The Search for Cross Subsidy in Segmented Health Systems: Can Private Wards in Public Hospitals Secure Equity Gains?

Abstract

The commercialization of health care presents a series of challenges for policy-makers concerned about improving access to health care for poorer groups. Health care tends to be used most by the richer groups of a population, even though they, in general, have better health and are likely to live longer than poorer people. This pattern is only reinforced by the market mechanisms associated with commercialization, such as user fees or private insurance. These entrench ability to pay, rather than health need, as the primary criterion on which resources and health care use are distributed within a population, and so disadvantage the poor. In addition, those health system actors that benefit from commercialization (such as insurers, private providers, the richer users) are likely to oppose any actions that threaten their privileges.

We thank the people interviewed for the study that underpins this chapter, and the colleagues involved in that study (Duane Blaauw, Ermin Erasmus, Okore Okorafor and Michael Thiede). We are particularly grateful to Di McIntyre and Maureen Mackintosh for their support. Funding for this work was received from UNRISD, the Health Systems Trust of South Africa, and The Wellcome Trust. All views expressed in this chapter are the authors’ own.