ETD Collection

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    Developing a constitutional law paradigm for a national health insurance scheme in South Africa
    (2014-08-21) Wayburne, Paul Allen
    The proposed National Health Insurance (‘NHI’) is the most extensive health policy initiative proposed by the South African government since 1994, to bridge the divide between the private and public health sectors. It is intended that the NHI will fund health care services for the entire population. Yet, despite its laudable goals, the implementation of NHI might be stalled by litigation concerning its constitutionality. In this thesis, I construct a constitutional paradigm within which such challenges can be understood. Departing from the premise that the Constitution places a positive obligation on the state to implement redistributive policies in the health sector in order to progressively realise the right to have access to health care services, the thesis identifies the tensions underlying the proposed implementation of NHI and aligns these to liberty-based and equality-based understandings of the right to health, respectively. This analysis takes place after having considered the history of health care reform in South Africa and debates on the desirability of NHI. The thesis then investigates and sets out the constitutional principles, values and standards embodied by the rights to equality, freedom and security of the person, and access to health care services, and considers the extent to which current the formulation of the proposed NHI adheres to these principles. Potential constitutional challenges to NHI by private sector interest groups are identified. These challenges are primarily concerned with adverse effects that the implementation of NHI may cause to current beneficiaries of private sector health services. It is argued that these adverse consequences will, for the most part, not justify a finding that relevant features of NHI are unconstitutional. This is either because they will not amount to an infringement of the relevant constitutional rights or because such an infringement will be capable of reasonable justification in terms of the general limitations clause. Only where the impairment of existing rights is disportionate or is related to some extraneous purpose inconsistent with constitutional rights and values will NHI not pass constitutional muster. Ultimately, the constitutionality of different features of NHI will depend on how the rights of those who already have access to health care services under the current health financing system are balanced with those who currently lack such access.
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    Entrepreneurial orientation and product innovation of private health insurers in South Africa.
    (2013-02-21) Streak, Milton Alfred
    This research study analyses a conceptual model investigating the relationship between the level of health insurer product innovation and entrepreneurial orientation (EO); the relationship between the level of health insurer product innovation and external collaboration between health insurers and healthcare service providers. This study also analyses whether low presence of perceived strategic regulatory factors, necessary for encouraging health insurer product innovation in the private healthcare industry in South Africa, weakens the relationship between the level of new health insurer product innovation and EO, as well as the relationship between the level of new health insurer product innovation and external collaboration between health insurers and healthcare service providers. The research study, focusing on major actors in both the demand and supply side structures of the private healthcare value chain, found that organisational-level EO is a very strong predictor of health insurer product innovation in the South African private healthcare industry. The research study also found that external collaboration between health insurers and healthcare service providers is a weak predictor of health insurer product innovation. An important finding of this study was that the low presence of strategic regulatory factors (which are necessary for encouraging health insurer product innovation in the South African private healthcare industry) means that the relationship between health insurer product innovation and EO is not moderated, and neither is the relationship between health insurer product innovation and external collaboration between health insurers and healthcare service providers. These findings contribute to the South African private healthcare industry in terms of innovation, regulation, external collaboration and entrepreneurial orientation literature and studies.
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    A regulatory capture explanation of South Africa's private health insurance legislation
    (2012-01-25) Hutcheson, Hugh-David
    Private healthcare financing in South Africa has undergone several regulatory reforms, the most recent of which saw the enactment of the Medical Schemes Act No. 131 of 1998. The stated reforms, most especially open enrolment and community rating, were touted by the government as necessary to address the undesirable effects of adverse selection. However, it was never questioned whether in fact adverse selection is a feature of the South African medical schemes landscape. Adverse selection is found to be absent. Thus, government’s supposition that adverse selection, as a consequence of the deregulation that took place during the late 1980s and early 1990s, is responsible for the deterioration in medical scheme coverage for the elderly, unhealthy or poor is fallacious. Since the ostensible reason for the current legislation does not stand up to scrutiny, regulatory capture is offered as the plausible alternative explanation for the promulgation of the current legislation governing medical schemes business.