ETD Collection

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Subject: search.filters.subject.Health insurance--South Africa

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    Health insurance coverage and the preference for public and private healthcare providers in South Africa: the case of outpatient healthcare services
    (2019) Godi, Khanani Theodora
    The paper sought to test if medical/health insurance coverage influences one’s preference or choice between a public and private service provider when seeking healthcare. Using the South African National Health and Nutrition Examination Survey (SANHANES) dataset conducted in 2012, we ran several regressions to test this theory. The methodology employed is based on Grossman’s theory of the demand for health. Logit and Probit regression models were used where the preference between a private/public service provider (dependent variable), is regressed against the determinants of demand for healthcare. We find that being insured (having medical aid) influences choice of healthcare facility with the likelihood of choosing private healthcare facilities over public ones. More specifically, the odds ratio of using a public facility decreases by 4.9 times when one is insured. This finding is consistent with that of Ataguba and Goudge (2012) who found that health insurance increases the use of private healthcare services. With the proposed National Health Insurance, it is likely that consumers will flood the private sector for the good quality service they could not afford without insurance. This influx may have an adverse impact on the efficiency and quality service delivery that the private healthcare sector boasts. As such, healthcare reforms such as the NHI should be coupled with quality improvement measures to enhance, monitor and maintain the performance and quality service in healthcare.
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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.