Policy brief on private sector expansion

Click on the link below to access this policy brief based on earlier work:

Doherty J. 2011. Expansion of the private for-profit health sector in East and Southern Africa. EQUINET with HEU UCT and TARSC Policy Brief 26. Harare: EQUINET.

One thought on “Policy brief on private sector expansion

  1. Jane

    Fact 1 is incorrect and fact 2 is misleading. More funds are directed through public budgets than through medical schemes. Although in the past medical schemes spent slightly more, public sector expenditure has increased by around 1% of GDP since 2006.

    Furthermore SA’s per capita public health expenditure is equivalent to countries with its level of development and exceeds that of many others. It also has low out-of-pocket expenditure when compared with both its peers and those with higher levels of expenditure.

    On fact 2 you fail to note that South Africa’s public sector spends more per capita than Vietnam, Thailand and many of it’s peers, all of whom achieve vastly better health outcomes on the indicators mentioned than South Africa. South Africa underachieves because of well-known failures within the public delivery system which are not sur[prisingly earmarked for change in any reform.

    A plain review of the evidence suggests that these failures have nothing to do with expenditure on medical schemes and it is misleading to present information in a way that suggests this. If this is what you believe in the absence of facts then say so. Otherwise provide the evidence.

    This blog also persistently refers to NHI as if it is some universally understood concept. It is hard to understand what you are purporting to support as NHI.

    Interestingly the Green Paper fails to define NHI or to provide any factual evidence for any part of the reform. If there were such a strong case to be made for the various proposals surely evidence could be provided.

    However all the references in the Green Paper to medical schemes’ cost increases are factually incorrect. As are the comments on health workforce distrubutions between the public and private sectors. In fact no evidence is provided anywhere in the Green Paper for any recommendation made.

    If there is a genuine interest in fostering debate and genuine understanding of the real health reform needs it would be more useful to isolate the areas of dysfunctionality in an honest way. Otherwise this stuff just comes across as propaganda with some references thrown in to create the veneer of academic neutrailty.

    It would be useful to answer the following questions raised no-where in the blog or in the Green Paper:

    What causes lead to the financial crises in Eastern Cape, Gauteng, Mpumalanga, Limpopo, Free State, and Kwazulu-Natal?

    Why is there no similar crisis in the Western Cape?

    How did medical schemes contribute to these crises?

    Why after 17 years are all provinces other than the WC unable to consistently achieve clean audits? And why is corruption so rife?

    Why has there been a general collapse of public hospital management in all provinces outside the WC?

    Why is the WC able to outperform all the other provinces while nevertheless receiving allocations on the same basis as other provinces? Note that Gauteng also receives top up conditional grants for tertiary services and training but somehow has a R3 billion accrual-based deficit.

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