It is possible to develop a sociological impression of the Republic of South Africa (RSA) by carefully analyzing its health care system. RSA has some of the most advanced health facilities in the world and also the largest hospital outside mainland China. Financially secure individuals from Africa and across the world travel to the different cities in RSA in search of specialized treatment and care, making for a successful medical tourism sector in the country. Unfortunately, the majority of South Africans cannot even access basic primary health care, despite it being a constitutional right in the country. Instead, they have to make do with limited services if at all or opt for ineffective traditional treatment. The paradoxical combination of a sorry health care system for the majority and a stellar system for the affluent minority is also a reflection of the general sociological stare of the RSA in general. This sociological state has its roots in a racially discriminative past and also an extremely corrupt present (Mayosi & Benatar, 2014). This research paper will present facts to support the contention that in the RSA, the minority enjoy an excellent all-around health care system while the poor suffer as a result of lack of a functional healthcare system.
How the Healthcare System Came About
The RSA health care system was developed through a combination of sea trade in the 17th and 18th centuries, missionary work, and war efforts within the course of the 19th and 20th centuries. The Southern Cape areas were important to the European trade with India and the rest of Asia before the building of the Suez Canal. Traders would stop after long tropical journeys in need of treatment for tropical and sea-caused illnesses and have their slaves treated for a variety of diseases. Missionaries who came to teach about Christianity would then set up mission hospitals in the interior. In the late 19th and 20th centuries, the Southern African regions became engulfed in global and local wars that necessitated the development of resources to treat the sick. A retinue of military hospitals was then added to the existing missionary hospitals. It is the combination of the mission and military hospitals that make the bulk of modern public hospitals on rural RSA (Mayosi & Benatar, 2014). While missions and military activities influenced the advent of the healthcare system, its development was mainly influenced by apartheid, a system where humans were ranked based on race. Under the system, whites were the cream of the society, Indians were second-rate citizens, and black Africans were third rate citizens. For most of the 20th century, the RSA healthcare system was built based on apartheid policies resulting in one of the most unfair and unbalanced healthcare systems in the world. Almost three decades after the end of apartheid, the de jure situation had changed but the de facto scenario remains the same (Mayosi & Benatar, 2014). The best facilities were only available to the whites and are now only available to the affluent while the poor have to content with a purely dysfunctional system.
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Sociological Evaluation
Universal Coverage
Universal coverage is a constitutional right for all South Africans and also anyone who is domiciled in RSA legally or otherwise, based on the 1996 Post-Apartheid RSA constitution. It can be argued that providing for universal healthcare coverage was inspired by an apartheid law that made health care insurance compulsory for all white South Africans. Unfortunately, the universal coverage is only available in law and not in fact as the situation on the ground is very different (Marten et al., 2014). Despite the fact that RSA spends a substantial amount of its annual budget on healthcare, the current system is primarily capitalist in nature with primary health care being available to those who can afford to pay for it. In all fairness, South Africa has some of the best theoretical healthcare concepts including a Uniform Patient Fee Schedule (UPFS), primary healthcare as a fundamental right, and even a proposed single-payer universal health insurance (Mayosi & Benatar, 2014). However, for primarily political reasons, all these concepts have not benefited the ordinary South African. Based on available research, the main reason why there is no universal coverage in RSA is that the rich do not want to incur the expense of providing health care for the poor.
Portability
In RSA, there are no general rules or laws that govern how health care insurance operates hence market dynamics are the primary driver (Marten et al., 2014). Secondly as indicated above, there is no government insurance scheme. A government scheme that had been put in place in 2009 has not yet taken effect. The ministry of health has created proposed legislation for a government insurance cover that is set to take effect from 2026, but the law has not yet even been tabled in parliament. The issue of portability thus varies from company to company but is generally only available based on pecuniary benefits to the service providers. Therefore, like most of the important healthcare facilities, portability is available for the affluent but not the poor. The issue of portability is critical to RSA because the country has a higher HIV and AIDS prevalence with many children being born with HIV. In a 2010 report, the World Health Organization indicated that RSA was seeking inter alia to:…. assure continuity and portability of national health insurance within the country” (WHO 2010), but eight years later, the goal has not yet been attained.
Geographic Accessibility
From the sociological approach of the instant research paper, geographical accessibility is among the most important parameters for assessing the RSA healthcare system. It is also important to indicate that accessibility relates to the availability of healthcare services, not just accessibility to physical institutions. RSA is a large country, dominated by vast rural areas and a collection of large and medium-sized cities. Access to hospitals and health centers in South Africa is very high with government-run institutions spread across the entire country. However, access to actual healthcare services is extremely limited and mainly predicated on pecuniary interests. For example, a majority of doctors in South Africa are trained in government institutions and to a large extent funded by taxpayers. However, upon graduation, most of these doctors take up employment in the private sector, leaving the public sector extremely understaffed (Surender, Alfers & van Niekerk, 2015). The lack of trained personnel in government institutions is worsened by corresponding poor management, under-funding, and lack of basic resources. It is thus common for needy South Africans who are unwell to bypass the public hospitals in order to seek treatment in the private sector institutions where real healthcare facilities are available.
