Van Den Heever A M
Health Econ. 1998 Jun;7(4):281-9. doi: 10.1002/(sici)1099-1050(199806)7:4<281::aid-hec355>3.0.co;2-z.
This paper discusses some of the trends, debates and policy proposals in relation to the financing of the private health sector in South Africa. The public and private sectors in South Africa are of equivalent size in terms of overall expenditure, but cover substantially different population sizes. Within this context the government has reached the unavoidable conclusion that the private sector has to play some role in ensuring that equity, access and efficiency objectives are achieved for the health system as a whole. However, the private sector is some way off from taking on this responsibility. Substantial increases in per capita costs over the past 15 years, coupled with a degree of deregulation by the former government, have resulted in increasing instability and volatility. The development of a very competitive medical scheme (health insurance) market reinforced by intermediaries with commercial interests has accelerated trends toward excluding high health risks from cover. The approach taken by the government has been to define a new environment which leaves the market open for extensive competition, but removes from schemes the ability to compete by discriminating against high health risks. The only alternatives left to the private market, policy makers hope, will be to go out of business, or to survive through productivity improvements.
本文探讨了与南非私营医疗部门融资相关的一些趋势、争论和政策建议。就总体支出而言，南非的公共部门和私营部门规模相当，但覆盖的人口规模却大不相同。在此背景下，政府得出了不可避免的结论，即私营部门必须在确保整个卫生系统实现公平、可及性和效率目标方面发挥一定作用。然而，私营部门距离承担这一责任还有一段路要走。过去15年人均成本大幅增加，再加上前政府的一定程度的放松管制，导致了日益增加的不稳定和波动。由具有商业利益的中介机构强化的极具竞争性的医疗计划（医疗保险）市场的发展，加速了将高健康风险人群排除在保险范围之外的趋势。政府采取的方法是定义一个新环境，让市场保持开放以进行广泛竞争，但消除医疗计划通过歧视高健康风险人群来竞争的能力。政策制定者希望，留给私营市场的唯一选择将是停业，或者通过提高生产率来生存。
