Development Of National Health Policies Research Articles

Belangrike ontwikkelings in gesondheidsdienslewering in die republiek van suid-afrika gedurende die sewentigerjare

A number of major developments have brought about important changes in the delivery and co-ordination of health services in South Africa. Some of these developments are: — the hospital-centric community-directed health services which were developed in the national states; — the changes to programme-budgeting which highlighted priority areas; — the Health Act 63 o f 1977 which provides for a formal structure for co-ordination of health services and the development of national health policy; — rationalisation in the civil service by which one Department of Health, Welfare and Pensions was created; — the Health Services Facilities Plan announced by the Minister of Health in 1980. This plan will greatly enhance the development of comprehensive health services for the South African community. The plan describes six levels according to which health services will be developed: providing for basic health needs; health education; primary health care (including self-care, community responsibility, community nursing and community health centres); the community hospital; the regional hospital; the academic hospital.

Who Gains from Public Health Programs?

Analysis of the economic impacts arising from the introduction of Medicare and Medicaid into federal and state budgets leads one to question the actual magnitude of gains which recipients can expect to obtain from new funding in the health area. A modified cost-benefit analysis of Medicare/ Medicaid income effects on program recipients, non-recipients, and physicians from 1966 to 1968 shows that scarcely 56 per cent of the $14.8 billion spent on the two programs represented gains to recipients. Over the same period, physicians received average net gains of between $5,400 and $7,400 over what would have been the case in the absence of both programs. The implications of these findings apply as much to the several proposals for national health insurance as they do to Medicaid and Medicare. It can be shown that the President's health in surance plan, among others, would result in a similar if not larger unintended allocation of public funds. This raises seri ous questions of equity in the development of national health policy.