Patients as consumers of health care in South Africa : the ethical and legal implications
Date
2013-03
Authors
Rowe, Kirsten
Moodley, Keymanthri
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Abstract
Background
South Africa currently has a pluralistic health care system with separate public and private
sectors. It is, however, moving towards a socialised model with the introduction of National
Health Insurance. The South African legislative environment has changed recently with the
promulgation of the Consumer Protection Act and proposed amendments to the National
Health Act. Patients can now be viewed as consumers from a legal perspective. This has
various implications for health care systems, health care providers and the doctor-patient
relationship.
Discussion
Calling a recipient of health care a ‘consumer’ as opposed to a ‘patient’ has distinct
connotations and may result in differential behaviour. Labels reflect the ideals of the context
in which they are used. Various models of the doctor-patient relationship exist and different
metaphors have been used to describe it. Increasingly there are third parties involved within
the doctor-patient relationship making it more difficult for the doctor to play the fiduciary
role. In certain parts of the world, there has been a shift from a traditional paternalist model to
a consumerist model. The ethical implications of the commodification of health care are
complex. As health care becomes a ‘product’ supplied by the health care ‘provider’, there is
the risk that doctors will replace professional ethics with those of the marketplace. Health
care is a universal human need and cannot be considered a mere commodity. In modern
medical ethics, great emphasis is placed on the principle of respect for patient autonomy.
Patients are now the ultimate decision-makers. The new Consumer Protection Act in South
Africa applies to consumers and patients alike. It enforces strict liability for harm caused by
goods and services. Everyone in the supply chain, including the doctor, can be held jointly
and severally liable. This may lead to enormous challenges in health care delivery.
Summary
Viewing patients as consumers may be detrimental to the doctor-patient relationship. While it
facilitates an emphasis on respect for patient autonomy, it inadvertently results in the commodification of health care. The new legislative environment in South Africa promotes
the protection of patient rights. It may, however, contribute to increased medical litigation.
Description
Publication of this article was funded by the Stellenbosch University Open Access Fund.
The original publication is available at http://www.biomedcentral.com/bmcmedethics
The original publication is available at http://www.biomedcentral.com/bmcmedethics
Keywords
Health care -- South Africa, Health care -- South Africa -- Law and legislation, Health care - South Africa - Ethical aspects
Citation
Rowe, K. & Moodley, K. 2013. Patients as consumers of health care in South Africa: the ethical and legal implications. BMC Medical Ethics, 14:15, doi:10.1186/1472-6939-14-15.