The impact of political transformation in South Africa on public/private mix policy debates

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Abstract
This paper documents the changing public/private mix in the South African health sector from 1980 to 1991, and offers some explanations for those trends in terms of developments in the macroeconomy and the dominance of particular political and ideological positions. The private sector has grown at the expense of the public sector over the last decade, to the point where, in 1991, despite providing for only a fifth of the population, the private health sector contains over half the doctors, nearly all the dentists, and spends more than half the total public and private financial resources spent on health care. The changing political context, from apartheid and free-market policies towards non-racial democracy with widespread acceptance of the need to address the problems of poverty and inequality, provides the background for an analysis of how the policy debates relating to the public/private mix in the health sector have changed since 1990. The strongly polarized positions of nationalization on the one hand, and privatization and free markets on the other, have given way to more realistic positions with a growing degree of consensus on goals, although not yet on methods. The debates around the public/private mix in health care now turn on whether one can counter the trend of decreasing equity and access to health care by drawing on financial resources currently being spent by the private sector through a national health insurance scheme, and on the degree of integration of private providers into the publicly financed health system.

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