Private or public: Which hospital is right for you or your family?

Healthcare is the perhaps the most important thing to consider when it comes to family or loved ones. Yet, to achieve that requires considerations of finances, because nothing is free. To be able to manage expectations and treatments requires a realistic engagement with what we can afford and what is necessary to help ourselves and our loved ones. There are numerous aspects to consider therefore. Let’s examine the most important questions to ask if you are caring for loved ones – whether elderly parents or young children.

Diagnosis

The most important first step is finding out what it is a loved one is suffering from. This requires diagnosis. A GP might be a good first step, but there’s a chance the situation requires immediate intervention. If you’re not medically trained, you will have no way of really knowing what it requires – even then, doctors need expensive equipment and time to come to a conclusion about the intervention required. However, if the pain is not particularly severe, that is usually a sign you can visit your GP. The GP can then recommend further tests or admission.

Dr Larry H. Killebrew writes: “You should go to the emergency room (ER) if you have symptoms so intense that you can’t wait for an appointment with your regular healthcare professional or if you have a medical problem that is out of the ordinary. In addition, you should call [emergency services] immediately if you experience any of these conditions:

  • Chest pain or signs of heart attack
  • Open fractures
  • Severe bleeding
  • Head injury or other major trauma
  • Weakness or numbness on one side
  • Loss of consciousness
  • Severe abdominal pain
  • Uncontrolled pain or bleeding
  • Poisoning”

Each is an indication of something quite serious that requires intervention as soon as possible.

Finances

Many people have medical coverage of some kind. Yet that doesn’t stop them looking for a private hospitals at an affordable rate. It’s important to know precisely what is covered by your plan, assuming you have one. There are all sorts of factors, particularly given that different insurances cover different elements. It’s important to know what you’re talking about. As Health News Today summarises:

“Health insurance is a type of insurance coverage that covers the cost of an insured individual’s medical and surgical expenses. Depending on the type of health insurance coverage, either the insured pays costs out-of-pocket and is then reimbursed, or the insurer makes payments directly to the provider. In health insurance terminology, the “provider” is a clinic, hospital, doctor, laboratory, health care practitioner, or pharmacy. The “insured” is the owner of the health insurance policy; the person with the health insurance coverage. In countries without universal health care coverage, such as the USA, health insurance is commonly included in employer benefit packages and seen as an employment perk.”

It is of course possible to pay cash. Sometimes people simply opt out due to their age and health status. These are sometimes referred to as the “young invincibles”. As Kaiser Health News points out: “A subset of voluntarily uninsured people are young and healthy, who may believe they don’t need health coverage or that it’s a bad deal because of the low probability that they’ll use it.”

Their reasoning is that if they don’t have chronic conditions or require expensive surgery, there’s no point in having coverage. They’ll just be giving money away that, basically, someone else benefits off. What’s the point of that?

Yet, given that people are mortal and you may have loved ones, this may not be a wise option. It’s important to get full details on your insurance – or at least the best insurance – before discarding the idea altogether. It could also mean you simply find compromises, such as options for a hospital plan instead of full coverage. Sometimes, however, you might find yourself with a chronic condition, requiring regular medical intervention. This might mean paying out money every time is worse – and if you’re paying money regularly, why not pay toward an insurance plan that suits your needs?

The local situation

In South Africa, as elsewhere, healthcare is a complicated issue. In a recent report, some stunning findings related to private and public care came about. Dr Jaco van Zyl, Medical Executive at Cipla SA, told Business Tech:

“In South Africa, healthcare services and products are provided by parallel running public and private health care systems. Even though private health care is only available to a very small section of the South African society (16.3%), it still accounts for a disproportionate 52% of the total expenditure on health care.”

There are also a range of concerns about the National Health Insurance (NHI). The NHI is designed to facilitate universal, quality healthcare for all South Africans but the reality could do the opposite and create an unstable future. As vocal critic Anthea Jeffery argues:

“The White Paper … assumes that all private health practitioners and facilities can successfully be drawn into the state-controlled NHI. However, it proposes paying the same capitation-based fees to both public and private practitioners, even though the latter have overhead expenses to meet which the former do not. Experience with the Compensation Fund also indicates that practitioners could wait months or years for the NHI Fund to reimburse them. This could encourage major emigration among professionals already in short supply.”

Given the necessary infrastructure needed to run such a massive operation, many are not hopeful of the project succeeding. No one wants the country to be without healthcare, but there are concerns that Jeffery and others points to that could undermine health insurance plans – that leaves more people in the hands of understaffed, underpaid facilities that don’t see anyone as priority due to a lack of support.

Though things seem to be improving, there is still a long way to go before South Africa has any claim toward universal, quality health care.