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A review of the quality assessment process within managed health care
Author(s)
Oosthuizen, Reney
Date Issued
2020
Type
Thesis
Publisher
Cape Peninsula University of Technology
Abstract
The research study was conducted in an HIV Disease Management Programme within a
Managed Health Care Organisation in Gauteng, South Africa.
This Managed Health Care Organisation provides Managed Care services to Medical Scheme
beneficiaries who have been exposed to HIV/AIDS by registering them onto the HIV Disease
Management Programme (DMP). This is to ensure adequate clinical care, education and
support are provided to the affected beneficiaries to promote their quality of life, whilst
managing the financial risk of the Medical Scheme.
The study focused on the non-clinical aspect of the HIV Disease Management Programme,
namely the Quality Assessment function. The Quality Assessment process evaluates the
quality of the Managed Care services rendered to the enrolled beneficiaries and Service
Providers by the employees of the Managed Care Organisation.
The objectives of this study were the following:
➢ To examine the current Quality Assessment process sampling activities from a service
quality perspective, identify best practice, and recommend improvements;
➢ To ascertain if the Quality Assessment Questionnaire (the process input) contains the
correct quality parameters to identify the critical errors to be addressed; and
➢ To determine if the monthly Quality Assessment reports (the process output) contain the
essential quality elements and tools to effectively demonstrate the quality of the services
rendered.
The research methods used in this research study included both qualitative and quantitative
methods. The research identified international and national best practice related to the Quality
Assessment process, specifically in the South African Managed Care environment. The
research methodology is within the ambit of an archival research.
Managed Health Care Organisation in Gauteng, South Africa.
This Managed Health Care Organisation provides Managed Care services to Medical Scheme
beneficiaries who have been exposed to HIV/AIDS by registering them onto the HIV Disease
Management Programme (DMP). This is to ensure adequate clinical care, education and
support are provided to the affected beneficiaries to promote their quality of life, whilst
managing the financial risk of the Medical Scheme.
The study focused on the non-clinical aspect of the HIV Disease Management Programme,
namely the Quality Assessment function. The Quality Assessment process evaluates the
quality of the Managed Care services rendered to the enrolled beneficiaries and Service
Providers by the employees of the Managed Care Organisation.
The objectives of this study were the following:
➢ To examine the current Quality Assessment process sampling activities from a service
quality perspective, identify best practice, and recommend improvements;
➢ To ascertain if the Quality Assessment Questionnaire (the process input) contains the
correct quality parameters to identify the critical errors to be addressed; and
➢ To determine if the monthly Quality Assessment reports (the process output) contain the
essential quality elements and tools to effectively demonstrate the quality of the services
rendered.
The research methods used in this research study included both qualitative and quantitative
methods. The research identified international and national best practice related to the Quality
Assessment process, specifically in the South African Managed Care environment. The
research methodology is within the ambit of an archival research.
Additional information
Thesis (MEng (Quality))--Cape Peninsula University of Technology, 2020
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Oosthuizen_Renee_21306249.pdf
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