A decent minimum of health care in South Africa: a bioethical proposal

Fourie, Francois (2018-03)

Thesis (MA)--Stellenbosch University, 2018.

Thesis

ENGLISH SUMMARY: In this thesis I identify some of the major challenges faced by the current health care system of South Africa. Thereafter conceptual analyses are done with regards to what is meant by a health care system and a decent minimum of health care (DMOHC). Although several questions around possible causes of the challenges are identified, I focus on one specific question: Is the health care system chosen for South Africa able to facilitate the service delivery expected of it? And if not, how should it be amended to achieve satisfactory results? A problem statement containing three main questions is formulated: Problem 1: Is a DMOHC in principle a good idea? Problem 2: Is a DMOHC a good idea for South Africa? Problem 3: If so, what ought that decent minimum to be? With regards to question three, I propose three main changes: 1. Prioritize and ration health care services at a policy level. 2. Integration of the public and private health care sector, by utilizing the National Health Insurance (NHI). 3. Innovations in regulating and taxing the private sector. Arguments in favour of and against each of the concepts are discussed, with conclusions being made at the end of each deliberation process. In this thesis I find that a DMOHC is in principle a good healthcare system and also a good system for South Africa. With regards to the proposed changes, I strongly support prioritizing and rationing health care services at policy level. The NHI will probably soon be supported with legislation and its implementation is imminent. Whether its proposed structure will be a success, is uncertain and I am highly sceptical of its lofty goals. I do not suggest the implementation of my third set of changes, although I do think a super tax on excessive profits made by health-related businesses is more palatable than additional taxes on the general community.

AFRIKAANSE OPSOMMING: In hierdie tesis identifiseer ek van die mees vernaamste uitdagings wat deur die Suid-Afrikaanse gesonheidstelsel ondervind word. Daarna doen ek konseptuele ontledings van wat bedoel word met ‘n gesondheidstelsel en ‘n "decent minimum of health care" (DMOHC) (behoorlike minimum van gesondheidsorg). Alhoewel daar verskeie vrae rondom moontlike oorsake van die uitdagings geidentifiseer is, focus ek op een spesifieke vraag: Is die gesondheidstelsel wat gekies is vir Suid-Afrika daartoe in staat om die gsondheid sorg te fasiliteer wat verwag word? En indien nie, hoe moet die stelsel aangepas word om die gewenste resultate te bewerkstellig? ‘n Probleem stelling wat drie hoof vrae bevat is geformuleer: Probleem 1: Is ‘n "DMOHC" ‘n goeie sisteem in prinsiep? Probleem 2: Is ‘n "DMOHC" ‘n goeie sisteem vir Suid-Afrika? Probleem 3: In dien wel, wat sou ‘n behoorlike minimum wees? Met betrekking tot die derde vraag, maak ek drie hoof voorstelle: 1. Prioriseer en ransoneer gesondheidsdienste op 'n beleids vlak. 2. Integrasie van die publieke en privaat gesondheids sektore deur die Nationale Gesondheidsversekering. 3. Innoverende geregulering en belasting van die privaat gesondheids sektor. Argumente vir en teen elkeen van hierdie voorstelle is bespreek en afleidings is aan die einde van elkeen van hierdie prosesse gemaak. In hierdie tesis bevind ek dat ‘n "DMOHC" in prinsiep ‘n goeie gesondheidstelsel is en ook ‘n goeie stelsel vir Suid-Afrika is. Met betrekking tot die voorgestelde veranderinge, ondersteun ek ten sterkste die priorisering en ransonering van gesondheidsorg dienste op beleids vlak. Die nationale gesondheidsversekering sal waarskynlik binne kort deur wetgewing ondersteun word en geimplementering word. Of die voorgestelde struktuur van die Nasionale gesondheidsversekering suksesvol gaan wees, is onseker en ek is baie skepties oor die doelwitte wat bereik wil word. Ek ondersteun nie die implementering van my derde stel van voorgestelde veranderinge nie, maar ek dink tog dat ‘n additionele belasting op oormatige winste gemaak deur gesondheid verwante besighede, meer aanvaarbaar is as additionele belasting op die algemene publiek.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/103356
This item appears in the following collections: