People-centeredness in health system reform. Public perceptions of private and public hospitals in South Africa

Abstract

INTRODUCTION: South Africa's planned National Health Insurance system seeks to transform and integrate public and private healthcare services, as part of wider efforts to realise universal health coverage. Ensuring quality, acceptable care is crucial for public buy-in to these changes. In this study the public perceptions of the country's private and state hospitals are explored. A better understanding may guide improvements in public sector services, and strengthen confidence and trust in health system reforms. METHODS: Eight qualitative focus group discussions were held with 54 participants delineated by race ('black' and 'white' South Africans) and experience (recent or indirect) of public and private hospital services. The views on quality of care, cleanliness, satisfaction, staff attitudes, origins of perceptions, and suggestions for improving state hospitals were explored. FINDINGS/RESULTS: Thematic content analysis revealed an almost-automatic initial perception that private hospitals are "good" and state hospitals "bad". However, on further exploration, a more nuanced understanding surfaced around the costs and affordability of private and public hospitals, and trust in and acceptability of health services. CONCLUSION: Health systems are also human systems, with personal encounters at their heart. In order to acceptably serve people and society, policy emphasis is needed to build a culture of person-centred care in the public sector. Key words: National Health Insurance, people-centeredness, health system reform, universal health coverage, public perceptions