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Where to in the business of health for general practitioners in a world of universal coverage and value-based care?

general practitioners
  • Prof Manie de Klerk
  • August 12 2019
8 minutes to read


By Prof Manie De Klerk, lecturer on USB’s MBA focused on Health Care Leadership (MBA HCL)

Value-based care is a major tsunami in health. Porter and Lee, in their Harvard Business Review article, defined value-based care as the health outcomes achieved that matter to patients relative to the costs of achieving those outcomes (Porter, M.E. & Lee, TH. 2013. The strategy that will Fix Health Care. Harvard Business Review). It coincides with a time when universal health coverage is being punted as the main funding mechanism for health.

Combined, value-based care and universal health coverage will challenge developing economies to do the best with that they have. How will this mean for general practitioners?

Value-based care:

Value-based care has two key pillars that can assist general practitioners and that will lead to value across the health chain. The two pillars are the hub-and-spoke model and task shifting.

  • Hub and spoke: General practitioners can become the main coordinators of care, and guide patients to lower levels of care (like primary care nurse practitioners and midwives) and to higher levels of specialist and super-specialist care. At the same time, back-referral needs to be done to the general practitioner if and when relevant. The practitioner can also work alone or with funders to select effective referral routes to optimise health value for patients. General practitioners must upskill themselves to be able to perform this function.
  • Task shifting: General practitioners in developing countries are usually well trained in clinical skills and perform these in programmes such as Community Health Practitioner positions. They acquire good basic surgical, obstetric and other clinical skills during the first years of training and work. Unfortunately, some environments dissuade them from using these skills. Upskilling and task shifting may lead to some more skilled work to be transferred to general practice levels. Training institutions and specifically Family Medicine Training institutions need to take note of this trend.

Universal health coverage (funding):

The business of health is to pay for value created through better or the same care for the same or lower costs. Task shifting will help in this regard.

What does the future hold for health care?

In developing as well as developed countries, general practices will increasingly play a crucial clinical role in health care. However, professionalising these practices requires leadership skills and business acumen. This combination of health care leadership and business skills is also needed other hubs in the public and private health care space – from hospitals and clinics to pharmaceutical businesses, health technology businesses and regulatory bodies.

This puts the business of health care in the spotlight.

  • If you want to lead change in the health care industry, USB’s MBA focused on Health Care Leadership will stand you in good stead. The two-year programme covers all the functional areas of management while giving you a contextual understanding of the health care landscape in South Africa and Africa. What’s more, you can study while you work. Please contact us for more information.
  • Article written by Prof Manie De Klerk, Director of Clinical Services at Qualsa Healthcare (Pty) Ltd and Learning Process Facilitator on USB’s MBA focused on Health Care Leadership (MBA HCL).

Gain the skills needed to manage and lead within the African and South African healthcare industry.

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