Browsing by Subject "Medical economics - South Africa"

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    The distribution and redistribution of health resources in South Africa
    (1991) Van den Heever, Alexander Marius; Wilson, Francis
    This thesis is intended as a broad examination of the distribution of health resources in South Africa. Issues both macro and micro in nature have been covered to provide a perspective that would be Jacking in a narrower study. Although the title refers to a redistribution of resources, the intention of this thesis is to stress the importance of providing appropriate health measures rather than merely apportioning existing facilities evenly. This realization is insufficient, however, if it is not accompanied by the introduction and utilization of analytical approaches for identifying resource selection priorities. The influences on health status are many. In defining appropriate measures to improve health status it is important to be aware of the limitations of medical-care. Chapter three involves a cross-sectional regression analysis of various countries in order to examine the influences certain variables have on health status. This study suggests the need for an integrated approach to improving the health of a population. Merely focusing on medical care will only have a limited affect. However, this does not mean that medical-care is not important. It must just be provided in an appropriate manner. The rest of the thesis evaluates health-care resource distribution in South Africa. The existing distribution of health-care resources in South Africa is ill-suited to the existing health status of the population. There is a bias toward urban based curative facilities. Furthermore, the location of facilities has been based on racial criteria, whereby some areas have sufficient resources for their needs while others do not. Two methods of identifying how these issues should be dealt with are produced in this thesis. The first deals with a method for adjusting the broad distribution of funds toward those areas where need is greatest. The suggestion put forward by this thesis is that a formula be developed that would be able both to define need on a geographical basis, and to allocate resources based on that need. The formula would be used to allocate government health expenditure. This section is based on a formula that was developed in the United Kingdom. The second deals with a method for defining appropriate medical interventions on the micro level. It is called cost-effectiveness analysis (CEA). CEA is used for micro-economic decision-making where a choice has to be made between at least two alternatives for attaining a particular objective. Furthermore, CEA evaluates projects or programmes that are on-going in nature. It should be noted that CEA can also evaluate non-medical interventions to solve a particular health problem. In order to indicate the type of information that a CEA can provide, an investigation into cervical cancer procedures used on black females was produced. The entire black female population of South Africa was examined. A computer simulation of incidence and mortality rates of the disease was used to evaluate various scenarios. The results indicate that significant gains can be made by introducing cervical cancer screening on a large scale in South Africa. A major priority of this thesis was to stress the importance of using economic criteria to assist in making decisions concerning health-care resource allocations. Very little work of this nature is produced in South Africa. Hopefully this will not always be the case.
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    An evaluation of expenditure in the private health care sector and its reporting in the national accounts of South Africa
    (1997) Valentine, Nicole Britt; McIntyre, Di
    There is currently much work underway internationally to improve the accuracy and to refine the detail of accounting for health care expenditures. This research was initiated by the increasing activity in the field of national health accounting, as well as by previous research indicating that the Reserve Bank might be underestimating private health care expenditure in the national accounts. The Reserve Bank estimate of health care expenditure is important as it is the only complete and regularly produced estimate of private sector health care expenditure for South Africa. It was posited that an independent estimation of private health care expenditure would show that its magnitude is underestimated in the expenditure estimates published by the Reserve Bank for the national accounts. This thesis was upheld by the results of the research. The thesis estimate of private health care expenditure was R15 billion, 39% higher than the Reserve Bank estimate available at the time. It was also 21% higher than the final Reserve Bank estimate published in December 1995. The methodology used to derive the thesis estimate involved a survey of national income accounting concepts and guidelines embodied in the internationally used publication, the 1993 System of National Accounts. Primary data was collected from a wide range of institutions in the South African health sector. Secondary data sources were also consulted in several instances. In particular, the Registrar of Medical Schemes was consulted for medical scheme expenditure estimates as they constitute the largest portion of private sector health care expenditure in South Africa. The thesis estimate was then calculated for a single year according to the 1993 System of National Accounts guidelines. The year chosen was the government financial year from April 1992 to March 1993. The year was chosen to coincide with the year chosen for a national health expenditure review. In the presentation of the results, the estimate was broken down in separate "sources" and "uses" matrices, which are being used internationally to present national health accounting information. From the comparison of the Reserve Bank and thesis expenditure estimates, one of the most important recommendations that emerged was that the Reserve Bank should consult a wider range of expenditure data sources, more timeously and regularly. In particular, it was suggested that the Reserve Bank should negotiate earlier access to the data held by the Registrar of Medical Schemes, as well as cross-check household survey data with independent estimates of out-of-pocket and statutory scheme health care expenditure. In addition to providing a new benchmark estimate for private sector health care expenditure in the government financial year 1992/93, the breakdown of the estimate into matrices provides a framework that could be used as the basis for the development of more detailed satellite national health accounts, in accordance with 1993 SNA standards.