The medical profession and the universalisation of South African Health Care: analysing the response of Eastern Cape general practitioners to the National Health Insurance proposals
- Authors: Hannah, Bridget
- Date: 2017
- Subjects: Health insurance -- South Africa , Health insurance -- Government policy -- South Africa , Medical care, Cost of -- South Africa , National health insurance -- South Africa , Medical policy -- South Africa , Physicians -- South Africa -- Attitudes
- Language: English
- Type: Thesis , Masters , MA
- Identifier: http://hdl.handle.net/10962/6075 , vital:21029
- Description: In 2011, the Green Paper on National Health Insurance (NHI) in South Africa was released, committing the South African government to a 14-year plan to radically transform the currently inequitable health system towards providing comprehensive quality health care free at point of access to all citizens. The pursuit of universal health coverage (UHC) in South Africa forms part of a global aspiration to achieve more equitable healthcare delivery. One of the critical issues emerging from the Green Paper was how the NHI would be staffed. The NHI is unlikely to be adequately staffed without GPs but evidence suggests that private sector doctors have always been resistant to nationalisation or socialisation as a threat to their occupational power and professional status. The core work of this thesis is a study undertaken of 78 doctors in the Eastern Cape, focusing on private sector general practitioners (GPs), as the largest constituency of medical professionals in the country. The interview schedule was designed to gauge doctors' responses to the NHI, encourage discussion on their reactions to the reforms, and its implications in their view for private medical practice. The responses of the doctors are analysed through application of two theoretical themes, namely: (i) actor-centred policy creation, discussed through application of Walt and Gilson's (1994) shared focus on content, context, process and actors in the policy process, and (ii) the debate on medical professionalism, espoused by Freidson (1973, 1994) and argued against by Haug and Sussman (1969), and McKinlay (1972, 1993). Thus, if the process of policy making must take into account key actors in order to deliver a successful policy transition, what are the implications if these actors are actively excluded, or do not willingly cooperate? Does this indicate anything telling about the private sector's role to play in the pursuit of universal healthcare?
- Full Text:
- Authors: Hannah, Bridget
- Date: 2017
- Subjects: Health insurance -- South Africa , Health insurance -- Government policy -- South Africa , Medical care, Cost of -- South Africa , National health insurance -- South Africa , Medical policy -- South Africa , Physicians -- South Africa -- Attitudes
- Language: English
- Type: Thesis , Masters , MA
- Identifier: http://hdl.handle.net/10962/6075 , vital:21029
- Description: In 2011, the Green Paper on National Health Insurance (NHI) in South Africa was released, committing the South African government to a 14-year plan to radically transform the currently inequitable health system towards providing comprehensive quality health care free at point of access to all citizens. The pursuit of universal health coverage (UHC) in South Africa forms part of a global aspiration to achieve more equitable healthcare delivery. One of the critical issues emerging from the Green Paper was how the NHI would be staffed. The NHI is unlikely to be adequately staffed without GPs but evidence suggests that private sector doctors have always been resistant to nationalisation or socialisation as a threat to their occupational power and professional status. The core work of this thesis is a study undertaken of 78 doctors in the Eastern Cape, focusing on private sector general practitioners (GPs), as the largest constituency of medical professionals in the country. The interview schedule was designed to gauge doctors' responses to the NHI, encourage discussion on their reactions to the reforms, and its implications in their view for private medical practice. The responses of the doctors are analysed through application of two theoretical themes, namely: (i) actor-centred policy creation, discussed through application of Walt and Gilson's (1994) shared focus on content, context, process and actors in the policy process, and (ii) the debate on medical professionalism, espoused by Freidson (1973, 1994) and argued against by Haug and Sussman (1969), and McKinlay (1972, 1993). Thus, if the process of policy making must take into account key actors in order to deliver a successful policy transition, what are the implications if these actors are actively excluded, or do not willingly cooperate? Does this indicate anything telling about the private sector's role to play in the pursuit of universal healthcare?
- Full Text:
Explaining the endurance of poverty and inequality : social policy and the social division of welfare in the South African health system
- Authors: Du Plessis, Ulandi
- Date: 2013
- Subjects: Health system , Private health , Public health , Poor , Subsidies , Profit motive , Quality , Efficiency , Public health -- Finance -- Research -- South Africa , Medical care -- Research -- South Africa , Poverty -- Research -- South Africa , Equality -- Research -- South Africa , South Africa -- Social conditions
- Language: English
- Type: text , Thesis , Masters , MA
- Identifier: vital:2755 , http://hdl.handle.net/10962/d1002002
- Description: This thesis examines the structure and flow of public funding between the public and private sectors in the South African health system and the consequences thereof for the achievement of equity. The conceptual framework used to undertake the analysis derives from Richard Titmuss’ core theoretical framework, the Social Division of Welfare. The application of the Social Division of Welfare applied to the South African health care context demonstrates how state resources end up benefitting the non-poor and, as a result, reproduce inequality. Those who access public institutions such as public health care are assumed to be ‘dependent’ on the state, whilst those who access private health facilities claim to be ‘independent’ of the state. However, this thesis shows that these assumptions are flawed. Access to the formal labour market, and subsequently the paying of taxes, authorises one to access state subsidies not available to those who do not. The application of the Social Division of Welfare shows that tax-paying private health care patients benefit considerably from state resources. This thesis argues that due to cost escalation in the private health sector, a consequence of the commodification of health care, these private health care ‘consumers’ as well as the private health industry in general are dependent upon state resources. This thesis analyses the role played by the profit motive present in the private health industry and the consequences for equity, quality, access and efficiency in health care provision
- Full Text:
- Authors: Du Plessis, Ulandi
- Date: 2013
- Subjects: Health system , Private health , Public health , Poor , Subsidies , Profit motive , Quality , Efficiency , Public health -- Finance -- Research -- South Africa , Medical care -- Research -- South Africa , Poverty -- Research -- South Africa , Equality -- Research -- South Africa , South Africa -- Social conditions
- Language: English
- Type: text , Thesis , Masters , MA
- Identifier: vital:2755 , http://hdl.handle.net/10962/d1002002
- Description: This thesis examines the structure and flow of public funding between the public and private sectors in the South African health system and the consequences thereof for the achievement of equity. The conceptual framework used to undertake the analysis derives from Richard Titmuss’ core theoretical framework, the Social Division of Welfare. The application of the Social Division of Welfare applied to the South African health care context demonstrates how state resources end up benefitting the non-poor and, as a result, reproduce inequality. Those who access public institutions such as public health care are assumed to be ‘dependent’ on the state, whilst those who access private health facilities claim to be ‘independent’ of the state. However, this thesis shows that these assumptions are flawed. Access to the formal labour market, and subsequently the paying of taxes, authorises one to access state subsidies not available to those who do not. The application of the Social Division of Welfare shows that tax-paying private health care patients benefit considerably from state resources. This thesis argues that due to cost escalation in the private health sector, a consequence of the commodification of health care, these private health care ‘consumers’ as well as the private health industry in general are dependent upon state resources. This thesis analyses the role played by the profit motive present in the private health industry and the consequences for equity, quality, access and efficiency in health care provision
- Full Text:
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