General practitioners and national health insurance - Results of a national survey

Objective. To determine the attitudes of South African general practitioner s (GPs) to national health insurance (NHI), social health insurance (SHI) a nd other related health system reforms. Design. A national survey using postal questionnaires and telephonic follow -up of non-responders. Setting. GPs throughout south Africa. Participants. Four hundred and forty-three GPs were randomly selected from a national sampling frame of 6 781 GPs. Main outcome measures. Acceptance of NHI and GP preferences wit regard to f inancing, provision, benefits, coverage and the role of GPs. Main results. A response rate of 82.1% was achieved. Sixty-two per cent of GPs approved of the introduction of some form of social or NHI in South Afr ica, while 24.1% disapproved. Approval rose to 81.6% if GPs were to maintai n their independent status, e.g. own premises and working hours, to 75% if additional private top-up insurance was allowed, at to 79.9% if payment was by fee-for-service. Seventy per cent of GPs in the study stated that they had the capacity to t reat more patients. The most important reason given for approving of NHI wa s to make health care more equitable and accessible to the majority of Sout h Africans. A high proportion of GPs approved of increasing the level of in teraction between GPs and district health authorities. Conclusions. Most GPs approved of some form of social or NHI system, provid ed that the system did not significantly threaten their professional autono my or economic and financial situation.