ArticlePDF Available

The potential market demand for biokinetics in the private health care sector of South Africa

Authors:

Abstract and Figures

Objective: Biokinetics, a profession registered with the Health Professions Council of South Africa (HPCSA), address inter alia chronic diseases of lifestyle (CDL) with exercise as treatment modality. The purpose of this investigation is to determine the potential market demand for biokinetic services in the private health care sector of South Africa. Methods: Data from a pharmaceutical benefit management system (PBM) were analysed to determine the prevalence of chronic diseases in the private health care sector for 2007. Telephonic interviews on a sub-sample of 50 biokineticists revealed the average number of patients that can be treated monthly per biokineticist. The number of biokineticists with active practice numbers was obtained from the Board of Health Care Funders (BHF). Results: The results indicate that 47% (747 199/1 600 000) of the patients managed by the PBM are treated with medication for one or more CDL. Non-steroid anti-inflammatory medication (21%), medication for cardiovascular diseases (13%) and bronchodilators (11%) had the highest prevalence. The sub-sample of biokineticists indicated that one biokineticist can treat an average of 100 patients per month. The potential market demand calculated from the above numbers indicated that 7 472 biokineticists are needed in the private health care sector, while only 625 active practice numbers were registered with the BHF in 2007.Conclusion: In conclusion, it is estimated that only 7.6% of patients with CDL can potentially be treated by the current number of registered biokineticists. Therefore an enormous market potential for biokinetics exists in the private health care sector of South Africa.
Content may be subject to copyright.
ORIGINAL RESEARCH
Introduction
Chronic diseases of lifestyle (CDL) are on the increase in South
Africa as in the rest of the world. This increase in the number of
communicable and non-communicable diseases has labelled South
Africa as a country with a ‘double burden of disease.1 CDL are a
group of diseases that share similar risk factors as a result of expo-
sure, over many decades, to unhealthy diets, smoking and lack of
exercise and possibly stress.2 These risk factors further include inter
alia high blood pressure, high blood cholesterol, diabetes and obes-
ity. These risk factors present in various disease processes such as
stroke, heart attacks, certain cancers, chronic bronchitis and many
others that culminate in high mortality and morbidity rates.3
Research has indicated that regular physical activity can positively
address all above-mentioned pathological conditions and thereby
reduce the mortality and morbidity rates in populations.3 Biokinetics
has drawn on and implemented this body of evidence to prescribe
scientically based exercise programmes to prevent and manage
non-communicable diseases in South Africa. In developed countries
physical inactivity is estimated to cause 6.0% of all deaths for men
and 6.7% for women.4 A study investigating the cost-effectiveness of
health care-based interventions aimed at improving physical activity
found evidence for cost effectiveness in groups with high risk, such
as older persons and persons with heart failure.5
In South Africa, biokinetics has been practised for the last 25
years after the scope of practice was published in the Government
Gazette.6 Although the road to obtaining recognition was very
difcult,7 the profession has continued growing, with 12 training
institutions training about 150 students every year. More than
1 000 biokineticists have completed their training during the last 25
years, with the current register of the Board of Health Care Funders
(BHF) reporting 799 active practice numbers for 2009.8 The scope
of practice for biokinetics deals with the prescription of scientically
based exercise for preventing and treating CDL as well as for nal-
phase rehabilitation of orthopaedic injuries.9
Biokineticists usually form part of a multidisciplinary team in the
treatment of chronic diseases and orthopaedic injuries together with
medical practitioners, physicians, physiotherapists and dieticians.
In the South African health care sector, however, biokineticists only
form part of the multidisciplinary team in the private health care
sector. Research indicates that this formal private health sector is
a large, well-developed, resource-intensive and highly specialised
sector that provids health insurance coverage to some 7 million
people.10 The other estimated 40 million South Africans make use
of either the public health care system or traditional healers, or pay
out of their pockets for private health care services. As biokineticists
are not employed in the public health sector, except in the National
The potential market demand for biokinetics in the private
health care sector of South Africa
CORRESPONDENCE:
Professor S J Moss
PhASRec in the School of Biokinetics, Recreation and Sport
Science
North-West University (Potchefstroom Campus)
Potchefstroom, 2520
Tel: 018 2991821
Fax: 018 285 6028
E-mail: Hanlie.moss@nwu.ac.za
Sarah J Moss (PhD)1
Martie S Lubbe (PhD)2
1Niche Area for Physical Activity Sport and Recreation (PhASRec) in the School of Biokinetics, Recreation and Sport Science, North-West
University (Potchefstroom Campus), Potchefstroom
2Niche Area for Medicine Use in South Africa (MUSA) in the School of Pharmacy, North-West University, Potchefstroom
Abstract
Objective: Biokinetics, a profession registered with the Health
Professions Council of South Africa (HPCSA), address inter alia
chronic diseases of lifestyle (CDL) with exercise as treatment
modality. The purpose of this investigation is to determine the po-
tential market demand for biokinetic services in the private health
care sector of South Africa.
Methods: Data from a pharmaceutical benet management sys-
tem (PBM) were analysed to determine the prevalence of chronic
diseases in the private health care sector for 2007. Telephonic
interviews on a sub-sample of 50 biokineticists revealed the
average number of patients that can be treated monthly per bioki-
neticist. The number of biokineticists with active practice numbers
was obtained from the Board of Health Care Funders (BHF).
Results: The results indicate that 47% (747 199/1 600 000) of
the patients managed by the PBM are treated with medication
for one or more CDL. Non-steroid anti-inammatory medication
(21%), medication for cardiovascular diseases (13%) and bron-
chodilators (11%) had the highest prevalence. The sub-sample of
biokineticists indicated that one biokineticist can treat an average
of 100 patients per month. The potential market demand calcu-
lated from the above numbers indicated that 7 472 biokineticists
are needed in the private health care sector, while only 625 active
practice numbers were registered with the BHF in 2007.
Conclusion: In conclusion, it is estimated that only 7.6% of pa-
tients with CDL can potentially be treated by the current number
of registered biokineticists. Therefore an enormous market po-
tential for biokinetics exists in the private health care sector of
South Africa.
