In South Africa, parallel private and public systems exist. The public system serves the vast majority of the population, but is chronically underfunded and understaffed. The wealthiest 20% of the population uses the private system and are far better served. In 2005, South Africa spent 8.7% of GDP on health care, or US$437 per capita. Of that, approximately 42% was government expenditure.[1] About 79% of doctors work in the private sector. [2]
See List of hospitals in South Africa.
HIV and AIDS in South Africa are major health concerns, and around 5.5 million people are thought to be living with the virus in South Africa.[3] HIV (human immunodeficiency virus) is the retrovirus that causes the disease known as AIDS (Acquired Immunodeficiency Syndrome). South Africa has more people with HIV/AIDS than any other country.[4]
The South African National HIV Survey estimated that 10.8% of all South Africans over 2 years old were living with HIV in 2005. There is an average of almost 1,000 deaths of AIDS a day in South Africa.[5]
The public sector uses a Uniform Patient Fee Schedule as a guide to billing for services. This is being used in all the provinces of South Africa, although in Western Cape, Kwa-Zulu Natal, and Eastern Cape, it is being implemented on a phased schedule. Implemented in November of 2000, the UPFS categorizes the different fees for every type of patient and situation. It groups patients into three categories defined in general terms, though it also includes a classification system for placing all patients into either one of these categories, depending on the situation and any other relevant variables. The three categories include full paying patients—patients who are either being treated by a private practitioner, who are externally funded, or who are some types of non-South African citizens—, fully subsidized patients—patients who are referred to a hospital by Primary Healthcare Services—, and partially subsidized patients—patients who’s costs are partially covered based on their income. There are also specified occasions in which services are free of cost. [6]
Antiretroviral Therapy: Because of its abundant cases of HIV/AIDS among citizens (about 5.6 million in 2009) South Africa has been working to create a program to distribute antiretroviral therapy treatment, which has generally been limited low economic countries. An antiretroviral drug aims to control the amount of virus in the patient’s body. In November of 2003 the Operational Plan for Comprehensive HIV and AIDS Care, Management and Treatment for South Africa was approved, which was soon accompanied by a National Strategic Plan for 2007-2011. When South Africa freed itself of apartheid, the new health care policy has emphasized public health care, which is founded with primary health care. The National Strategic Plan therefore promotes distribution of antiretroviral therapy through the public sector, and more specifically, primary health care. [7] According to the World Health Organization, about 37% of infected individuals were receiving treatment at the end of 2009. It wasn’t until 2009 that the South African National AIDS Council urged the government to raise the treatment threshold to be within the World Health Organization guidelines. Although this is the case, the latest antiretroviral treatment guideline, released in February 2010, continue to fall short of these recommendations. In the beginning of 2010, the government promised to treat all HIV-positive children with antiretroviral therapy, though throughout the year, there have been studies that show the lack of treatment for children among many hospitals. In 2009, a bit over 50% of children in need of antiretroviral therapy were receiving it. Because the World Health Organization’s 2010 guidelines suggest that HIV-positive patients need to start receiving treatment earlier than they have been, only 37% of those considered in need of antiretroviral therapy are receiving it.
A controversy within the distribution of antiretroviral treatment is the use of generic drugs. When an effective antiretroviral drug became in available in 1996, only economically rich countries could afford it at a price of $10,000 to $15,000 per person per year. For economically disadvantaged countries, such as South Africa, to begin using and distributing the drug, the price had to be lowered substantially. In 2000, generic antiretroviral treatments started being produced and sold at a much cheaper cost. Needing to compete with these prices, the big-brand pharmaceutical companies were forced to lower their prices. This competition has greatly benefited low economic countries and the prices have continued decline since the generic drug was introduced. The antiretroviral treatment can now be purchased at as low as eighty-eight dollars per person per year. While the production of generic drugs has allowed the treatment of many more people in need, pharmaceutical companies feel that the combination of a decrease in price and a decrease in customers reduces the money they can spend on researching and developing new medications and treatments for HIV/AIDS. [8]
Following the end of the Second World War, South Africa saw a rapid growth in the coverage of private medical provision, although this development mainly benefited the predominately middle class white population. From 1945 to 1960, the percentage of whites covered by health insurance grew from 48% to 80% of the population. Virtually the entire white population had shifted away from the free health services provided by the government by 1960, although 95% of non-whites remained reliant on the public sector for treatment. Membership of health insurance schemes became effectively compulsory for white South Africans due to membership of such schemes being a condition of employment, together with the fact that virtually all whites were formally employed. Pensioner members of many health insurance schemes received the same medical benefits as other members of these schemes, but free of costs[9].
Since coming to power in 1994, the African National Congress (ANC) has implemented a number of measures to combat health inequalities in South Africa. These have included the introduction of free health care in 1994 for all children under the age of six together with pregnant and breastfeeding women making use of public sector health facilities (extended to all those using primary level public sector health care services in 1996) and the extension of free hospital care (in 2003) to children older than six with moderate and severe disabilitieshttp://www.ci.org.za/depts/ci/pubs/pdf/general/gauge2006/gauge2006_healing.pdf
The current government is working to establish a national health insurance (NHI) system out of concerns for discrepancies within the national health care system, such as unequal access to healthcare amongst different socio-economic groups. Although the details and outline of the proposal have yet to be released, it seeks to find ways to make health care more available to those who currently can’t afford it or who’s situation prevents them from attaining the services they need. Because of the discrepancy of money spent in the private sector (which serves the wealthy) and than spent in the public sector (which serves the majority of the population), the total population does not have health care coverage, most of whom are low or middle class, and in many cases, need it more than anybody else.
The NHI is speculated to propose that there be a single National Health Insurance Fund (NHIF) for health insurance. This fund is expected to draw its revenue from general taxes and some sort of health insurance contribution. The proposed fund is supposed to work as a way to purchase and provide health care to all South African residents without detracting from other social services. Those receiving health care from both the public and private sectors will be mandated to contribute through taxes to the NHIF. The ANC hopes that the NHI plan will work to pay for health care costs for those who cannot pay for it at all themselves. There are those who doubt the NHI and oppose its fundamental techniques. For example, many believe that the NHI will put a burden on the upper class to pay for all lower class health care. Currently, the vast majority of health care funds comes from individual contributions coming from upper class patients paying directly for health care in the private sector. The NHI proposes that health care fund revenues be shifted from these individual contributions to a general tax revenue. [10]
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