Healthcare costs are likely to skyrocket and employers are becoming less and less prepared to carry the burden, according to the fifth in a series of surveys done by Old Mutual and released in Johannesburg on Wednesday. With findings based on in-depth interviews with 60 leading SA companies, representing close to 600 000 medical scheme lives, and focus group discussions with members of medical schemes, Old Mutual's bi-annual survey provides valuable insight into the challenges facing SA's private healthcare industry.
Public-Private Mix
SA: Employees face skyrocketing healthcare costs -
shock report
SACP Statement on plans by private hospitals to increase fees
SACP, 6 January 2008
The SACP is outraged at the plans by some of the big private hospital groups, including the National Hospital Network and Netcare, to hike fees by as much as up to 33% as from this year. The private health care sector is already consuming a much bigger slice of our health resources and is also making huge profits for itself at the direct expense of the majority of the people of our country, feeding like parasites on workers’ already overstretched medical aid schemes.
Safe male circumcision in Botswana: Tension between traditional practices and biomedical marketing
KKatisia M; Daniela M: Global Public Health, DOI: 10.1080/17441692.2015.1028424 April 2015
Botswana has been running Safe Male Circumcision (SMC) since 2009 and has not yet met its target. The objective of this paper is to explore responses to SMC in relation to circumcision as part of traditional initiation practices. More specifically, the authors present the views of two communities in Botswana on SMC consultation processes, implementation procedures and campaign strategies. The methods used include participant observation, in-depth interviews with key stakeholders, community leaders and men in the community. The authors observe that consultation with traditional leaders was done in a seemingly superficial, non-participatory manner. While SMC implementers reported pressure to deliver numbers to the World Health Organisation, traditional leaders promoted circumcision through their routine traditional initiation ceremonies at breaks of two-year intervals. There were conflicting views on public SMC demand creation campaigns in relation to the traditional secrecy of circumcision. In conclusion, initial cooperation of local chiefs and elders was reported to have turned into resistance.
Saleability of anti-malarials in private drug shops in Muheza, Tanzania: a baseline study in an era of assumed artemisinin combination therapy (ACT)
Ringsted FM, Massawe IS, Lemnge MM and Bygbjerg IC: Malaria Journal 10(238), 15 August 2011
The main objective of this study was to conduct a baseline study of the private market for anti-malarials in Muheza town, an area with widespread anti-malarial drug resistance, prior to the implementation of a provider training and accreditation programme that will allow accredited drug shops to sell subsidised Artemether-lumefantrine (ALu). All drug shops selling prescription-only anti-malarials in Muheza voluntarily participated from July to December 2009. Qualitative in-depth interviews were conducted with owners or shopkeepers on saleability of anti-malarials, and structured questionnaires provided quantitative data on drugs sales volume. Results showed that all surveyed drug shops illicitly sold sulphadoxine-pymimethamine (SP) and quinine (QN), and legally amodiaquine (AQ). In community practice, the saleability of ACT was negligible. SP was best-selling, and use was not reserved for Intermittent Preventive Treatment (IPTp), as stipulated in the national anti-malarial policy. The authors express concern that such drug-pressure in the community equals de facto intermittent presumptive treatment. In an area where SP drug resistance remains high, unregulated SP dispensing to people other than pregnant women runs the risk of eventually jeopardising the effectiveness of the IPTp strategy.
Sales and pricing decisions for HIV self-test kits among local drug shops in Tanzania: a prospective cohort study
Chiu C; Hunter L; McCoy S; et al: BMC Health Services Research 21(434), 1-11, 2021
From August to December 2019, the authors provided free HIV self-test kits, a new product, to 26 pharmacy shops in Shinyanga, Tanzania to sell to the local community. Sales volume, price, customer age and sex were measured using shop records, together with willingness-to-pay to restock test kits. Purchase prices ranged from 1000 to 6000 Tsh. Within shops, prices were 11.3% higher for 25 to 34 and 12.7% higher for 45+ year olds relative to 15 to19 year olds and 13.5% lower for men on average. Although prices varied between shops, prices varied little within shops over time, and did not converge over the study period or cluster geospatially. Shopkeepers charged buyers different prices depending on buyers’ age and sex and there was low demand among shopkeepers to restock at the end of the study. The authors propose that careful consideration is needed to align the motivations of retailers with public health priorities while meeting their private for-profit needs.
