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Comparison of average length of stay by type of hospital services. South African sample and OECD, 2013
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The health system in South Africa is unique in many ways. South Africa spends 41.8% of total health expenditures on private voluntary health insurance – more than any OECD country – but only 17% of the population – mostly high income citizens - can afford to purchase private insurance. Given the magnitude of private health expenditures, the activit...
Citations
... South Africa has made little progress in strategic purchasing, with public purchasers utilising almost no services from the large private sector and not using strategic purchasing within the public sector either [19]. Feefor-service remains dominant as the main provider payment mechanism in the private sector, contributing to problems of high prices and supplier-induced demand [23]. ...
Background: Many countries have committed to achieving Universal Health
Coverage. This paper summarizes selected health financing themes from five
middle-income country case studies with incomplete progress towards UHC.
Methods The paper focuses on key flagship UHC programs in these countries,
which exist along other publicly financed health delivery systems, reviewed
through the lens of key health financing functions such as revenue raising,
pooling and purchasing as well as governance and institutional arrangements.
Results: There is variable progress across countries. Indonesia’s Jaminan Kesehatan
Nasional (JKN) reforms have made substantial progress in health services
coverage and health financing indicators though challenges remain in its implementation.
In contrast, Ghana has seen reduced funding levels for health and
achieved less than 50% in the UHC service coverage index. In India, despite
Ayushman Bharat (PM-JAY) reforms having provided important innovations in
purchasing and public-private mix, out of pocket spending remains high and
the public health financing level low. Kenya still has a challenge to use public
financing to enhance coverage for the informal sector, while South Africa has
made little progress in strategic purchasing.
Conclusions: Despite variations across countries, therefore, important challenges
include inadequate financing, sub-optimal pooling, and unmet expectations
in strategic purchasing. While complex federal systems may complicate the path
forward for most of these countries, evidence of strong political commitment
in some of these countries bodes well for further progress.
... South Africa has made little progress in strategic purchasing, with public purchasers utilising almost no services from the large private sector and not using strategic purchasing within the public sector either [19]. Feefor-service remains dominant as the main provider payment mechanism in the private sector, contributing to problems of high prices and supplier-induced demand [23]. ...
Background:
Many countries have committed to achieving Universal Health Coverage. This paper summarizes selected health financing themes from five middle-income country case studies with incomplete progress towards UHC.
Methods:
The paper focuses on key flagship UHC programs in these countries, which exist along other publicly financed health delivery systems, reviewed through the lens of key health financing functions such as revenue raising, pooling and purchasing as well as governance and institutional arrangements.
Results:
There is variable progress across countries. Indonesia's Jaminan Kesehatan Nasional (JKN) reforms have made substantial progress in health services coverage and health financing indicators though challenges remain in its implementation. In contrast, Ghana has seen reduced funding levels for health and achieved less than 50% in the UHC service coverage index. In India, despite Ayushman Bharat (PM-JAY) reforms having provided important innovations in purchasing and public-private mix, out of pocket spending remains high and the public health financing level low. Kenya still has a challenge to use public financing to enhance coverage for the informal sector, while South Africa has made little progress in strategic purchasing.
Conclusions:
Despite variations across countries, therefore, important challenges include inadequate financing, sub-optimal pooling, and unmet expectations in strategic purchasing. While complex federal systems may complicate the path forward for most of these countries, evidence of strong political commitment in some of these countries bodes well for further progress.
... The failure of private insurers to carry out strategic purchasing can push up prices throughout the health system, undermining overall performance. In South Africa, for example, private insurers have had limited purchasing power over health care providers and the introduction of medical savings accounts in the 1990s further weakened their leverage (McLeod & McIntyre, this volume it more expensive for the public sector to recruit and retain medical specialists (Lorenzoni & Roubal, 2016). ...
... In spite of this, a fragmented private health insurance market has not been able to exert leverage over private health care providers. As a result, private insurers have responded to having to pay the very high prices charged by private hospitals in South Africa (Lorenzoni & Roubal, 2016) by shifting costs onto subscribers through medical savings accounts, eroding the quality of private health insurance coverage and adding to fragmentation (McLeod & McIntyre, this volume). ...
... Currently, there is a substantial difference in cost between private and public medical care in South Africa, with public care being more affordable and the only option available to the majority of South Africans. Private medical care is expensive in relation to the wealth of the country, with prices on par with that of first world countries such as Germany and France (Lorenzoni and Roubal 2016). The participants recruited from the private clinic have a higher average income than those recruited at the state clinic and they must either have access to medical aid or the financial means to afford private medical tariffs. ...
... Study participants were recruited in a ratio of 3:2, with the majority hailing from the state clinic. Although 83% of South Africans are dependent on state-provided medical care (Lorenzoni and Roubal 2016), the recruitment ratio does give a realistic picture of the current utilization pattern of more specialized medical services, such as high risk maternal mental health care. The state-provided service is mainly focused on primary health-care provision, with less referrals for specialized treatment than in the private care context. ...
