Caring for our patients - fact or legend - an economic view.

THE debate on economic aspects o f health care is beset with the conflict of balancing supply and de­ m and, o f offering a less adequate service to all people, or a maximal service to relatively few. Somewhere along this continuum is an area o f optimal service; providing a range o f services which the country can afford , the point at which we can best cut our coat to fit our cloth. It is over to the health professionals to make the best use of the economic input, they are the vital manpower elements and the utilisation o f resources is in their hands. Can there be any blue print or prescribed answers? for these are surely problems which each country must see against its own sociological background and varying health needs yet being ever mindful that needs and expectations are not always synonomous. The resources are limited no m atter how large the health budget may sound it is still necessary to make choices in the dilution o f services and compromises bet­ ween ideals and possibilities in realistic economic and social terms. In this country the sources of such funds for services may arise in direct payments by the individual, from employer-employee schemes, insurances, benefits or aids, and State funds to which the population contribute directly or indirectly. Various criteria as to the effectiveness of our pro­ grammes have been suggested. M echanic(5) for one, sites such factors as m ortality and m orbidity rates, costs, quality of services and controls, but these are doubtful indicators, for medical care is a highly intangible pro­ duct, not as much regulated by the health or sickness of the population as by the level o f provision of the ser­ vices. C onsultations and investigations are limited where the services are scarce and expensive, yet when readily available it is com m on for the number of visits to increase — and patients present with less serious con­ ditions. W ithin this general statem ent there is a controversial thought that where the population is sparse a basic essential service is offered. This often better meets the needs o f the m ajority o f the com m unity a simpler cost effective service. (The hospital costs in S.A. range from ± R8,00 to R82,00 per patient per day)(4). Inevitably the doctors have a trem endous impact on the type o f service, the levels of specialisation, the equipment which can be dem anded the level o f medical technology. Their practice influences the num ber of beds and the average length of stay in hospital. (Direc­ to r o f H ospital Services T .V .L . reports length of patien t’s stay as Whites 5,8; non-Whites 8,5 days)(8).