Resumen

MALULEKE, Simon A.  y  MOODLEY, Vanessa R.. Practitioner perceptions about optometric networks in South Africa. AVEH [online]. 2023, vol.82, n.1, pp.1-7. ISSN 2410-1516.  http://dx.doi.org/10.4102/aveh.v82i1.810.

BACKGROUND: Private healthcare in South Africa is largely financed by medical schemes. Optometrists reluctantly contract with administrators and networks to service these patients, despite them feeling networks are undesirable and exploitative. Networks contend that various mechanisms employed are necessary to ensure sustainability and prevent fraud, wastage and abuse. A working relationship between practitioners and networks should ideally be cordial and appreciated by each party as being mutually beneficial to the success of their respective businesses. AIM: To assess practitioners' knowledge and perceptions regarding optometric networks. SETTING: The study was conducted amongst optometric professionals in the private sector in South Africa. METHODS: A descriptive, mixed-method study was conducted using a semi-structured questionnaire. Interviews with senior personnel from the networks were conducted. RESULTS: Approximately 77% of respondents belonged to networks with 91% being knowledgeable about networks and their role within optometry. Opticlear had 72% members, while Iso Leso and preferred provider negotiators (PPN) had 67% and 41%, respectively. Most optometrists (69%) neither believed in the need for networks nor that they provide value to the profession, while 94.7% joined networks merely to receive direct payment and access patients, with no other benefits noted. CONCLUSION: Practitioners reluctantly contract to networks for direct payment and to access patients. Furthermore, practitioners feel that networks bully and victimise them while networks highlight their responsibility to reduce healthcare costs and negative practices of fraud, waste and abuse. CONTRIBUTION: Providing sustainable, cost-effective and quality eye care services requires collaboration between networks and practitioners and appreciating each other's roles in the delivery of eye care services.

Palabras clave : networks; managed care organisations; designated service providers; Medical Schemes Act; Health Professions Council of South Africa; South African Optometric Association.

        · texto en Inglés     · Inglés ( pdf )