THE ROLE OF PRIVATE HOSPITALS IN SOUTH-AFRICA .2. TOWARDS A NATIONAL POLICY ON PRIVATE HOSPITALS

This paper reviews some aspects of present state policy on private hos pitals and sets out broad policy guidelines, as well as specific polic y options, for the future role of private hospitals in South Africa. C urrent state policy is reviewed via an examination of the findings and recommendations of the two major Commissions of Inquiry into the role of private hospitals over the last 2 decades, and comparison of these with the present situation. The analysis confirms that existing state policy on private hospitals is inadequate, and suggests some explanat ions for this. Policy options analysed include the elimination of the private hospital sector through nationalisation; partial integration o f private hospitals into a centrally financed health care system (such as a national health insurance system); and the retention of separate , privately owned hospitals that will remain privately financed and ou tside the system of national health care provision. These options are explained and their merits and the associated problems debated. While it is recognised that, in the long term, public ownership of hospitals may be an effective way of attaining equity and efficiency in hospita l services, the paper argues that elimination of private hospitals is not a realistic policy option for the foreseeable future. In this scen ario, partial integration of private hospitals under a centrally finan ced system is argued to be the most effective way of improving the eff iciency of the private hospital sector, and of maximising its contribu tion to national health care resources.