Did South Africans see private and state hospitals differently?

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South Africa’s planned National Health Insurance system aims to transform and integrate public and private healthcare services as part of wider efforts toward universal health coverage. The authors say quality, acceptable care is crucial to public support for these changes. They explored public perceptions of private and state hospitals in South Africa, seeking insights that could guide public-sector improvements and strengthen confidence and trust in health system reforms.

The study held eight qualitative focus group discussions with 54 participants, delineated by race—Black and white South Africans—and by recent or indirect experience of public and private hospital services. Discussions explored quality of care, cleanliness, satisfaction, staff attitudes, the origins of perceptions and suggestions for improving state hospitals.

Thematic content analysis found an almost automatic initial perception that private hospitals were “good” and state hospitals “bad.” Further exploration revealed more nuanced views about the costs and affordability of both types of hospital, and trust in and acceptability of health services.

The authors conclude that health systems are also human systems, with personal encounters at their heart. They call for policy emphasis on building a culture of person-centred care in the public sector so it can serve people and society acceptably.