Redressing dis-advantage: Promoting vertical equity within South Africa
Redressing dis-advantage: Promoting vertical equity within South Africa
复制标题
DOI：
10.1023/a:1009483700049
复制
发表时间：
2000-09-01
影响因子：
1.9
通讯作者：
Gilson, L
中科院分区：
文献类型：
--
作者：
McIntyre, D;Gilson, L
本文是首次尝试将纵向公平原则应用于南非卫生部门。纵向公平办法承认不同群体有不同的起点，因此需要区别对待，这似乎为考虑如何最好地纠正南非在种族隔离后存在的巨大不平等提供了适当的基础。纵向公平原则适用于批判性地分析最近的政策行动的两个领域，这两个领域与南非卫生部门的公平特别相关，即公私部门的交叉补贴和各省之间的政府资源分配。尽管有纠正历史不平等的坚定政治承诺，但从纵向公平透镜来看，政府最近在这两个领域采取的政策行动似乎没有达到理想的目标。特别是，自1994年第一次民主选举以来的政策几乎没有减少政府对私营保健部门的补贴，而私营保健部门只为少数人口服务。此外，最近关于社会健康保险的建议将允许高收入者和低收入者之间的最低限度交叉补贴，并不能充分纠正目前不公平的公私交叉补贴。关于政府资源在各省之间的分配，纵向公平办法表明，历史上最不发达的省份对政府资源的要求甚至比财政部制定的现行公式所反映的要大。本文还认为，在确定什么是不利因素在南非的情况下，参与社会观点的潜在好处，以确定那些谁应该得到优先资源分配的决定。报告最后审查了可采取的一些实际步骤，以便将纵向公平原则纳入政策行动。
This paper represents the first attempt to apply vertical equity principles to the South African health sector. A vertical equity approach, which recognises that different groups have different starting points and therefore require differential treatment, appears to offer an appropriate basis for considering how best to redress the vast inequities which exist in post-Apartheid South Africa. Vertical equity principles are applied in critically analysing two areas of recent policy action which are particularly relevant to health sector equity in South Africa, namely public-private sector cross-subsidies and the allocation of government resources between provinces. Despite a strong political commitment to redressing historical inequities, recent government policy actions in these two areas appear to fall short of desirable goals when viewed through a vertical equity lens. In particular, policies since the first democratic elections in 1994 have done little to reduce the extent of government subsidies to the private health sector, which serves a minority of the population. In addition, recent proposals for a Social Health Insurance will allow minimal cross-subsidies between high- and low-income earners and would not adequately redress the currently inequitable public-private cross-subsidies. With respect to the allocation of government resources between provinces, a vertical equity approach would suggest that the most historically dis-advantaged provinces have an even greater claim on government resources than reflected in the current formula, as developed by the Department of Finance. This paper also considers the potential benefits of engaging with societal views in determining what constitutes dis-advantage in the South African context, in order to identify those who should receive priority in resource allocation decisions. It concludes with a review of a number of practical steps that can be taken to draw vertical equity principles into policy action.