14 SAJSM VOL 23 NO. 1 2011
SAJSM VOL 23 NO. 1 2011 15
Defence Force, people making use of the public health care system
are not exposed to biokinetic intervention.
Although other health disciplines are attracted away from the
public health sector with large nancial and personal incentives,10
this is not the case with biokinetics. This lack of job opportunities
in the public health sector has forced biokineticists to become
entrepreneurs by starting private practices. These practices are solo
practitioners, associations or partnerships with other biokineticists
or other health practitioners. This is, however, not as straightforward
as other entrepreneurial ventures. Strict ethical guidelines set by
the HPCSA to guide the profession and protect the public against
exploitation hamper biokineticists to do marketing to the same extent
as unregistered/unregulated professions.9
In order to start any new venture, determining the market
potential for the product is extremely important. As the purpose of
all businesses is to create wealth, the product, price, packaging and
place of sale should be thoroughly investigated.11 Health professionals
are unfortunately seldom trained in business principles. This lack of
business skills often results in the failure of biokinetic practices to be
sustainable over a long period. This may create the perception that
the potential market demand is too small to sustain the number of
biokineticists trained annually. In the history of biokinetics in South
Africa no studies have investigated the potential market demand for
biokinetics, based on the services delivered by the profession to the
public.
The purpose of this study was to determine the potential market
demand for biokinetics in the private health care sector of South
Africa. The results obtained from this investigation will shed some
light on the potential number of biokineticists that could be trained
per year, given no restrictions from the training institutions with
regard to lecturing staff.
Research methodology
Data collection
The study was an observational study to determine the potential
market need for biokinetics. In order to understand the method-
ology, it is important to dene the market. According to Wood12 the
market potential is all the customers who may be interested in the
service that is presented. It is, however, important to remember that
some customers in this potential market are unaware of the product,
some may not have access to it, some may not be able to use it and
some may not be able to afford it. The potential market represents
the maximum number of customers who might buy the product – but
not the number who will realistically buy it.13
The approach that was followed (Fig. 1) was to determine the
number of persons in the identied segment (persons with a chronic
disease of lifestyle) that potentially require the service and the
number of potential service delivery points (practising biokineticists)
matching each other. This was performed within the South African
private health care framework.
For the purpose of this study, the market segment that was
identied to base the potential market demand on was that of
persons with CDL and orthopaedic abnormalities. Although the
scope of practice for biokineticists9 includes the pathogenic and the
fortogenic (health promotion) paradigms, it was decided to focus only
on the pathogenic paradigm for the purpose of this study. Because
secondary data were used for the analyses, it was important to ensure
that they are timely, unbiased, legitimate, reliable and qualied.12 In
order to comply with these criteria, it was decided to make use of
timely (2007), unbiased and reliable information from a private sector
medicine claims database. The data are reliable as the database is
created online in real time as patients collect their prescriptions. The
geographical area, according to postal code of the consultation room
of the prescriber, was also captured.
The medicine claims data were from a pharmacy benet
management company (PBM). The PBM company administered
medicine claims data of members of medical schemes from almost
all community pharmacies and 98% of the dispensing doctors. For
security, ethical, patient and provider identication reasons, PBM
company was not identied by name.
Prevalence of chronic diseases of lifestyle
The Niche Area: Medicine Use in South Africa (MUSA) has the rights
to use the medicine claims database of the specic PBM for research
purposes. Ethical clearance was obtained from the Ethics Committee
of the North-West University (Project number: NWU-0046-08-S5).
This system is a fully integrated management system for more than
42 medical scheme clients administered by 17 different health care
administrators. In 2007, 1.6 million South Africans beneted from this
system. All medicines prescribed for chronic diseases were classi-
ed according to the coding system in the Monthly Index of Medical
Specialties (MIMS) classication system, which classies medicine
according to its pharmacological action.14 A further classication of
medicine information was performed with regard to the place (con-
sultation room) of prescriber (province, district council, municipality
and main place level).
The Statistical Analysis System®, SAS 9.1®15 programme
was used to group all prescribed practice addresses according to
province, district council, municipality and main place level. This
allowed the researchers to identify the number of diseases treated
with medication and the number of patients who received chronic
medicine in different geographical areas in South Africa.
From the database all chronic conditions where exercise is
considered an appropriate treatment modality and that is addressed
by biokineticists in their scope of practice as announced in the
Government Gazette6 in 1983, were extracted to determine the
national and provincial prevalence of the following chronic diseases
in South Africa: hypertension, diabetes, obesity, dyslipidaemias,
cardiovascular diseases, osteoporosis, depression and chronic
obstructive pulmonary diseases (COPD).
Biokineticist to patient/client ratio
In order to determine the potential market for biokinetics in the pri-
vate health care sector, the ratio of biokineticist to patient or client
Fig. 1. A schematic presentation of the research methodological approach.
PBM dataset
Biokinetics
Prevalence
Distribution
Chronic disease
HPCSA & BASA dataset
Biokineticists
Bio/Patient ratio
Distribution
Number of
Biokineticists
?
=
Number of
Biokineticists
Chronic disease of lifestyle
Fig. 1. A schematic presentation of the research methodological
approach.
16 SAJSM VOL 23 NO. 1 2011
was also determined by means of a telephone survey. Biokinetics
practice owners registered with the Biokinetics Association of South
Africa (BASA) website were asked to indicate the average number
of active clients/patients treated at their facility monthly, the number
of biokineticists and intern-biokineticists working in the practice. The
ratio of biokineticist to patient/client was determined from this infor-
mation.
Statistical analysis
Descriptive statistics with frequency tables, mean ± standard devia-
tion and graphs were performed in order to determine the market
potential for biokinetics in the private health sector. Mathematical
calculations were performed to calculate the potential market need
for biokineticists.
Results
The purpose of this study is to determine the potential market de-
mand in the broad term for biokinetics in the private health care sec-
tor, specically with reference to the pathogenic paradigm. In order
to determine this potential demand the results will be presented by
determining the prevalence of CDL, reporting on the physical activity
levels of the population and the available biokineticists and practices
that address the CDL with exercise.
