Attitudes of private general practitioners towards health care in South Africa

• Published in: South African medical journal Vol. 83; no. 11; pp. 827 - 833
• Main Authors: VOLMINK, J. A, METCALF, C. A, ZWARENSTEIN, M, HEATH, S, LAUBSCHER, J. A
• Format: Journal Article
• Language: English
• Published: Pinelands Medical Association of South Africa 01-11-1993
• Subjects: Adult; Aged; Attitude of Health Personnel; Biological and medical sciences; Delivery of Health Care - economics; Female; Financing, Organized; Health and social institutions; Health participants; Humans; Male; Medical sciences; Middle Aged; Physicians, Family; Professional Competence; Public health. Hygiene; Public health. Hygiene-occupational medicine; Reimbursement Mechanisms; South Africa; Surveys and Questionnaires; Tropical medicine; South Africa; Africa; Health center; Questionnaire; Attitude; General practitioner; Physician; Occupational training; Public health
• ISSN: 0256-9574

The need for health care reform in South Africa is acknowledged by the government as well as by the non-governmental health sector. There is, however, no unanimity regarding the nature of the envisaged reform. A country-wide postal survey of 700 private sector general practitioners (GPs) from a commercial database of 5,000 was conducted to explore attitudes towards health care. A response rate of 67.4% was obtained. Respondents were mostly male (92%) and urban-based (64%). The median age was 42 years. Most respondents: (i) believed health care to be a right for all citizens; (ii) favoured private or a combination of private and public funding mechanisms with fee-for-service arrangements; (iii) opposed cost-containment measures imposed by funders, e.g. medical aids; and (iv) believed doctors should be responsible for primary care in under-served areas. After sex, age, location (urban versus rural) and GP postgraduate qualification had been controlled for by means of logistic regression techniques, the university at which a respondent's basic degree was obtained emerged as the only independent predictor of attitudes to the following: (i) comprehensive care as a right; (ii) integration of the public and private sectors; (iii) preferred funding source for a future health system; and (iv) preference for fee-for-service remuneration. Both university and gender independently predicted attitudes on GPs' income. Graduates of white, Afrikaans-medium universities were strongly in favour of a privately funded and fee-for-service orientated system. Those who qualified at black universities, on the other hand, favoured public funding with less emphasison fee-for-service.