SAHR 2007 - Health Systems Trust

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Health Care Financing and Expenditure 3 Figure 1: Health care expenditure in South Africa, 2005 (Rand billion) National Department of Health R1 billion Local Departments of Health R1 billion Provincial Departments of Health R45.5 billion Households (out-of-pocket) R16.5 billion Other public sector, including administration R12.5 billion Local and provincial PHC R7.9 billion Tertiary hospitals R8.4 billion Chronic and other public hospitals R2.4 billion Regional hospitals R9.3 billion Medicines R15.9 billion District hospitals R8.4 billion Dentists R3.1 billion Major flows (considerably >R1 billion) Minor flows (
Medical schemes are the largest financing intermediaries, accounting for nearly 46% of health care expenditure. Provincial health departments follow as the next largest intermediary, with 38% of all health care funds flowing via them. Households’ out-of-pocket payments directly to health care providers also account for a sizeable contribution of nearly 14% of all health care expenditure. Given that all expenditure data used in this analysis are based on recent audited reports (for public sector expenditure and for medical schemes), with the exception of estimated out-of-pocket payments, which relies on extrapolating from the somewhat dated (late 1990s) National Health Accounts, it is likely that out-of-pocket payments are underestimated. In relation to the original sources of finance, the vast majority of funds flowing through public sector financing intermediaries are funded through nationally collected general tax and other revenues. About R1 billion accrues from local government rates, taxes and other local revenues, while provincial revenues are insignificant. Most of the funds flowing through private intermediaries are attributable to households. In addition to their direct out-of-pocket payments, households contribute significant amounts to medical schemes. From the provider perspective, about 41% of all health care expenditure is attributable to public sector health services and administration and 59% on private sector services and administration. Key issues in the public health sector There was very limited real growth in public health sector expenditure in the decade after the first democratic elections in South Africa. Government health budgets were particularly constrained in the late 1990s, largely as a result of the Growth Employment and Redistribution (GEAR) macroeconomic policy of reducing government debt through constraints on government expenditure. Figure 2 illustrates that by early 2000, health care expenditure was increasing in real terms (after taking inflation into account), but it should be noted that these increases did not keep pace with population growth and as a result there was a small decline in real per capita expenditure. Increases in expenditure have been greater since 2002/03, and considerable in 2005/06 and 2006/07. This has resulted in a small real per capita increase in recent years. Although real annual increases of approximately 5% are promised, based on the Medium Term Expenditure Framework (MTEF) budget projections, these increases are barely keeping pace with population growth in South Africa. The bottom line is that public sector health care expenditure has been stagnant in real per capita terms for a considerable period of time, despite the fact that the demands on public sector services have increased dramatically due to the AIDS epidemic. Although total government expenditure has been constrained for the past decade, the health sector has been receiving a declining share of these resources. As indicated in Figure 3, the health sector’s share of total government expenditure has declined from 11.5% in 2000/01 to 10.9% Figure 2: Annual increase in real government health care expenditure (until 2005/06) and budgets (2006/07 onwards) 12 11.0 11.2 Percentage increase over previous year 10 8 6 4 2 0 2.2 2000/01 3.1 2.7 Source: National Treasury; 4,7,8,9,10 StatsSA, 2007. 11 6.7 5.1 2001/02 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 5.8 4.5 5.3 38
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South African Health Review 2007 LI
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Foreword The 12th edition of South
Page 7 and 8: 12 Traditional and Complementary Me
Page 9 and 10: Other Funders for the Health System
Page 11 and 12: This response raises a number of qu
Page 13 and 14: ucts are currently sold without reg
Page 15 and 16: The authors conclude that mandatory
Page 17 and 18: servicing and inappropriate hospita
Page 19 and 20: systems is also critical; worrying
Page 22 and 23: Authors: Laetitia Rispel i Geoffrey
Page 24 and 25: Stewardship: Protecting the Public
Page 36: Stewardship: Protecting the Public
Page 39 and 40: Introduction The importance of the
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Page 47 and 48: Year Act No. Title Objects 1997 90
Page 49 and 50: References 1 Department of Health.
Page 52: Purchasing of Health Care 33Pooling
Page 55: Introduction This chapter presents
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Page 65 and 66: References 1 McIntyre D, Thiede M,
Page 67 and 68: Policy and legislative framework In
Page 69 and 70: Medical schemes and revenue collect
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Page 75 and 76: Figure 2: Historic membership of me
Page 77 and 78: Solvency of the risk pools has beco
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Page 81 and 82: will retain that benefit for their
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Page 89 and 90: 37 Du Preez L. Registrar wants cura
Page 91 and 92: Introduction There has long been co
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Page 101 and 102: Revenue collection: Collecting orga
Page 103 and 104: Current debates A key area of ongoi
Page 105 and 106: References 1 Gluckman H. The Provis
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Authors: Patrick Matshidze i Lyn Ha
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Health Information Systems in the P
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Authors: Shahieda Adams i Reno Mora
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Health and Health Care in the Workp
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Author: Bettina Taylor i 8 Rationin
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Rationing of Medicines and Health C
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Health Care Delivery 139
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Authors: Haroon Wadee i Farzana Kha
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Human Resources for Health 9 Table
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Human Resources for Health 9 Table
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Human Resources for Health 9 source
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Human Resources for Health 9 Refere
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Authors: Shadrack Shuping i Sipho K
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Public-Private Partnerships 10 Alth
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Public-Private Partnerships 10 Tabl
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Public-Private Partnerships 10 Conc
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Authors: Thulani Matsebula i Michae
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Private Hospitals 11 Table 1: Priva
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Private Hospitals 11 Table 3: Distr
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Private Hospitals 11 Human resource
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Private Hospitals 11 Figure 3: 16 T
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Private Hospitals 11 Figure 4: 2 50
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Private Hospitals 11 Monitoring qua
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Private Hospitals 11 Recommendation
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Authors: Nceba Gqaleni i Indres Moo
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Traditional and Complementary Medic
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Authors: Myles Mander i Lungile Ntu
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Economics of the Traditional Medici
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Authors: Marion Stevens i Edina Sin
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HIV and AIDS, STI and TB in the Pri
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Indicators 213
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Authors: Candy Day i Andy Gray ii 1
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Health and Related Indicators 15
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Glossary AFA AIDS ALP AMA ANC ART A
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Glossary KZN LFS LIMS LP LPP MAR MC
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Glossary SAPC SARS SASIM SASSA SEP
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Index A Acts (Legislation and Bills
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Index N and O National Health Refer
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SAHR 2007 - Health Systems Trust

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