The prevalence of CDL as represented by chronic medication
use from a medicine claims database of a PBM company indicated
that 911 212 chronic diseases were treated within the 1.6 million
subscribers (Table I). The average age of the persons taking chronic
medication for diseases related to CDL was 36.8 ± 21.8 years.
The average age was calculated according to the age at the rst
prescription date. The females were slightly older than the males
(M=35.4±21.9 years; F=37.9±21.8 years). Totals in the table do not
add up, as a few claims could not be placed according to geographical
region (provinces) but are included in the calculations.
The results of Table I indicate that the prevalence of CDL is
66% in the specic PBM database for 2007. It is however known
that one person could be diagnosed and treated for more than one
disease, as is often the case for persons with diabetes mellitus. The
calculation of the number of patients represented by the prevalence
of CDL in the PBM (Table II) indicates that 47% of persons registered
with the PBM are treated for CDL and receiving medication for the
CDL. The prevalence of persons with CDL is the highest in the
Gauteng province at 19%, with the lowest prevalence the Northern
Cape at 1%.
When the results form Table II are further divided by age and
ratio of female/male it shows that except for gout, the ratio of women
obtaining chronic medication is higher than for men. The average
age of the patients also indicate that lung disease is present mainly
in the younger population, with the average age of persons treated
with bronchodilators at 33.0±23.2 years and those with asthma
TABLE I. The prevalence of diseases related to chronic diseases of lifestyle receiving medication in the private
health care sector based on a PBM company database in 2007 for the different provinces in South Africa
CDL
Eastern
Cape Free State Gauteng
KwaZulu-
Natal Limpopo
Mpuma-
langa
North-
West
Northern
Cape
Western
Cape TOTAL
Anti-
depressants 9 080 8 149 50 763 16 106 6 854 5 650 7 692 2 314 14 993 122 026
Epilepsy 1 547 1 604 13 583 5 091 958 1 081 1 476 324 2 717 28 481
Parkin-
sonism
291 268 1 807 593 145 154 235 60 557 4 123
NSAID 23 214 16 022 137 497 48 487 23 156 19 820 23 304 5 130 33 836 332 173
Gout 1 333 994 7 708 2 113 913 1 150 999 233 2 196 17 681
Osteopo-
rosis
855 607 4 815 1 670 211 292 429 100 1 851 10 872
CVD 210 248
Inotropic
agents
507 495 2 384 1 028 286 259 310 131 925 6 345
Arrhyth-
mias
258 478 2 155 610 83 157 210 66 735 4 774
Hyperten-
sion
11 570 9 249 66 102 22 151 6 365 6 945 8 467 2 455 23 559 157 354
Angina 4 553 3 012 19 081 7 236 2 613 2 415 2 869 10 704 7 588 50 587
Vasodilator 50 104 782 97 54 69 142 32 107 1 444
Vasocon-
strictors
233 270 2 746 514 156 303 386 89 442 5 138
Hyperlipi-
daemia
6 393 4 166 36 455 10 509 1 986 2 891 3 519 875 14 133 81 204
Bronchodi-
lators
12 471 7 639 27 495 11 095 10 548 12 764 2 739 21 642 175 277
Asthma 2 478 2 533 19 964 6 463 3 479 1 959 3 083 508 4 805 45 367
Diabetes 3 388 2 335 19 638 7 981 2 557 2 129 2 586 693 6 010 47 459
Total 76 543 45 905 403 129 135 009 54 314 45 662 46 683 11 029 92 774 911 212
CDL = chronic diseases of lifestyle; NSAID = non-steroid anti-inammatory drugs; CVD = cardiovascular disease.
SAJSM VOL 23 NO. 1 2011 17
medication 32.6±25.3 years. The average age of people obtaining
medication for cardiovascular diseases is 60 - 70 years. Non-steroid
anti-inammatory medication (NSAID) is mostly prescribed to
persons around the age of 45 years. This may be due to the onset of
arthritis and joint and muscle pain from previous injuries.
The calculation from Fig. 2 indicates that from 1.6 million persons,
747 199 persons are on medication for a CDL that could be treated
through exercise intervention such as presented by biokineticists.
This is further divided into 316 894 persons suffering from a single
disease and the rest treated for more than one disease within the
CDL. The prevalence of participants on anti-inammatory medication
is the highest (21%), followed by patients who received medication for
cardiovascular diseases (13%) and then patients on bronchodilators
(11%) and medication for hypertension (10%).
Physical inactivity proles of South Africans
As biokineticists address CDL with exercise as treatment, it is also
important to report on the current levels of physical inactivity as it
is a risk factor for CDL.3 Secondary data reported in the South Afri-
can Health Review10 compared the levels of inactivity reported in the
general population with those reported in a corporate survey (Table
III). The results indicate that about 50% of the general population
does not participate in levels of physical activity that would reduce
or manage CDL.
Current biokinetic practices
In order to determine the market potential, the current number of
biokineticists who render this service had to be determined. The
number of practising biokineticists according to the BASA website,
which is an optional place to register and not compulsory (Table IV),
indicates 284 biokinetic practices. Seventy-one of the 284 practices
are accredited to employ biokinetic interns (students in training who
have to complete a nal year of practical training before nal regis-
tration with the HPCSA can be obtained). These practices may em-
ploy more than one biokineticist and a maximum of two interns per
registered biokineticist.9
Data obtained from the BHF,8 the management system for practice
numbers that enables biokineticists and patients to claim from
medical insurance, indicate 625 biokineticists with active practice
numbers who were also registered with the HPCSA in 2007. The
distribution of these practices within South Africa (Table IV) indicates
that the majority of the practices are in the Gauteng province (130),
with the second most in the Western Cape (63). This means that
46% of biokineticists are practising in and around Gauteng, while
about 22% of the total pool of practising biokineticists is active in the
Western Cape. This leaves about 32% of the biokineticists in the rest
of South Africa.
