Structuring Sustainable Universal Health Care in South Africa

Abstract

Intervening in debates around universal health care in South Africa, this article draws on class-based analytical tools from social medicine, political economy, and historical sociology. It is argued there are 3 keys to achieving sustainable universal health care in South Africa: addressing the socioeconomic roots of ill health; establishing a fully public, nonprofit health care system; and adequate investment in undervalued female workers who are the backbone of public health care. Each key is discussed with accompanying recommendations, using evidence from South Africa and other countries. Principal constraints are also identified through an analysis demonstrating the links between inequality, health care financing, and the monopoly structure of the South African health care industry.

A Comparative Cross-Sectional Study of the Prevalence and Determinants of Health Insurance Coverage in Nigeria and South Africa: A Multi-Country Analysis of Demographic Health Surveys

“…The willingness of government and non-governmental agencies to disburse the necessary funds to the health sector in developing countries has been associated with a lack of political will, fraud and corruption within the health system [20,21]. Sustainable development and sustaining health financing remain pertinent in light of social, demographic and epidemiological changes [57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72], and the incidence of financing health system viability has long been a major subject of health policy problems across the globe, and in sub-Saharan African countries, such as in Nigeria and South Africa [1][2][3][4].…”

“…Financial protection, which concerns medical expenses paid out of pocket, is an essential factor in accomplishing universal health coverage [1,2]. Studies have shown that considerable dependence on out-of-pocket payments (OOP) as the most important source of payment for medical needs not only has an inauspicious consequence on demand for services, but also represents an increasing financial problem among families, leading to deprivation [3,4]. In addition, existing studies have indicated that per capita income expenditure on health and welfare in many low-and middle-income countries is likely to increase quickly in the long run [5,6].…”

“…In addition, existing studies have indicated that per capita income expenditure on health and welfare in many low-and middle-income countries is likely to increase quickly in the long run [5,6]. Moreover, the prevention of extremely harmful health disbursements and the necessity to strive towards universal health coverage have drawn the attention of governments and several stakeholders to provide health insurance schemes that will offer subsidized fees and healthcare accessibility to citizens, especially in developing countries such as Nigeria and South Africa [3,4].…”

“…In South Africa, the government has made UHC one of the top priorities of the sustainable development goals to protect the vulnerable population from medical financial risks and to increase participation in the uptake of health insurance [4]. Despite progress made in certain aspects of the country after the end of apartheid in 1994, a well-established healthcare system is structured around a strict referral mechanism, yet wide disparities still continue to exist between the public and private health systems amid escalating medical costs and inequalities of underlying socio-economic factors, which have followed as a consequence of the apartheid regime [17,18].…”

Should Dentists Treat Despite Medical Contraindications?

“…This state of affairs is not helped by the United States being the only industrialized country without universal health insurance 30 ; this, while even some developing countries, such as South Africa, are examining ways to introduce universal health insurance to its population. 31,32 While it certainly improved the state of affairs in the United States, the Affordable Care Act of 2010 still leaves millions without health insurance. 33 Based on the ADA Code, therapeutic alliance, and virtue ethics, Dr V has a duty to advocate on Mr S's behalf and to encourage him to seek and pursue treatment for his hypertension and health care generally.…”