The implications of legislative changes on bargaining councils and occupational health services : a management consulting case study

Regensberg, Deborah Jean (1999-12)

Thesis (MBA (Business Management))--University of Stellenbosch, 1999.

Thesis

ENGLISH ABSTRACT: As part of South Africa's transformation, legislative changes have been introduced to support the Constitutional rights of the people, including the right of access to health care. In restructuring the health services, the redistribution of resources between the private and public sector is addressed through a long-term vision which includes a Social Health Insurance scheme. The focus has been shifted to primary health and prevention, with community based services at the centre. Various Acts and regulations have been introduced to give substance to the transformation, including the Acts affecting medical schemes and the pharmaceutical services, labour legislation, education and training. The Bargaining Councils and Occupational health services have been extended to include primary health care, and in many cases this is extended to the dependents of the workers, bringing them into the ambit of the private sector. The proposed redistribution of resources into the public sector has placed the low-wage earner at risk as the cost of private health care increases. The legislation controlling medical schemes and pharmaceutical services are a threat to the viability of the Health Care Funds, particularly in the short-term until the Social Health Insurance has been established. The restrictions placed on dispensing and the measures which are intended to make drugs more affordable also provide a challenge to the low-cost medical funds. The relevant legislation is being subjected to judicial challenges, and the replacement legislation promulgated prematurely, resulting in confusion and uncertainty. It is within this context that the Funds must prepare for the changes ahead. A management consulting case study is presented using the Clothing Industry Bargaining Council of the Western Cape with the Clothing Industry Health Care Fund which provides comprehensive primary health services in Fund owned clinics, factories and through panel doctors. Because of the complexity of the organisation and the issues surrounding the implementation of changes to the pharmaceutical services, Yolles' viable approach to management systems has been used as a framework for the consultancy intervention. This is a newly published approach grounded in chaos theory, which directs the nature of inquiry according to form and the behaviour of the situation, aiming to maintain viability and adaptability. This case study examines the impact of the legislative changes on the health services which are accessed through the workplace, and tests the applicability of the viable approach to management systems.

AFRIKAANSE OPSOMMING: As deel van Suid-Afrika se transformasie is veranderings aangebring aan die wetgewing om die Konstitusionele regte van die mense te ondersteun, insluitend die reg van toegang tot gesondheidsorg. Met die herstrukturering van die gesondheidsdienste, word die verdeling van bronne tussen die privaat en publieke sektor aangespreek deur middel van 'n lang-tenmyn visie wat 'n gemeenskapsgesondheidsversekering insluit. Die lokus het herskuil na primêre gesondheid en voorkoming, met gemeenskapsdienste as sentrum. Verskeie wette en regulasies is voorgestel om as kern van die verandering te dien, insluitende wette wat die mediese skemas en farmaseutiese dienste, asook die werknemer, opleiding en opvoeding beinvloed. Die gesondheidsdienste van die Onderhandelingsrade en die Beroepsgesondheiddienste is uitgebrei om primêre sorg in te sluit. Dit sal ook die afhanklikes van die werkers dek en hulle sodoende binne die privaatsektor betrek. Die voorgestelde herverdeling van bronne in die publieke sekdor veroorsaak dat daar 'n risiko is vir die werker met 'n lae inkomste as gevolg van die stygende koste van gesondheidsorg. Die wetgewing wat mediese skemas en farmaseutiese dienste beheer veroorsaak ook dat die Siekefonds se lewensvatbaarheid bedreig word, veral in die korttenmyn tot tyd en wyl die gemeenskapsgesondheidsversekering gestig word. Die beperkings wat op reseptering geplaas word en die metodes wat beplan word om medisyne meer bekostigbaar te maak, veroorsaak ook 'n uitdaging vir die inkomste mediese fondse. Die relevante wetgewing word tans in die hof betwis, en die plaasvervangende wetgewing is voortydig gepromulgeer, wat verwarring en onsekerheid veroorsaak. Die siekefondse moet hulle binne die konteks voorberei vir die veranderinge wat voorlê. 'n Bestuurskonsultasie gevallestudie is voorgelê, met die hulp van die Klerasienywerheid Gesondheidsorgfonds (Weskaap), wie se siekefonds omvattende primêre gesondheidsdienste lewer binne klinieke, fabrieke en deur gemeenskapsgeneeskundiges. Omdat die organisasie en die omstandighede rondom die veranderings aan die farmaseutiese dienste kompleks is, word Yolles se lewensvatbare benadering (viable approach) as 'n raamwerk gebruik vir die konsultasie. Die model is nuut gepubliseer, en is gebaseer op chaos teorie, wat rigting gee aan die aard van die ondersoek volgens die vorm en die gedrag wat die situasie aanneem. Dit is daarop gemik om lewensvatbaarheid en aanpassingsvermoë te ondersteun. Daar word 'n studie gemaak van die impak wat die veranderings tot wetgewing op gesondheidsdienste wat deur middel van die werksplek bereik word mag hê, en toets die toepaslikheid van Yolles se model in die konteks van bestuurskonsultasie.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/5040
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