Ratio of biokineticist to patient/client
A telephonic interview with 50 randomly selected available bioki-
neticists indicated that each biokineticist could manage about 100
1
Fig 2. The prevalence (%) of disease in participants on the PBM database taking
medication for the different chronic diseases of lifestyle. (NSAID =
non-steroid anti-inflammatory drugs; CVD = cardiovascular disease




 




 
 


Fig 2. The prevalence (%) of disease in participants on the PBM
database taking medication for the different chronic diseases of
lifestyle. (NSAID = non-steroid anti-inammatory drugs; CVD =
cardiovascular disease.)
TABLE II. Prevalence of CDL according to the number of persons diagnosed and treated with medication for each
of the provinces and in relation to the estimated population
Provinces Estimated population Persons with CDL % of the estimated population
Eastern Cape 6 906 200§46 503 2.9
Free State 2 965 600§33 110 2.1
Gauteng 9 688 100§300 659 18.8
KwaZulu-Natal 10 014 500§112 948 7.1
Limpopo 5 402 900§47 221 2.9
Mpumalanga 3 536 300§42 221 2.6
North-West 3 394 200§49 895 3.1
Northern Cape 1 102 200§11 271 0.7
Western Cape 4 839 800§100 343 6.3
Not indicated 3 028 0.2
Total 47 849 800§747 199 46.7
§Total mid-year population estimates, 2007.16
TABLE III. A summary of the prevalence (%) of phys-
ical inactivity reported in different surveys
Surveys Total (%) Males (%)
Females
(%)
51-country survey17 46.2 44.7 47.6
Youth risk behaviour18 36.8 30.5 43
Corporate survey19 69 62 75
SADHS20 46 43 49
World Health Survey21 46 43 49
SADHS = South African Demographic and Health Survey.
18 SAJSM VOL 23 NO. 1 2011
(range 40 - 160) patients per month depending on the type of prac-
tice and the business strategy followed. There was an average of 2
biokineticists working in each practice. If every biokineticist managed
100 clients in South Africa from the specic PBM, where 747 199
clients are treated for CDL, then 7 438 biokineticists will be required
in South Africa. Table IV indicates the current number of practising
biokineticists with regard to each province together with the market
potential based on the prevalence of chronic disease as indicated by
the PBM system.
Discussion
CDL are a reality in South Africa, a country with a double burden of
disease that is created between CDL, also known as non-communi-
cable diseases, and the infectious diseases such as HIV/AIDS and
tuberculosis, also known as communicable diseases. The results of
this study indicate that the prevalence of the CDL in this PBM system
is 56% and represent 47% patients. The major three conditions rep-
resent nearly a third of all the total medicine expenditure managed
by this studied PBM. This is much higher than the reported 37%
of deaths attributed to CDL.18 Considering that most of the surveys
report on data that were obtained either during 199820 (SADHS) or
until 2005,2 it is therefore possible that the prevalence of CDL has
increased substantially since the last survey.
Although the percentages are not very high, the corresponding
numbers of persons who require treatment are substantial. If these
percentages of prevalence for the various CDLs are extrapolated
to the general population, estimated to be 47 498 00016 (StatsSA,
2009) at June 2007, it could mean that about 26 795 888 people in
South Africa are diseased by one of the CDLs. Steyn et al.2 report
that about 6 million people are living with hypertension, 4 million with
diabetes and about 4 million have hyperlipidaemia. Steyn et al.2 also
mention that about 56% of the population has at least one of these risk
factors. The prevalence of CDL as found in this investigation based
on the prescription of medication, observed comparable prevalence
for hypertension and diabetes as reported by Puoane et al.23 Studies
investigating the cost of managing CDL have highlighted the burden
of CDL on an economy. 23,24
When interpreting the data on CDL from a biokineticist’s point
of view, it is important to also consider the inactivity patterns in
South Africa. The results indicate that females are more inactive
than males, with people in the corporate sector reporting inactivity
levels of close to 70% in the total for males and females.10 This is a
daunting number of physically inactive persons who are often also
exposed to high levels of stress in the work environment. These high
levels of physical inactivity indicate that there is a huge potential for
the management of chronic diseases with exercise and physical
activity interventions, as the majority of the population are currently
not participating in the required amount of activity as prescribed by
the ACSM3 to achieve health outcomes.
The results of the number of biokineticists registered with the
HPCSA that also have active practice numbers indicate that the
approximately 625 biokineticists are most likely accommodated
within the 284 biokinetics practices in South Africa. These are
crude delineations as it is impossible to obtain the exact number of
biokineticists who are actively earning a living as biokineticists. The
reason is that persons on the register of the HPCSA continue to pay
registration fees annually to ensure they stay on the role, even if they
are not practising, in order to keep their registration. The reason for
this behaviour is that it is difcult to obtain registration again once
you have been deregistered and have not practised for a number of
years. Another reason for inaccurate numbers on the BASA website
is the fact that it is optional to register practices on the website. In
spite of the inaccurate numbers, the data described are still the most
accurate available that were used in the analysis and assumptions
made.
The distribution of the biokinetics practices simulate the areas
of high income in South Africa, with the most practices being in the
Gauteng area and the least practices in the Northern Cape, which has
the lowest income per capita.16 The population density in Gauteng is
also higher than in the Northern Cape, resulting in shorter travelling
distances between home and biokinetic practices. The analyses of
the number of patients/clients that a biokineticist is able to treat per
month indicated an average of 100 persons with a range of between
40 and 160. There was an average of 2 biokineticists working per
accredited practice.
In order to calculate the potential market demand for biokinetics,
the potential number of persons taking medication for CDL according
to the analysed PBM system was divided by 100 to determine the
number of potential biokineticists needed. This calculation indicated
that about 7 438 biokineticists are needed. If an average of two
persons work together, that means that about 3 719 practices are
potentially needed. The current number of biokinetic practices is
therefore calculated to be rendering a service to only 8% of the
potential market. As these are pure calculations to determine the
market potential, it is necessary to take into account the factors
that may hamper people from visiting a biokineticist for exercise as
treatment of a CDL.
