Faculty of Commerce, Law and Management (ETDs)

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    Realising the right to healthcare: the legislative frameworks pertaining to private health establishments and private healthcare funding models in South Africa
    (University of the Witwatersrand, Johannesburg, 2024) Labuschagne-Kom, Lindsie; Mahery, Prinslean; Martin, Blake
    The Universal Declaration of Human Rights recognises access to healthcare as a fundamental human right and is guaranteed by the South African Constitution. An analysis of this right reveals that it comprises of two main components, namely financing and delivery of healthcare services. These are fulfilled by the government in the public sector and by private healthcare funders and private health establishments in the private sector. However, an analysis reveals that access to healthcare is substantively inequitable due to the fragmentation of the health system and unveils significant inefficiencies in the private sector that impeded realisation of this right. This dissertation examines the cause of this fragmentation and the inefficiencies within the private healthcare funders and private health establishments market. It investigates how these issues can be resolved to realise the right to healthcare. This study applied a qualitative desktop review of governmental policies, direct and incidental legislation, and multidisciplinary fields of academic reviews such as competition, healthcare, constitutional law and international policies to evaluate the effect of historical, contemporary and prospective policies and legislation, on access to healthcare. This analysis reveals that access to healthcare was historically manipulated to achieve political ideology through a legislative framework that provided the foundation for private funding models and private health establishments to flourish. This occurred at the expense of the public sector and embedded the fragmentation and inefficiencies in the health system. Notwithstanding the enactment of the Constitution, which envisioned a transformed and equal society, access to healthcare remains substantively inequitable. This is due to governmental failings to regulate these stakeholders. Given this state of affairs, the government intends to enact legislative reform through the National Health Insurance Bill to meet its constitutional mandate to realise the right to healthcare. An analysis of the Bill’s framework, however, reveals that it will have a cascading effect with the collapse of the private healthcare funders and private health establishment markets. This will ultimately cause a regression in access to healthcare and impede the practical realisation of this right. An investigation into alternative mechanisms to fulfil the right to healthcare reveals that incorporation and collaboration with private healthcare funders and private health establishments is a pragmatic alternative to the National Health Insurance Bill that will aid with the practical realisation and vindication of this right. These findings indicate the need for government to improve its stewardship of the health system and provide pragmatic solutions to reform the legislative and regulatory frameworks governing these stakeholders to resolve inefficiencies and to foster collaboration to fulfil the right to healthcare.
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    A Decomposition Analysis of Gender Disparities in Need and Unmet Need for Care and Support in Urban Gauteng
    (University of the Witwatersrand, Johannesburg, 2024) Lusanda Mhlahlo, Siphesihle; Booysen, Frederik
    Gender inequalities are a pervasive issue with far-reaching effects across all aspects of society, including the economy. This study delves into gender health disparities, specifically focusing on need and unmet need for care and support. Using data from the Gauteng Quality of Life Survey of 2020/2021, the study employs logistic regressions and a decomposition model to analyse the prevalence of need and unmet need, and how these differ across sex. The findings of this study highlight a higher prevalence of need among women, with employment emerging as the most significant factor contributing to the gender gap in need. Equalizing employment levels between men and women could potentially reduce the gender difference in need by 15%. Additionally, the study identifies a self-reported history of intimate partner violence (IPV) as a key contributor to gender disparities in need, suggesting that reducing the prevalence of IPV among women to match that of men would help narrow the gender gap. Furthermore, the study reveals a greater prevalence of unmet need among men, once again linking a self-reported history of IPV to this disparity. These findings shed light on the complex interplay of gender, health, and societal factors, emphasizing the importance of addressing gender inequalities in healthcare and support systems.