| Popis: |
Health care is an unusual issue for collective bargaining. It was forced onto the bargaining agendas of some unions in South Africa by a combination of failing and racially discriminatory public sector health care and inflationary private sector health care. Sick Funds arc industry-specific health insurance schemes in South Africa, which give their members access to specific and limited private sector medical benefits, sick pay and sometimes maternity pay. They are jointly funded and managed by employer and trade union representatives, through the collective bargaining structures of Industrial Councils. This research, a case study of three Sick Funds for clothing and leather workers, and a more elaborate health insurance scheme for workers in the public transport sector, examines the process of restructuring the content and delivery of medical services, and the management of the schemes. This is done in the context of dramatic political developments on the national stage from 1992, through the period of South Africa’s first democratic election in 1994, to 1996. The membership of the Sick Funds was highly homogeneous, comprising low-paid black workers, predominantly women. Recommendations for reform and expansion of the Sick Funds focused particularly on a shift from reliance on contracted doctors to the establishment of a network of neighbourhood-based worker health centres, with medical staff employed directly by the Funds. The other major recommendation was the extension of benefits to dependants for the first time. The fourth case highlights the difficult process of transforming a much more elaborate scheme in a complex multi-union situation in a large publicly owned company facing privatisation. Membership of the transport scheme was much more heterogeneous: overwhelmingly male and predominantly black, there was a substantial minority of white members and a far greater range of income. The argument is that under certain conditions, trade unions can transform existing arrangements for health care for their members, imprinting a trade union character on both the services and their management. The projects achieved their aims to varying degrees. The thesis explores the conditions for success and failure. The studies do not produce a model, which can be extracted from its context and applied generally. The argument is that struggle is part of the model. Nevertheless, these projects raise crucial questions about proposals for mandatory social health insurance and have important implications for the national project of restructuring the health system for equity. |