When calculating a market potential, the broadest market is
rst determined,12 as was done with this study. It is important to
remember that these results are a crude indication of the potential
market demand for biokinetics in the private health care sector. This
study also only focused on the pathogenic paradigm, and not the
fortogenic (health promotion) paradigm, where biokinetic intervention
addresses the prevention of CDL. The section of the market that has
the income to afford the service and has access to the product should
be determined. Important factors that can inuence the behaviour of
the potential consumers will include gender, level of education, age,
ethnic background and the perceived value for the client/patient,
TABLE IV. The relationship between the current
number of practising biokineticists and the potential
market need for the different provinces
Province
Current number of
practices (N)
Market need
for biokineti-
cists* (N)
Eastern Cape 19 465
Free State 11 331
Gauteng 130 3 006
KwaZulu-Natal 33 1 129
Limpopo 5 472
Mpumalanga 9 422
North-West Province 11 498
Northern Cape 3 112
Western Cape 63 1 003
Total 284 7 438§
*Based on 100 patients/biokineticist.
§Numbers differ due to some claims not being linked to original place of prescribing
of medication.
SAJSM VOL 23 NO. 1 2011 19
various social connections and personal elements, of which lifestyle
would be the most prominent together with motivation.
A study investigating the factors that inuence the demand for
health care in South Africa using a multinomial logit estimation, found
that there are three categories of factors that inuence the demand.
These factors are: (i) demographic and location variables (e.g.
income, race and location); (ii) characteristics of the care provided
(e.g. cost and distance from the respondent); and (iii) characteristics
of the illness (such as severity).25 This study also found that an
increase in income indicated a decrease in the use of primary health
care. Where income was above R2 785 per month, primary health
care was only utilised in less than 5% of the respondents.25 These
results give an indication of the income group that can be expected
to seek treatment for CDL as offered by biokinetics.
The limitations of this study were that the numbers on which
the calculations are based are relative, although currently the most
accurate available. The calculations from the PBM are also based
on the prevalence of the 2007 data, as the classication of the 2008
data is not available. The number of biokineticists is also a crude
number as accurate numbers are difcult to obtain. Registered
biokineticists often become pharmaceutical representatives to earn
a larger income while also learning business and marketing skills
before returning to the profession.
Conclusions
The conclusion that can be drawn from this study is that there is a
large potential market for biokinetics in the private health care sector
of South Africa. Currently only an estimated 8% of the potential mar-
ket is addressed by biokinetics with exercise as a treatment modality.
This is only the calculation for the pathogenic paradigm. It therefore
seems that the number of biokineticists trained annually could be
increased to address the shortage in the market. However, an inves-
tigation is recommended to determine the factors that may prevent
the large potential market demand from realising.
Re f e r e n c e s
1. Vorster HH, Kruger A. Chronic diseases of lifestyle in South Africa: the role
of public health nutrition in the promotion of health, and prevention and
treatment of disease. S Afr J Diab Vasc Dis 2006;3(4):179-181.
2. Steyn K, Fourie J, Temple N, eds. Chronic Diseases of Lifestyle in South
Africa: 1995-2005. MRC - technical report. Cape Town: South African
Medical Research Council, 2006:1- 266.
3. Thompson WR, ed. ACSM’s Guidelines for Exercise Testing and Prescrip-
tion, 8th ed. Philadelphia: Lippincott Williams & Wilkins, 2009:152-206.
4. World Health Organization. World Health Report 2002. Geneva: WHO.
5. Hagberg LA, Lindholm L. Cost-effectiveness of healthcare-based in-
terventions aimed at improving physical activity. Scand J Public Health
2006;34:641-653.
6. The South African Medical and Dental Council - rules for the registra-
tion of medical scientists (Notice 673, 1983). Government Gazette,
1983;8879:19.
7. Strydom GL. Biokinetics: the development of a health profession from physi-
cal education – historic perspective. SAJR SPER 2005;27(2):113-128.
8. Board of Health Care Funders. www.bhfglobal.com. 2009 (accessed 10
September 2009).
9. Health Professions Council of South Africa (HPCSA). www.hpcsa.co.za
2009. (accessed 30 August 2009).
10. Harrison S, Bhana R, Ntuli A, eds. South African Health Review. Durban:
Health Systems Trust, 2007.
11. Kotler P, Armstrong G. Principles of Marketing. 12th ed. Upper Saddle
River, New Jersey: Pearson: Prentice Hall, 2008.
12. Wood MB. Marketing Planning: Principles into Practice. Harlow, England:
Prentice Hall, 2004.
13. Roger JB. Market-Based Management: Strategies for Growing Customer
Value and Protability, 2nd ed. Upper Saddle River, NJ: Prentice Hall,
2000:59-62.
14. Snyman JR, ed. MIMS Monthly Index of Medical Specialities. MIMS:
Pretoria. 2009.
15. SAS Institute Inc., 2003.
16. Statistics South Africa. www.statssa.gov.za. 2008 (accessed 9 September
2009).
17. Guthold R, Ono T, Kathleen L, Strong KL, Chatterji S, Morabia A. World-
wide variability in physical inactivity: A 51-country survey. Am J Prev Med
2008;34(6):486-494.
18. Reddy SP, Panday S, Swart D, et al. Umthenthe Uhlaba Usamila – The
South African youth at risk behaviour survey 2002. Cape Town: South
African Medical Research Council.
19. Kolbe-Alexander TL, Buckmaster C, Nossel C. Chronic disease risk fac-
tors, healthy days and medicine claims in South Africa employees pre-
senting for health risk screening. BMC Public Health 2008;8(228):1-11.
20. Department of Health, Medical Research Council. The South African De-
mographic Health Survey. Pretoria: Department of Health, 2002.
21. World Health Organization. Preliminary Results of the World Health Sur-
vey 2002-2003, International Physical Activity Data, South African results.
Geneva: WHO, 2005.
22. Puoane T, Tsolekile L, Sanders D, Parker W. Chronic non-communicable
diseases. In: Barron P, Roma-Reardon J, eds. South African Health Re-
view. Durban: Health Systems Trust, 2008.
23. Kouris-Blazos A, Wahlqvist M. Health economics of weight management:
evidence and cost. Asia Pac J Clin Nutr 2007;16(Suppl 1):329-338.
24. Ruchlin HS, Dasbach EJ. An economic overview of chronic obstructive
pulmonary disease. Pharmacoeconomics 2001;19(6):623-642.
25. Havemann R, Van der Berg S. The demand for health care in South Af-
rica. J Stud Econ Econometrics 2003;27(3):1-27.
... Large market demands are present in South Africa for Biokineticists; however, to successfully access these market demands the correct business knowledge, training and skills are required. [14,15] Biokineticists are left with limited career choices within South Africa, often finding themselves working for, or opening, private practices [14] . The prospect of succeeding with these options are slim in South Africa, where the small business failure rate is between 70-80% [15] . ...
... Large market demands are present in South Africa for Biokineticists; however, to successfully access these market demands the correct business knowledge, training and skills are required. [14,15] Biokineticists are left with limited career choices within South Africa, often finding themselves working for, or opening, private practices [14] . The prospect of succeeding with these options are slim in South Africa, where the small business failure rate is between 70-80% [15] . ...
... This may result in the growth of small practices, becoming sustainable and successful in a modern business environment. [14,15] Furthermore, by addressing the abovementioned gaps in education and knowledge, Biokineticists may have an opportunity to evolve and implement themselves in addressing the larger socioeconomic and health-related issues. ...
Article
Full-text available
Background: Business management training is essential for success in the modern era. Health and medical professionals are exposed to knowledge that allows them to treat pathologies. However, their training does not prepare them to manage their practices as businesses and in a sustainable, effective, and efficient manner.Objectives: To investigate the business management training needs of registered South African Biokineticists. Methods: A quantitative and descriptive research design was used. Sixty-nine registered Biokineticists answered the emailed survey. The survey was sent out on two separate days, two weeks apart. Participants could only answer the survey once. The survey was sent out by the Biokinetics Association of South Africa (BASA). The sample in this study consisted of both male and female participants who graduated between the years of 1985-2019. The survey consisted of demographic questions about their study methods. It also included a 5-point Likert Scale where a score of 1 indicated an exceptionally low need and a score of 5 indicated a very high need for corresponding business processes. The business processes included accounting, business sustainability, corporate social responsibility, ethics, financial management, human resource management, leadership and managerial decision-making, marketing, operational management, and strategic management. A final open-ended question on what other business management training the participant needed was asked at the end of the survey. Results: Combined high to very high needs (X≥4 on the Likert Scale) for the business management processes explored were: accounting: 28%, business sustainability: 33%, corporate social responsibility: 23%, ethics: 55%, financial management: 35%, human resource management: 29%, leadership and managerial decision-making: 43%, marketing: 41%, operational management: 39%, and strategic management: 33%. Seventy-one percent of the participants who took part in the study suggested that they needed other business management training needs, providing suggestions in the final question. Of the 71% of participants who answered this question, the most important requests identified included information technology (17%), tax- related management and knowledge (19%) and medical aid training for ICD-10 coding (13%). The other 51% of the participants that answered the final question provided suggestions that could be categorised into the areas of business already reported on in the Likert Scale. Sixty-nine out of a possible ±1600 registered Biokineticists who were BASA members completed the survey. This represents a response rate of about 4%. Conclusion: Business management training needs exist for South African Biokineticists. By addressing these needs, it may lead to improvements in overall patient care, practice management and small business growth which in return can lead to the socioeconomic stimulation of the country.
... Physiotherapists, occupational therapists and biokineticists are registered clinicians with the Health Professions Council of South Africa (HPCSA, 2013) and are managed by their respective Boards (BASA, 2016), while the chiropractors are registered with the Allied Health Professions Council of South Africa (AHPCSA, 2016). Moss and Lubbe (2010) reported that there is substantial patient market for the service of biokineticists in South Africa. Biokineticists rehabilitate 6.2-9.1% of the total rehabilitative out care patient population in South Africa, which indicates a positive future for this young profession (Moss & Lubbe, 2010). ...
... Moss and Lubbe (2010) reported that there is substantial patient market for the service of biokineticists in South Africa. Biokineticists rehabilitate 6.2-9.1% of the total rehabilitative out care patient population in South Africa, which indicates a positive future for this young profession (Moss & Lubbe, 2010). ...
Article
Full-text available
Biokinetics is the youngest profession to emerge among the South African rehabilitative fraternity to assist with the management of lower back pain. This discipline is borne out of the philosophy “Exercise is Medicine” and primarily focuses on final phase rehabilitation, applying inter alia cardiorespiratory endurance, range of motion and strengthening exercises. The aim of this communication is to describe some of the views of the profession of Biokinetics, how it may assist patients to manage their lower back pain and its position in the multidisciplinary South African rehabilitative fraternity including: Physiotherapy, Occupational Therapy and Chiropractic Therapy.
... 18 While the number of registered practicing physiotherapists in South Africa in 2012 was 6,159, only 1,069 (17.3%) were employed by the SADH. 21 Moss and Lubbe 22 identified that the South African populace needs one exercise therapist in order to optimally manage 100 NCD patients per month, thereby requiring 60,582 therapists if we take the aforementioned statistics regarded treated patients at face value. We can therefore conclude that in 2012, an additional 59,513 physiotherapists were required in order to meet this demand. ...
Article
Full-text available
The mortality of South African noncommunicable diseases (NCDs) is rising. One of its primary contributors is physical inactivity. Therefore, South African National Health Plan included exercise therapy as part of their strategy to inhibit the NCDs upsurge. This study aimed to determine whether the number of South African exercise therapists is sufficient to equitably manage this NCD epidemic. The 2013 and 2017 Health Professions Council of South Africa reports identified the number of physiotherapists, biokineticists, and their respective students-in-training. In 2012, 10,623,820 people were identified with NCDs; however, South African Department of Health only treated 6,058,186 patients (57.0%) ( p < .05). South African Health Review has estimated a 28.7% increase in the number of NCDs patients treated from 2012 (6,058,186) to 2025 (7,799,770) ( p < .05). The average yearly growth of practicing physiotherapists (3.4%) and the physiotherapy student-in-training (2.2%) is inequitable to manage this NCD epidemic. In 2012, the extrapolated physiotherapist-to-NCD patient ratio was 1:5667. The South African Department of Health should consider including biokineticists to aid in the management of the NCD epidemic.