Salt, sugar, and malaria pills: How the Affordable Medicine Facility–malaria endangers public health
Kamal-Yanni M: Oxfam Briefing Paper 163, 24 October 2012
This paper argues that the Affordable Medicine Facility–malaria, a global subsidy for malaria could skew investment away from more effective solutions to the disease. The AMFm advocates selling artemisinin-based combination therapy (ACT) medicines through the private sector, such as small shops. But selling ACT drugs, even at a small cost, is argued to exclude poor people who cannot afford to pay for a full course of treatment. Furthermore, the informal private sector does not have the ability or incentive to provide correct diagnosis and treatment, which may contribute to worsening drug resistance. The authors raise that getting malaria medicines from informal private providers is not a sound public health approach and not a substitute for investment in public service provision.
Sharing the burden of TB/HIV? Costs and financing of public–private partnerships for tuberculosis treatment in South Africa
Sinanovic E, Kumaranayake L: Tropical Medicine & International Health 11(9): 1466-1474
The objective of this study was to explore the economic costs and sources of financing for different public–private partnership (PPP) arrangements to tuberculosis (TB) provision involving both workplace and non-profit private providers in South Africa. The financing required for the different models from the perspective of the provincial TB programme, provider, and the patient are considered.
Shifting the Burden: The Private Sector\\
As the economic burden of HIV/AIDS increases in sub-Saharan Africa, allocation of the burden among levels and sectors of society is changing. The private sector has more scope to avoid the economic burden of AIDS than governments, households, or nongovernmental organisations, and the burden is being systematically shifted away from the private sector. The article suggests that the shift in the economic burden of AIDS is a predictable response by business to which a deliberate public policy response is needed. Countries should make explicit decisions about each sector's responsibilities if a socially desirable allocation is to be achieved.
Shot in the arm for HIV and AIDS treatment and for public-private partnerships
Kahn T: Business Day, 18 February 2010
The South African Government Treasury is reported to have set aside an extra R8,4bn for HIV and AIDS over the next three years, reflecting its commitment to improving the quality of services for people affected by the disease and to doubling the number of patients getting life-saving antiretroviral therapy. An increase in funds flowing to provinces through conditional grants for HIV and AIDS and increased budget allocations to to wage increases for doctors, dentists, pharmacists and emergency services personnel, and for therapeutic practitioners such as physiotherapists intend to retain vital skills in the public sector, while a hospital revitalisation grant covers costs of refurbishing public hospitals. Citing Finance Minister Pravin Gordhan, the report notes that these investments seek to improve the public health care sector as part of building a closer partnership between the public and private healthcare systems.
Smith and colleagues' response to Hanson and colleagues' viewpoint on the private sector in low-income countries
Smith R, Feachem R, Feachem NS, Koehlmoos TP and Kinlaw H: PLoS Medicine, November 2008
These two viewpoints agree much more than they disagree. Both agree that the public sector cannot be ignored and both agree that there is a role for the private sector in improving the health of the world's poorest. The disagreement is about emphasis. Smith et al believe that many countries will benefit more from harnessing the energy of the private sector rather than continuing to invest solely or mainly in the public sector. The public sector, growing evidence of the effectiveness of the private sector, and energetic non-state organisations, are already working to harness the power of the private sector to achieve better health care for all. Evaluation will be crucial, but the most important research question is not ‘Can the private sector help?’ but ‘How can public–private partnerships be made most effective and equitable?’