There is evidence that it is common practise amongst the poorer groups in the country to use private primary health care. Data are discussed to provide some perspective on the magnitude of this utilisation pattern. The chapter explores why low income groups pay out of pocket for the services of private providers, even where the care is often worse than in the public sector.
Themes from ten focus groups in Eastern and Western Cape are discussed. The essence of the themes is the perception that public sector treatment is not effective, that clinics cannot treat all illnesses and that the way that patients are treated in the public sector is unacceptable. People believe that they receive better quality care from private providers.
The chapter concludes that most patients are keen to use the private sector and that private practitioners play an important role in PHC delivery in many small towns. It is clear that the relationship between public and private services is intricate. There is a need to educate the public about the range of services that is available at public sector clinics, to overcome the incentives for private doctors to convince patients that private services are better, to ensure that politeness and respect are shown to patients in public sector clinics, and to establish acceptable working relationships between the public and private sectors (through contractual mechanisms, regulation, elimination of perverse incentives and perhaps accreditation of private providers).
In: South African Health Review 1999, Health Systems Trust, chp 8.