Capitation as a Model for South African Health Funds

Will the Capitation Model work in SA? This model is used in the United States by their HMO's with varying degrees of success

In seeking ways to regulate the South African health care industry, a number of models have been discussed and considered. One possible model, that has been stipulated in the National Health Amendment Bill, is that of Capitation.

Essentially, the Capitation Model sees health care providers receive a fixed sum per patient from the government, in return for a pre determined level of services.

It has been pointed out that the Capitation Model Health Care Service provision is the same as the one used by Health Management Organizations (HMO's) in the United States, with varying degrees of success.

The Chief Principal Officer of Bonitas Medical Fund, Bafana Nkosi, said that in order for the Capitation Model to work in South Africa, all medical aid schemes would need to be open to adopt a brand new scheme, despite the fact that the model is used at various levels in the country at the moment.

"Medical aid providers who might previously have viewed this model as a mean to lose money in that the amount they would lose per patient would be restricted to a fixed monthly fee," explained Nkosi. "A different way of seeing this might be for providers to view this more as an opportunity to retain patients on a long term basis, managing their care as opposed to just providing it."

"Providers would also be more motivated to provide high levels of service to ensure repeat businesses," said Nkosi, "because the more patients who are pleased with their service, the more new patients will choose the address their health care requirements through them."