Reimbursement models for community pharmacies under universal health coverage; lessons for the South African National Health Insurance

Abstract

Universal Health Coverage (UHC) is a global strategy aimed at ensuring access to quality health services at no financial strain. Community pharmacies in many countries play an important role in improving access to medicines and primary care. However, community pharmacy integration within UHC is often hindered by unclear reimbursement processes. As South Africa moves closer to implementing its National Health Insurance (NHI), it is important to understand how reimbursement models impact community pharmacies in comparable low-and middle-income communities. This study aimed to explore commonly used reimbursement models (capitation, fee-for-service, and mixed method) reimbursement and their impact on community pharmacies in Low-Middle-Income-Countries (LMICs) with established UHC models.