Comprehensive Benefits
Almost all commentators agree that comprehensive benefits insurance is crucial in RSA but out of reach for most of the country’s citizens. In Apartheid South Africa, comprehensive benefits insurance was readily available for whites who were also generally affluent. With the end of apartheid, the service was expended to more South Africans, more so within the rapidly expanding middle and working classes. However, according to Pallot (2010), the situation sharply changed with the passage of a new law that required all healthcare insurers to have a 25% reserve of all issue policies. An insurance crisis ensued, many companies collapsed while countless others were forced to merge. The comprehensive cover was among the casualties of the 2010 changes as it remained a preserve of a few rich South Africans. The rest of the insured populace have had to make do with wiry and circumspect programs that cover a select group of conditions. The situation is unfortunate since according to Pallot (2010): “ Comprehensive, rather than basic, cover is important ” hence the problem of affordability needs to be handled expeditiously.
Affordability
Affordability is another important social issue when it comes to healthcare, and in the case of RSA, it reflects negatively on the country. As has been canvassed above, most doctors in the country operate in private hospitals thus the public hospitals are understaffed. Private hospitals are also very expensive and according to Pallot (2010), seeking to get treatment from a private institution without proper insurance can be financially draining. On the other hand, there are programs that make the public institutions affordable to some extent and in some cases, free. Among the instances where treatment at public hospitals is free includes care and antiretroviral therapy for HIV patients. However, free and cheap treatment is either rare or poor thus forcing most patients to opt for the more expensive treatment in private hospitals (Surender, Alfers & van Niekerk, 2015). The poor state of the health insurance sector exacerbates the problem of unaffordability.
Financial Efficiency
What apartheid was for the old healthcare system in RSA, corruption and poor management have become for the modern healthcare system. A country that falls under the top 30 economies in the world, and with a population of slightly over 50 million then spends over 8% of its GDP on healthcare should have a stellar health care system (Rispel, de Jager & Fonn, 2015). However, corruption has been a major problem in the overall governance of South Africa, including its healthcare sector. More importantly, the monies allocated to healthcare are poorly managed in a variety of ways. For example, the country spends a lot on training doctors who then go on to practice commercially rather than help the poor. Similarly, the monies allocated to the healthcare sector end up assisting middle class and working calls citizens rather than the very poor (Rispel, de Jager & Fonn, 2015). There is a need for political will to end corruption and for the affluent to sacrifice for the benefit of the poor to remedy the situation.
Consumer Choice
The subject of consumer choice has gradually been covered in the research analysis above but can be limited to the summary that choice is predicated on pecuniary capacity. The very rich can afford comprehensive benefit insurance leading to unlimited choices in terms of access to healthcare. The middle and working class have to balance between limited insurance covers and carefully selecting where to get assistance based on affordability. The very poor can only access the limited public health facilities or opt for traditional means. Like all other parameters, consumer choice in the RSA healthcare system is grossly unfair (Rispel, de Jager & Fonn, 2015).
Conclusion
The glimpse of the RSA healthcare system as presented in the instant research paper reveals the importance of health-based issues as a window for studying the sociological status of a country. RSA has some of the best healthcare institutions in the world that attract the affluent globally who are searching for premier healthcare services. However, for an overwhelming majority of South Africans, healthcare services remain a mirage as they are in a major crisis. The primary paradox within the problem lies in the fact that the current RSA constitution provides for universal primary health care for anyone domiciled within the country. Further, the country spends a major cross-section of its national budget on healthcare services. The main problem with the system in its entirety is an extensive lack of social parity. RSA has a history of extreme institutionalized racism under apartheid. The health care system was created to mainly serve rich whites and ignore the majority and predominantly poor blacks. When apartheid stopped in the early 1990s, corruption and mismanagement took over. Major efforts to reform the system have been sought including a single payer insurance cover, but most have been frustrated by lack of social and political goodwill. As the few rich enjoy some of the best healthcare services in the world, the majority poor continue to make do with mediocre services if any.
References
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Marten, R., McIntyre, D., Travassos, C., Shishkin, S., Longde, W., Reddy, S., & Vega, J. (2014). An assessment of progress towards universal health coverage in Brazil, Russia, India, China, and South Africa (BRICS). The Lancet , 384 (9960), 2164-2171
Mayosi, B. M., & Benatar, S. R. (2014). Health and health care in South Africa—20 years after Mandela. New England Journal of Medicine , 371 (14), 1344-1353
Pallot, P. (2010, May 21). Expat guide to South Africa: Health care. Retrieved from https://www.telegraph.co.uk/news/health/expat-health/7733901/Expat-guide-to-South-Africa-health-care.html
Rispel, L. C., de Jager, P., & Fonn, S. (2015). Exploring corruption in the South African health sector. Health Policy and Planning , 31 (2), 239-249
Surender, R., Alfers, L., & van Niekerk, R. (2015). Moving towards universal health coverage in South Africa: the role of private sector GPs. Public Health Association of South Africa , 3 ,1-4
WHO (2010). Bridging the gap in South Africa. www.who.int/bulletin/volumes/88/11/10-021110/en/c
