Bestuurde gesondheidsorg 'n Suid-Afrikaanse perspektief

Abstract

Private health care in South Africa needs reform as the current fee-for-service system of reimbursement of service - providers has resulted in an uncontrolable cost spiral. The only alternatives are; i) a national health system where all citizens contribute to one centrally controlled fund and receive health care from a unitary system, or; ii) managed health care where predetermined health care services are rendered to subscribers of a health care plan for a fixed pre-paid fee. Managed health care can be offered up to 30% less expensive than the fee-for-service system and the cost spiral can be broken. For it to be successful, the users of health care must be satisfied with the heal th care service the system offers. This study compares the degrees of satisfaction between members of a health maintenance organization and members of a medical fund who finance a fee-for-service system with regard to health care service in general as well as the specific component thereof. The managed heal th care users studied, were equally or more satisfied with their health care than the fee-for-service users while the formers' care was rendered at lower cost.