Public-Private Mix

Drastic change is needed to save SA\'s system of health care

The cost of private health care is rising so rapidly that it is in danger of becoming unaffordable to all but the wealthy. The punch-drunk public health sector is, however, failing to provide an alternative for the average salaried person. Everyone, from blue-collar workers to senior executives, is clamouring for more affordable, quality health care. A radical new deal is needed for the private and public sectors. New ways of delivering and funding health care must be created. Both sectors are on the ropes and are being forced to act.

Social Capital, Disorganized Communities, and the Third Way:
Understanding the Retreat from Structural Inequalities in Epidemiology and Public Health

Carles Muntaner, John Lynch, and George Davey Smith, International Journal of Health Services Volume: 31 Issue: 2, May 2001
The construct of social capital has recently captured the interest of researchers in social epidemiology and public health. The authors review current hypotheses on the social capital and health link, and examine the empirical evidence and its implications for health policy.
The construct of social capital employed in the public health literature lacks depth compared with its uses in social science. It presents itself as an alternative to materialist structural inequalities (class, gender, and race) and invokes a romanticized view of communities without social conflict that favors an idealist psychology over a psychology connected to material resources and social structure. The evidence on social capital as a determinant of better health is scant or ambiguous. Even if confirmed, such hypotheses call for attention to social determinants beyond the proximal realm of individualized sociopsychological infrastructure. Social capital is used in public health as an alternative to both state-centered economic redistribution and party politics, and represents a potential privatization of both economics and politics. Such uses of social capital mirror recent "third way" policies in Germany, the United Kingdom, and United States. If third way policies lose support in Europe, the prominence of social capital there might be short lived. In the United States, where the working class is less likely to influence social policy, interest in social capital could be longer lived or could drift into academic limbo like other psychosocial constructs once heralded as the next big idea.

SA: Employees face skyrocketing healthcare costs -
shock report

Healthcare costs are likely to skyrocket and employers are becoming less and less prepared to carry the burden, according to the fifth in a series of surveys done by Old Mutual and released in Johannesburg on Wednesday. With findings based on in-depth interviews with 60 leading SA companies, representing close to 600 000 medical scheme lives, and focus group discussions with members of medical schemes, Old Mutual's bi-annual survey provides valuable insight into the challenges facing SA's private healthcare industry.

Towards A Dynamic Concept of Health - CPRN Report

Sholom Glouberman, Director of Canadian Policy Research Networks, May 2001
One characteristic stands out above all in the history of our developing understanding of health, - its complexity. "We now realize that health is shaped by numerous, perhaps countless, forces from many different spheres of influence, ranging from the molecular to the socioeconomic," says Sholom Glouberman, Director of CPRN's Health Network. Glouberman is the author of Towards a New Perspective on Health Policy, the final report of a three-year research project at CPRN. The report ties together a number of separate studies and the results of discussions involving some 3,500 people at more than 90 events held over the course of developing the research conclusions. Judith Maxwell, President of CPRN, says Glouberman's study points to the importance of placing the reform of the health care system in this broader context. "All of us want to feel secure in the knowledge that health care will be there for us should we need it." says Maxwell. "What Sholom's study underlines is that further investment in the health care system should consider how to regain public confidence in it. It is this interactive sense of security that has a significant impact on health along with other factors such as biological condition, social relationships, economic status, work experience and culture."


Paper prepared for WHO’s Commission on Macroeconomics and Health by Adam Wagstaff The World Bank, The University of Sussex, UK
There are three key levels of government action—the macro level, the health system, and the micro level. Government decisions and actions at each level influence the amount households pay for their health care (financing), and the quantity, quality and type of services they receive (delivery). At the macro level, governments decide how much to spend on health care (and related services) and where, and how to raise the revenues to finance them. At the system level, they decide the mode of service delivery and how to regulate the private sector, and how much to charge for different services and how far to exempt the poor from fees. At the micro level, they influence the accountability of providers and the services and interventions they deliver, and how best to implement facility-based revenue collection schemes. There are, in short, many ways that governments can potentially influence both health gaps between the poor and better-off, and the degree to which poor households are affected disproportionately by the costs of health services.