The Blackwell Companion to Medical Sociology

376 H. C. J. van Rensburg and Charles Ngwena
RECTIFYING DISTRIBUTIVE DISPARITIES IN HEALTH PROVISION
There are no quick fixes to the pronounced discrepancies and inequalities in the
apportionment and distribution of health resources that have been entrenched
over centuries. Current reforms aim to redress these gross inequities in a twopronged
approach implying, firstly, large-scale resource reallocation and redeployment
of personnel and facilities to smooth out gross disparities, and
secondly, controllingthe referral and flow of patients to the various public
providers and facilities to ensure a more even and appropriate spread. Among
the specific redistributive measures contemplated to encourage staff to deploy
and redeploy in underserviced areas are; retrainingof personnel; providing
incentives for staff to work in rural areas; introducingcontractual obligations
for those receivingsubsidized training; importingCuban doctors to serve in
underresourced facilities and communities; and strengthening the public sector
in order to attract staff from the private sector. Regarding the flow of public
patients to providers and facilities, various measures are beingdevised to effect
more appropriate and cost-effective referral flows. Foremost are: makingPHC
the first point of entry for patients utilizingthe public health sector; introducing
penalizingpayments to restrict the bypassingof PHC facilities, and thus deterringthe
unjustified use of public hospital facilities; and regionalizinghealth care,
i.e. deployinghealth facilities and workers in such a manner and in such
numbers that patients would be able to receive the appropriate services in their
respective health regions and districts, except for services of a tertiary nature.
Expanding Free Health Services to Deprived and Vulnerable Groups
A major step toward equity and accessibility in health care, and particularly to
remove financial barriers to access for vulnerable groups, was the introduction
and expansion of free health services. Such socialization of health care stands in
sharp contrast to policy under the previous government where the deliberate
strengthening and expansion of the private sector in health care was one of the
mainstays in health policy. Since mid-1994, formidable strides have been made
toward free health services by broadening the groups eligible for such care. In
tandem with these measures, and in particular to limit the expansion of the
private health sector, a number of regulatory measures have been proposed to
reform the private health sector and to limit its expansion, and these apply to
private providers, private hospitals, and the health insurance industry. Amongst
others, are the authorization of the construction of new private hospitals by the
minister; cuttingof state subsidies to private hospitals in order to discourage
their growth; barring doctors from share-holding or having other financial
interests in private hospitals; regulating the importation of expensive technology
in both the public and private sectors; controllingthe dispensingof medicines by
medical practitioners; introducingmandatory health insurance coverage for a
defined hospital benefit package; ensuring cross-subsidization and risk-pooling
in health insurance; and enhancingefficiency of and cost-containment in the
health insurance market (Department of Health 1996b).