... There are on-going negotiations for biokineticists to be allowed entrance into the public healthcare sector. Despite this challenge, Moss and Lubbe have reported that there is a viable private healthcare biokinetic patient market [18]. South African biokineticists predominantly operate in private biokinetic practices, corporate wellness programmes, private school and the SADF. ...
... The demand for biokineticists is evident within the private health care sector as demonstrated by Moss and Lubbe. [8] However, the vast majority of people (40 million people) cannot afford the expense of private health care. They are therefore reliant on a public health care system already crippled by a quadruple burden of disease of HIV/AIDS and tuberculosis (TB), high maternal and child mortality, high levels of violence and injuries, and a growing burden of NCDs. ...
Article
Full-text available
Background: Noncommunicable diseases (NCDs) are increasingly prevalent within South Africa. Physical inactivity is a significant, independent and modifiable risk factor increasing the prevalence of NCDs. Discussion: The integration of physical activity programmes into the primary health care system through multidisciplinary platforms is thus advocated for and envisioned to be more cost-effective than current practices. However, currently within the primary health care setting of South Africa, there is an absence of health care professionals adequately equipped to develop and implement physical activity programmes. Biokineticists, whose scope of practice is to improve physical functioning and health through exercise as a modality, are ideally suited to developing and implementing physical activity programmes in the public sector. Yet despite their evident demand, the role of the biokineticist is not incorporated into the national public health care system. Conclusion: This short report calls firstly, for the inclusion of biokinetics into the public health care sector, and secondly, for the funding of multidisciplinary community health programmes supporting education, healthy eating and physical activity levels.
Article
Full-text available
The World Health Organization estimates that around one billion people throughout the world are overweight and that over 300 million of these are obese and if current trends continue, the number of overweight persons will increase to 1.5 billion by 2015. The number of obese adults in Australia is estimated to have risen from 2.0 million in 1992/93 to 3.1 million in 2005. The prevalence of obesity has been increasing due to a convergence of factors--the rise of TV viewing, our preference for takeaway and pre-prepared foods, the trend towards more computer-bound sedentary jobs, and fewer opportunities for sport and physical exercise. Obesity is not only linked to lack of self esteem, social and work discrimination, but also to illnesses such as the metabolic syndrome and hyperinsulinaemia (which increases the risk of developing heart disease, diabetes, hypertension, fatty liver), cancer, asthma, dementia, arthritis and kidney disease. It has been estimated that the cost of obesity in Australia in 2005 was $1,721 million. Of this amount, $1,084 million were direct health costs, and $637 million indirect health costs (due to lost work productivity, absenteeism and unemployment). The prevalence cost per year for each obese adult has been estimated at $554 and the value of an obesity cure is about $6,903 per obese person. Government efforts at reducing the burden remain inadequate and a more radical approach is needed. The Australian government, for example, has made changes to Medicare so that GPs can refer people with chronic illness due to obesity to an exercise physiologist and dietitian and receive a Medicare rebate, but so far these measures are having no perceptible effect on obesity levels. There is a growing recognition that both Public Health and Clinical approaches, and Private and Public resources, need to be brought to this growing problem. Australian health economist, Paul Gross, from the Institute of Health Economics and Technology Assessment claims there is too much reliance on health workers to treat the problem, especially doctors, who have not been given additional resources to manage obesity outside a typical doctor's consultation. Gross has recommended that further changes should be made to Medicare, private health insurance, and workplace and tax legislation to give people financial incentives to change their behaviour because obesity should not just be treated by governments as a public health problem but also as a barrier to productivity and a drain on resources. A Special Report of the WMCACA (Weight Management Code Administration Council of Australia) (www.weightcouncil.org) on the "Health Economics of Weight Management" has been published in the Asia Pacific Journal of Clinical Nutrition in September 2006. This report explores the cost benefit analysis of weight management in greater detail.
Article
Full-text available
Non-communicable diseases (NCD) accounts for more than a third (37%) of all deaths in South Africa. However, this burden of disease can be reduced by addressing risk factors. The aim of this study was to determine the health and risk profile of South African employees presenting for health risk assessments and to measure their readiness to change and improve lifestyle behaviour. Employees (n = 1954) from 18 companies were invited to take part in a wellness day, which included a health-risk assessment. Self-reported health behaviour and health status was recorded. Clinical measures included cholesterol finger-prick test, blood pressure and Body Mass Index (BMI). Health-related age was calculated using an algorithm incorporating the relative risk for all case mortality associated with smoking, physical activity, fruit and vegetable intake, BMI and cholesterol. Medical claims data were obtained from the health insurer. The mean percentage of participation was 26% (n = 1954) and ranged from 4% in transport to 81% in the consulting sector. Health-related age (38.5 +/- 12.9 years) was significantly higher than chronological age (34.9 +/- 10.3 yrs) (p < 0.001). Both chronological and risk-related age were significantly different between the sectors (P < 0.001), with the manufacturing sector being the oldest and finance having the youngest employees. Health-related age was significantly associated with number of days adversely affected by mental and physical health, days away from work and total annual medical costs (p < 0.001). Employees had higher rates of overweight, smoking among men, and physical inactivity (total sample) when compared the general SA population. Increased health-related expenditure was associated with increased number of risk factors, absenteeism and reduced physical activity. SA employees' health and lifestyle habits are placing them at increased risk for NCD's, suggesting that they may develop NCD's earlier than expected. Inter-sectoral differences for health-related age might provide insight into those companies which have the greatest need for interventions, and may also assist in predicting future medical expenditure. This study underscores the importance of determining the health and risk status of employees which could assist in identifying the appropriate interventions to reduce the risk of NCD's among employees.
