The impact of political transformation in South Africa on public/private mix policy debates

Abstract

South Africa has experienced the change from apartheid and free market policies towards a nonracial democracy addressing poverty and inequalities. Changes also occurred in the private/public health care sector between 1980 and 1991. An explanation for the health sector changes and the nature of the policy debate are discussed. Private sources of health care have expanded while real per capita public expenditure on health declined private sources of finance increased and the distribution of health care providers changed. Private sector was directly affected by the pressures to reduce public spending s a means of adjustment to the debt crisis the influential ideology of monetarism and privatization lobbies and the growth in numbers of Black workers with health insurance. The proportion of private sector providers increased from 47.2% in 1979 to 57.8% in 1987 while public sector providers declined from 53% to 42%. In 1987 96% of private sector doctors were self-employed. Public health services deteriorated concomitantly with decreased expenditures and the shift of skilled personnel to the private sector. Rural health services declined due to the lack of supply of overseas doctors; this supply was affected by the anti-apartheid boycotts the perception of South Africa as politically unsafe the exits out of the country of military conscripts due to compulsory service requirements and higher incomes for doctors overseas. Currently the private sector has over 50% of the doctors serving over 20% of the population. The transitional end of the post-apartheid era will expose the greater demand for public spending while economic uncertainties prevail. A strong health lobby of medical professional groups and business interests has promoted privatization of health care as an economic advantage and an opportunity to deracialize the issues of access to health care. The opposition has rallied behind a demand for a National Health Service while the Black trade unions have helped to secure the fee for service in the private sector. After 1990 the policy debates changed markedly. Nationalizing private health care would increase the states liability to pay for care which opens up discussion of how the private sector can be regulated in order to control the more destructive impacts.