Pregnant women in general are at an increased risk of experiencing symptoms of mental illness, and those living in a developing country are even more vulnerable. Research points towards a causal relationship between unplanned pregnancy and perinatal mental illness and suggests that pregnancy planning can aid in reducing the negative impact of mental illness on a woman, her unborn baby, and the rest of the family. In this quantitative, descriptive study, we investigated both socio-demographic factors and variables relating to mental illness itself that may place women at an increased risk of experiencing unplanned pregnancy. Data was gathered at two maternal mental health clinics in Cape Town by means of semi-structured interviews. Univariate analyses of the data revealed five independent key risk factors for unplanned pregnancy: lower levels of education, unmarried status, belonging to the Colored ethnic population, substance use, and having a history of two or more suicide attempts. Some of these factors overlap with findings of similar studies, but others are unique to the specific population (women with mental illness within a developing country). Screening of women based on these risk predictors may pave the way for early interventions and reduce the incidence of unplanned pregnancy and the negative consequences thereof in the South African population.
... 10 The private hospital sector has been criticised for driving increases in healthcare expenditure over time, 10,16,17 as well as for being expensive by international standards. 18 It certainly constitutes a financially significant component of the health sector -expenditure on private hospitals accounted for 37% of annual medical scheme expenditure in 2013. 19 By contrast, public hospitals provide care to the 84% of South ...
The hospital sector in South Africa mirrors deep inequalities in the country as a whole. The private, for-profit hospital sector is well resourced and caters to a population that tends to be wealthier, urban and more likely to be formally employed. The public-hospital sector, catering to the majority of South Africans, faces lower human-resourcing ratios, financial constraints and ageing infrastructure. This chapter contextualises the development of the two sectors, describes the current divide, and considers the implications in terms of equity, access and quality of care. A unique dataset of quality-accreditation-survey scores was used, which allowed
for analysis of the two sectors according to a common yardstick. These data reflect a wide array of structure-
and process-related quality indicators; in addition, the patient perspective reflected in data from the General Household Survey was used to illustrate the quality differential. The research provides evidence of the polarisation between public and private facilities: private facilities consistently scored above public facilities across a range of accreditation categories, and there was far greater variability in the scores achieved by public facilities. The same polarised relationship was found to hold across key sub-components of the scores, such as management and leadership of hospitals in the two sectors. We conclude that there is a need for the measurement of health outcomes across the system. Policy attention is required in terms of accountability and quality improvement. A focus on improving value in the system will, by necessity, have to engage with the discrepancies between the sectors.
The South African private health care market combines a highly concentrated demand side with expensive medical services. This combination suggests that medical insurance schemes are not using their full market power. To explain this puzzle, we construct a delegated bargaining model in which agency costs give rise to two different pricing regimes. In the ‘good’ pricing regime, the scheme incentivises its administrator towards aggressive bargaining behaviour with health care providers. The ‘bad’ pricing regime results when the scheme decides against such incentivation. Policy measures that push the number of providers above some critical threshold can force a change from the ‘bad’ to the ‘good’ pricing regime.
Cet article présente une revue critique des données disponibles pour les comparaisons internationales de l’offre et de l’activité hospitalières et des dépenses associées. Il montre que les différences entre pays résultent à la fois du rôle joué par les hôpitaux dans les systèmes de santé, de différences dans le champ couvert par les statistiques nationales et de variations géographiques dans le recours aux soins. Les comparaisons portant sur l’ensemble des établissements et des séjours ne permettent pas de porter un jugement éclairé sur l’adéquation de l’offre ou sur l’efficience des hôpitaux, qui nécessitent des analyses plus fines au niveau d’un diagnostic ou d’une intervention.
Governments frequently draw upon the private health care sector to promote sustainability, optimal use of resources, and increased choice. In doing so, policy-makers face the challenge of harnessing resources while grappling with the market failures and equity concerns associated with private financing of health care. The growth of the private health sector in South Africa has fundamentally changed the structure of health care delivery. A mutually reinforcing ecosystem of private health insurers, private hospitals and specialists has grown to account for almost half of the country's spending on health care, despite only serving 16% of the population with the capacity to pay. Following years of consolidation among private hospital groups and insurance schemes, and after successive failures at establishing credible price benchmarks, South Africa's private hospitals charge prices comparable with countries that are considerably richer. This compromises the affordability of a broad-based expansion in health care for the population. The South African example demonstrates that prices can be part of a structure that perpetuates inequalities in access to health care resources. The lesson for other countries is the importance of norms and institutions that uphold price schedules in high-income countries. Efforts to compromise or liberalize price setting should be undertaken with a healthy degree of caution.