Article
In the Government Gazette of 9 September 1983, Biokinetics was announced to have been registered with the Professional Board of Medical Science at the South African Medical and Dental Council. This registration heralded the beginning of a new profession of Biokinetics, which would position specialised exercise science as a health profession that aimed not only at contributing to the curative sciences but also to the promotion of health and wellness. This milestone in the history of Biokinetics occurred after a long process of deliberations with other role players in the health profession. In some cases serious resistance against this new discipline existed – not only from other disciplines but also among scientists in the field of exercise science. Since this historical event the profession of Biokinetics has gone from strength to strength. With 536 professionals on the register of the Health Professions Council of South Africa as on 18 November 2004 and 10 tertiary institutions providing training to approximately 130 students per year the profession can become a profession that contributes to the spreading of the message of the responsibility that individuals have for their own health and wellness. In this respect some medical aid funds supported this philosophy of health promotion, as the curative treatment of health problems are becoming increasingly expensive and are burdening health-care costs. At present qualified professionals are found all over the world practising their profession and making superb contributions, although not always under the name of Biokinetics. South African Journal for Research in Sport, Physical Education and Recreation Vol. 27(2) 2005: 113-128
Article
Contenido: I) Orientación y rendimiento del mercado; II) Análisis del mercado; III) Estrategias de mezcla de mercadotecnia; IV) Planeación estratégica; V) Plan y rendimiento de mercadotecnia.
Article
Supply-side solutions to health-care provision dominate the South African debate. These are often premised on views that health resources are too concentrated in the private health sector - which supposedly serves only a small minority - and that public provision needs to be expanded. This misunderstands the nature of the demand for health services. This paper estimates the determinants of the demand for health care using a multinomial logit estimation and finds that three categories of factors influence this demand: demographic and locational variables (e.g. income, race and location); characteristics of the care provided (e.g. cost and distance from the respondent); and characteristics of the illness (such as its severity). Even poor respondents reveal a clear preference for private care, despite constraints of money and access. This dominance of the demand for private health care is likely to increase with rising incomes, or if all health services were to be similarly subsidised (e.g. from mooted medical insurance-type schemes). Greater attention should therefore perhaps be given to health demand in considering policy alternatives.
Article
Chronic obstructive pulmonary disease (COPD) is a major cause of mortality and morbidity. Relatively few pharmacoeconomic studies have been conducted on this disease. This article reviews available information about the utilisation of healthcare resources and cost of care, and the cost or cost effectiveness of therapeutic interventions reported for this disease. Burden-of-illness data indicate that hospital care, medications and oxygen therapy were the major cost drivers in these studies. Mean annual Medicare expenditures in the US were $US11 841 (2000 values) for patients with COPD compared with $US4901 for all covered patients. Utilisation was skewed; the most expensive 10% of the Medicare beneficiaries accounted for nearly 50% of total expenditures for this disease. Costs are associated with health status, age, physician specialty, geographic location and type of insurance coverage. Six types of interventions were assessed in the literature - pharmacotherapy, oxygen therapy, home care, surgery, exercise and rehabilitation and health education. The studies used different analytic strategies (e.g. cost-minimisation and cost-effectiveness analyses) and even within the realm of cost-effectiveness analyses, no uniformity existed as to how outcome was measured. Patient severity was not always delineated, and the length of the follow-up period, while quite short, varied. Only 11 of the 34 evaluations were based on randomised controlled trials. Cost-minimisation studies generally found no significant difference in the cost of antimicrobial treatment for first-line, second-line and third-line agents. Studies of bronchodilators indicated that ipratropium bromide alone or in combination with salbutamol (albuterol) was the preferred medication. The major area for achieving cost savings is by reducing hospital utilisation. As the annual rate of hospitalisation is relatively low, large patient samples will be required to demonstrate an economic advantage for a new therapy. The major challenges will be financing such a study, and selecting an outcome measure that satisfies both clinical and economic conventions.
Article
This article aims to review current knowledge concerning the cost-effectiveness of healthcare-based interventions aimed at improving physical activity. A search was performed for economic evaluations containing the terms "physical activity", "exercise", or "fitness". Cost-effectiveness for the articles found was described based on a model for evaluating interventions intended to promote physical activity. A total of 26 articles were found in the search. Nine of them concern a general population, 7 evaluated older people, and 10 studied disease-specific populations. A preventive perspective is most common, but some have a treatment perspective. Around 20 of the interventions studied were cost-effective according to their authors, but all analyses had some shortcomings in their evaluation methods. This review found many examples of cost-effective interventions. There is a lack of evidence for the cost-effectiveness of interventions aimed at those whose only risk factor for illness is a sedentary lifestyle. There is more evidence, although it is limited, for the cost-effectiveness of interventions aimed at high-risk groups or those who manifest poor health related to physical inactivity. Most of the evidence for cost-effectiveness is for older people and those with heart failure. Promotion of physical activity can be cost-effective with different methods and in different settings, but there remains a lack of evidence for specific methods in specific populations.
Article
Physical inactivity is an important risk factor for chronic diseases, but for many (mainly developing) countries, no prevalence data have ever been published. To present data on the prevalence of physical inactivity for 51 countries and for different age groups and settings across these countries. Data analysis (conducted in 2007) included data from 212,021 adult participants whose questionnaires were culled from 259,526 adult observations from 51 countries participating in the World Health Survey (2002-2003). The validated International Physical Activity Questionnaire (IPAQ) was used to assess days and duration of vigorous, moderate, and walking activities during the last 7 days. Country prevalence of physical inactivity ranged from 1.6% (Comoros) to 51.7% (Mauritania) for men and from 3.8% (Comoros) to 71.2% (Mauritania) for women. Physical inactivity was generally high for older age groups and lower in rural as compared to urban areas. Overall, about 15% of men and 20% of women from the 51 countries analyzed here (most of which are developing countries) are at risk for chronic diseases due to physical inactivity. There were substantial variations across countries and settings. The baseline information on the magnitude of the problem of physical inactivity provided by this study can help countries and health policymakers to set up interventions addressing the global chronic disease epidemic.