ETD Collection

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    A discussion on the ethical complexities of micro-level decision making in the South African private health insurance industry.
    (2017) Cazes, Aerelle Liëtte
    Health and, by extension, healthcare is accepted to be a valuable and important social good that is both a good in and of itself, as well as necessary to achieve life’s goals. Its fair distribution is therefore properly the subject of ethical concern and in the era of modern medicine where costs and potentially limitless treatments exceed available resources, rationing healthcare has become an unavoidable necessity. Since such rationing implies that not everyone’s needs or preferences can be met, a fair and just way of rationing healthcare is a widely debated and controversial topic that, to date, remains unresolved. Where third-party private funding organisations are tasked with these rationing responsibilities, the ethical complexities are compounded by perceived conflicts between the ethical frameworks that govern corporate organisations versus those that govern healthcare. Given the apparent inability of normative theories to resolve the problem of how to ration healthcare fairly, there has been a shift in thinking to considerations of procedural justice and a dominant model, Accountability for Reasonableness (AFR), has emerged as the favoured procedure for healthcare decision-making. The report shows why health is an important social value and examines the key models and principles that dominate the rationing debate as well as why the conflict between healthcare ethics and organisational ethics create additional complexities that must be considered when making these funding decisions. Furthermore it explores the rationales for resorting to procedural accounts with specific emphasis on the parameters and validity of AFR. The report concludes that even though the AFR framework may be a legitimate and just process that can effectively frame decision-making and provide a platform to drive transparency and consistency, like most procedural accounts, it does not guarantee that the outcomes it produces are necessarily fair or just. Therefore a straightforward application of AFR cannot resolve the healthcare rationing debate which should, given its ethical complexity, continue to appeal to the important ethical principles that currently govern the field.
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    Utilisation of evaluation information in the Gauteng Department of Health
    (2017) Sidzumo, Sibulele
    The evaluation information has a critical role in informing decision making relating to implementation of the development interventions. This study is underpinned by the fact that the worth of evaluation information is determined by the extent of its influence on decision making. It is premised from the fact that there is limited utilisation of the evaluation information for decision making in the Gauteng Department of Health. Thus, the study is aimed at establishing the underlying institutional features and evaluation characteristics that serve as facilitators and/or barriers for the use of evaluation information. Past studies are reviewed to identify the knowledge gap and develop a conceptual framework to inform the research enquiry. Based on the purpose of the study and the conceptual framework, a qualitative research strategy with interpretive case study design and a purposive sample are applied to obtain in-depth description of the factors pertaining to the use of evaluation information. In addition, three research theories are employed simultaneously to understand the subject phenomenon and inform interpretation of the research findings, based on their unique concepts. The triangulation method is applied in data collection and analysis to ensure reliability and validity of the research results, with one-on-one semi-structured interviews conducted through an interview guide. The findings reveal that there are no systematic processes and procedures for identification of the users and uses of the evaluation information prior to implementation of the evaluation process. The emphasis on alignment of the evaluations to the institutional context is minimalistic in its orientation since there is little focus on the broader development agenda. There is no demonstration of facilitating inculcation of information use during the evaluation process. In general, the evaluation systems are fragmented, with no formal reward system for encouraging effective utility. The adoption and use of the evaluation findings hinges on the type of recommendations versus the institutional development agenda and capacity. There are no formal information dissemination strategies and procedures for confirming implementation of the adopted evaluation recommendations. The role of the evaluation champions is limited and thus manifested by low awareness and application of the evaluation policy framework and limited institutionalisation of the evaluation function. Last, the findings highlight key institutional features and evaluation characteristics that influence use and/or non-use of the evaluation information, which should be considered in-line with the proposed recommendations.