NHI Snippets (6): The high cost of private health care in South Africa

So, I’ve elaborated a little on the poor health of South Africans relative to the country’s level of economic development and wealth.

The second major point I made at the beginning of this blog series was that a huge proportion (43%) of all the money spent on health care in South Africa is paid as premiums by people on medical aid (medical aid is what is know internationally as ‘voluntary private health insurance’).  In fact, the proportion is so huge that South Africa tops the list of countries around the world in this regard, even outdoing the United States.

If you want to see this point displayed graphically, click on this link – Proportion of spending on health insurance – for a slide by Prof. Di McIntyre of the Health Economics Unit at UCT.1   On the extreme right of the graph are South Africa and the United States, each spending a large amount on voluntary private health insurance (the red section of the bars).  The other countries shown in the graph have health systems which are getting close to achieving universal health care coverage (in a later blog I’ll explain this term but in broad terms it means that most citizens are able to access and afford adequate health care).  You’ll see that, for these countries, the red section of the bar is very small.

The last bit of information you need to know to appreciate this graph is that ‘the big red bit’ of South Africa’s bar is spent by only 16 percent of the population.2  So the following picture emerges:

1.  Only a very small proportion of South Africa’s population has access to high quality care (this is assuming that lots of resources translates into good quality, which isn’t wholly true, so I’d like to qualify this statement in a later blog as well as note that good quality care is also available in the under-resourced public sector);

2. Private health care is very expensive and funding this care places a very high financial burden on those who can afford it.

3. Countries achieving universal health care coverage have not relied on private voluntary health insurance to do so (I’ll elaborate this point later and, of course, we need to have the discussion about why universal health care coverage is desirable.)

 

REFERENCES

1. McIntyre D.  2011.  Options for South Africa:  Financing.  Presented at National Department of Health Consultative Conference on “National Health Insurance:  Lessons for South Africa”, Gallagher Estate, Midrand, 7-8 December 2012.  Available at:  http://www.hst.org.za/publications/presentations-national-health-insurance-nhi-conference-2011

2.  McIntyre DE, Doherty JE, Ataguba JE. (forthcoming). Health care financing and expenditure – progress since 1994 and remaining challenges. Health and health care in South Africa (2nd edition). Van Rensburg H. Pretoria: van Schaik Publishers.

NHI Snippets (4): Too many women die in South Africa from causes related to childbirth

In NHI Snippets (2) I made the point that health in South Africa is poor, especially when viewed in light of the country’s relative wealth.

I gave some figures on how many women die from causes related to childbirth.  I know these figures can seem very abstract so, as promised, I’ve found a graph (by Jack Langenbrunner) that helps to show how well South Africa does in preventing these deaths compared to other countries. 

Click “MMR relative to other countries” to see the graph and here to see the full presentation which includes additional graphs on other health indicators (the link takes you to the Health Systems Trust page with all the conference presentaitons – you will find Jack Langenbrunner’s presenation on Day 2).

As you can see, South Africa does badly when one considers both its average per capita income and its average per capita spending on health (in the graph, countries in the top right block manage to ‘buy’ much less health for the money they have at their disposal).  In this sense, South Africa is much less ‘efficient’ than some poorer countries that do much better.

Decentralised financial management capabilities for pilot hospital sites in South Africa

I have finally uploaded scanned copies of the last few annexures from the 1996 Hospital Strategy Project’s analysis of decentralised financial management issues.

Annexure F is very relevant to the current debate on readying public hospitals for National Health Insurance as it presents recommendations for decentralised financial management capabilities in pilot hospitals. 

Look on one of my ealier posts, entitled Decentralised Financial Management of Hospitals, for the uploaded files.

Guidelines for measuring the critical areas for financial management

I have just uploaded a scanned copy of another annexure (Annexure B contd.) from the 1996 Hospital Strategy Project’s analysis of decentralised financial management issues.

This annexure presents useful guidelines for measuring the critical areas for financial management.

Look on one of my ealier posts, entitled Decentralised Financial Management of Hospitals, for the uploaded files.  You can find it under ‘Categories’ to the right of the screen – under ‘Financing,’ ‘Hospitals’ or ‘Management and leadership.’

More information on financial management in public hospitals

I have just uploaded scanned copies of the conclusion of the 1996 Hospital Strategy Project’s analysis of decentralised financial management issues, as well as Annexures A and B.

Look on one of my ealier posts, entitled Decentralised Financial Management of Hospitals (and available under the Hospitals category to the right of the screen), for the uploaded files.

Creating effective decentralised financial management

I have just uploaded a scanned copy of another chapter from the 1996 Hospital Strategy Project’s analysis of decentralised financial management issues.

This chapter outlines the way forward for creating effective decentralised financial management.

Look on one of my ealier posts, entitled Decentralised Financial Management of Hospitals, for the uploaded files.

The context of decentralised financial management in South African hospitals

I have just uploaded a scanned copy of another chapter from the 1996 Hospital Strategy Project’s analysis of decentralised financial management issues.

This chapter examines the regulatory and policy environment that governed options for decentralised financial management in South African hospitals in the 1990s.  Some of these factors remain pertinent today although other aspects may be somewhat out of date.

Look on one of my ealier posts, entitled Decentralised Financial Management of Hospitals, for the uploaded file.