Introduction South Africa has a two tiered health care system: a private sector catering for seven of the 47 million people and public sector providing care to the majority. The private sector consists of for-profit providers that are funded either through medical schemes, health insurance policies or out of pocket expenditure. To attain the goal of the health care system of improving health, it is essential that healthcare financing is understood. The provision of quality, accurate and comprehensive financial data is necessary for the efficient mobilization and allocation of financial resources. Health Expenditure Reviews and National Health Accounts provide such invaluable information. Aim To provide a trend analysis of health financing and expenditure data for the private health care sector in South Africa from 01 January 2003 to 31 December 2006. Methods This study is employs an observational, descriptive cross-sectional design. The methodology used in the study is adapted from the World Health Organization’s guide to producing National Health Accounts. Data was obtained from the Council for Medical Schemes annual reports and from Statistics South Africa Income and Expenditure Survey. The annual average medical inflation for each of the years was removed from the nominal value so that a real trend analysis could be observed. Results For the four year period, the overall cost-drivers of consolidated schemes were private hospitals (31.0-35.0%), medical specialists (20.0-21.0%), medicines dispensed out of hospital (17.0-22.0%) and non-healthcare expenditure like administration and broker fees (14.0-15.0%). From the households’ consumable expenditure on health, 37.0% was spent on medical services, 35.0% on pharmaceutical products and 11.0% on hospital services. Discussion The majority of expenditure in the private sector is through medical schemes. The precise amount spent by households is unknown due to the lack of data but it is a large amount for the South African household. Proper National Health Account Matrices could not be constructed since access to data was limited, not routinely available and not disaggregated at the required level. Recommendations Better quality information on out-of-pocket household expenditure and expenditure in the traditional sector is needed. To improve access to the private sector, the proposed policy and legislative changes need to be implemented. / Thesis (MMed.)-University of KwaZulu-Natal, Durban, 2010.

Bibliography: pages 94-102. / 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.

The study was aimed at furthering the health objectives of the government's Reconstruction and Development Programme (ANC 1994b) in the area of primary health care. . The purpose of the study was to examine the possible reduction of medical scheme claims for cardiovascular disease by means of primary health care, so that medical scheme benefits do not become exhausted so rapidly. The overall outcome of the study showed that if cardiovascular disease could be diagnosed and treated early, the financial benefits could be substantial. This was illustrated by the comparison of primary, secondary and tertiary treatment of cardiovascular disease using case studies over a period of one year. Recommendations centered around nurse-based primary health care for cardiovascular disease and the cost-effective management of the medical scheme. It was concluded that as a result of nurse-based primary health care, costs could be contained so that medical scheme benefits would not become exhausted so rapidly. / Health Studies / M.A. (Nursing Science)

The purpose of this study was to develop a framework for provision of essential medicines for the district health services. A qualitative descriptive, exploratory and contextual action research design was followed. The data collection was conducted through site visits and semi structured interviews targeting the responsible pharmacists who were purposively selected on the basis of their expert knowledge and experiences from the eight of the nine provinces of the Republic of South Africa which is a developing country with limited resources for provision of healthcare services. The study found that there was no standardised framework for provision of essential medicines for the District Health Services. Based on the site visits and action research findings a proposed framework covering the selection, procurement, warehousing, distribution and management support components for provision of essential medicines for district health services was developed and subjected to national pharmaceutical experts and district health services managers review and critique which is finally presented, after taking into consideration the experts inputs as a proposed framework emanating from the study. The proposed framework will contribute towards improving the provisioning and availability of essential medicines within the district health services. / Health Studies / D.Litt. et Phil. (Health Studies)

The study was aimed at furthering the health objectives of the government's Reconstruction and Development Programme (ANC 1994b) in the area of primary health care. . The purpose of the study was to examine the possible reduction of medical scheme claims for cardiovascular disease by means of primary health care, so that medical scheme benefits do not become exhausted so rapidly. The overall outcome of the study showed that if cardiovascular disease could be diagnosed and treated early, the financial benefits could be substantial. This was illustrated by the comparison of primary, secondary and tertiary treatment of cardiovascular disease using case studies over a period of one year. Recommendations centered around nurse-based primary health care for cardiovascular disease and the cost-effective management of the medical scheme. It was concluded that as a result of nurse-based primary health care, costs could be contained so that medical scheme benefits would not become exhausted so rapidly. / Health Studies / M.A. (Nursing Science)