Abstract
M.Comm.
Health care is recognised as a basic human right. The current position of private health
care in South Africa is of great concern. Not only is health care almost unaffordable but
the future quality of health care also causes great concern. With this in mind it is obvious
that alternatives to conventional medical aids and health insurance are necessary to
guarantee the continued availability of quality medical care to the South African public.
Most people would agree that our private sector health care system is characterised by a
depressing history of inadequate planning, control and management. It is for this reason
that amendments to the Medical Schemes Act were considered necessary. Certain of
these amendments will extend the role played by medical schemes in the management of
health care resources. This will result in the traditional boundaries and relationships
between the public, health professionals and health care facilities, and the financiers in
our private health care system being altered. A new philosophy will evolve based on open
and participative practices, as well as increased coordination, integration and cooperation
(Veliotes et al, 1993: 12). Internationally, the health care objectives of most countries are to provide access to highquality care for all the people, and to provide this care efficiently and effectively. In the last decade the task of achieving these potentially conflicting objectives has become more difficult. At present, private health care is funded by medical schemes, health insurance companies, employers and individuals themselves. Neither medical aids nor health insurance companies are able to contain the rise in health care cost, which has led to the emergence of a new method of finding, namely Managed Health Care (MHC). Health care cost has accelerated at a rate far above the consumer price index(CPI). Rising health care costs in the private sector have been blamed on structural inefficiencies in the medical aid system. While patients have little incentive to minimise care expenditure, providers have an incentive to overuse the system.