nkosi, Mutyambizi, Castilo-Riquelme, Gilson, Erasmus & Goudge, 2007). The main aim was to ensure medical schemes were able to maintain solvency levels and maintain benefits offered to beneficiaries. The pharmaceutical industry saw legislative changes governing the pricing of medicines, generic substitution of medicines and open ownership of pharmacies. The researcher aimed to provide the medical scheme industry with valuable insight into the challenges experienced by pharmacists, when processing and submitting claims for medical scheme members and their beneficiaries. The intention was to enable the medical scheme industry to improve service quality and efficiency in provider relationships, and customer relationships. The research consisted of qualitative and quantitative research methods. A focus group interview consisted of the initial phase, producing qualitative data. The researcher utilised the qualitative data to construct an online questionnaire, which he then sent out through email, to a larger group of retail pharmacists in KwaZulu-Natal. The majority of retail pharmacists who participated in the research had a limited knowledge of all medical schemes and the different options available in South Africa. The majority of pharmacists in both groups were of the opinion that the redesigning and simplification of computer programmes, utilised for submitting prescriptions, would improve efficiency in service delivery. The research further found that the dissemination of information, on a variety of topics, from medical schemes to their members and service providers, should improve to increase efficiency in service delivery and foster better relationships.

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