title: Introducing a national health insurance system in South Africa: a general practitioner's bottom-up approach to costing.
abstract: BACKGROUND
  The introduction of national health insurance (NHI) is an important debate in South Africa, with affordability and institutional capacity being the key issues. NHI costing has been dominated by estimates of exorbitant cost. However, capitation is not only a different payment system but also a different service delivery model, and as a result there are opportunities for risk management and efficiencies.
  
  
  OBJECTIVE
  This study explores how private general practitioners (GPs) may choose to embrace these service delivery concepts and deal with the cost implications to meet NHI requirements.
  
  
  METHODS
  Data were collected from 598 solo private GPs through a self-administered online questionnaire survey across South Africa.
  
  
  RESULTS
  In spite of poor engagement with the public sector, and some challenges in costing and organisation, GPs appear to have an affordable and pro-active response to NHI capitation costing and fee setting. On average, they would accept a minimum global fee of R4.03 million to look after a population of 10 000 people for personal healthcare services.
  
  
  CONCLUSIONS
  At a total cost to the country of R16.9 billion, government could affordably use GPs to develop the primary health care part of NHI to cover the entire South African uninsured population. It is anticipated that a similar approach would be successful in other developing countries.
authors.affiliation: Department of Family Medicine, University of the Witwatersrand, Johannesburg, South Africa. shabir@dmoosa.co.za
authors.forename: Shabir
authors.initials: S
authors.lastname: Moosa
authors.forename: John M
authors.initials: JM
authors.lastname: Luiz
authors.forename: Teresa
authors.initials: T
authors.lastname: Carmichael
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D018588:Fee-for-Service Plans; D005260:Female; D058006:General Practice / Q000191:economics*; D058005:General Practitioners / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics*; D013019:South Africa