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Perceptions Of Health Insurers Towards Pay-For-Performance As A Cost Control Model For Hospital Services, Mandlenkosi Moyo

Doctoral Dissertations and Projects

Hospital costs are the most significant portion of health-related costs incurred by non-profit health insurers registered as medical schemes in South Africa. Medical schemes continue to use retrospective reimbursement models for hospitals despite general acknowledgment that these models do not limit hospital costs and utilization. Although medical schemes are interested in implementing alternative reimbursement models, such as pay-for-performance (P4P), they are uncertain about which P4P models they can use to reduce hospital costs, resulting in their inability to make critical changes to their costs from traditional fee-for-service models. This qualitative exploratory multiple case study used 17 open-ended case interviews to …