Distribution of Study Population

5.2.1 Hospital sample

As mentioned in Chapter 3, (Methodology) the researcher experienced major resistance in selecting the study population. Hospital managements from all private hospitals situated in the Western Cape Metropole admitting stroke patients, refused access to the hospital register book as well as to the patient medical folders. According to Dr. Lebo Manthata, the legal advisor of one of the three biggest private hospital groups (Health System Trust 2007), namely the Medi-Clinic group, the request was denied for reasons of confidentiality and the decision based on the National Health Act of 2003 section 16 (Manthata , email 24 May 2007).

The National Health Act, 2003 (Act 16 of 2003), provides a framework for a single health system for South Africa. It highlights the rights and responsibilities of health-providers and -users and ensures broader community participation in healthcare delivery from health facilities up to national level. The Act provides for the right to emergency medical treatment, a patient’s right to access to all information about his condition, the right to exercise informed consent, to participate in decisions regarding one’s health, to be

informed when participating in research, to confidentiality and access to health records as

well as the right to complain about service, and the right of health workers to be treated with respect.

Section 16 – Access to Health Records by Health Care Provider - states as follows:

“A health care provider may examine a user’s health records for the purposes of:

a.) treatment with the authorisation of the user; and

b.) study, teaching or research with the authorisation of the user, head of the health establishment concerned and the relevant health research ethics committee.

If the study, teaching or research contemplated in subsection b) reflects or obtains no information as to the identity of the user concerned, it is not necessary to obtain the authorisations mentioned in that subsection”.

Believing that the legal adviser acting for all Medi-Clinics misinterpreted Section 16 of the National Health Act of 2003, the researcher consulted an independent lawyer, who

confirmed this view. The lawyer also informed the researcher that she could obtain access to the register book only by challenging the medical legal adviser’s decision in court.

The Hospital Association of South Africa (HASA) (2005, p. 8) states that “the private health care sector is keen to partner the public sector to provide training and research to lessen the burden on the public sector”. It further reports that academic institutions should source information from providers to ensure appropriate training and research projects (HASA 2005). However, the table listing all costs spent in private hospitals in recent years such as taxes, salaries, purchases and training does not show any funds to have been spent on research projects. This as well as her own experience lead the researcher to query the credibility of HASA’s promises regarding the support of further research projects.

However, even despite these difficulties, all hospitals eligible for the study were represented in the study through doctor and/or patient participants.

5.2.2 Doctor population

Although 74% of identified doctors expressed their willingness to participate in the study, many were resistant. In her effort to engage with doctors, often the researcher got no further than the secretary’s desk. Most doctors cited time constraints and busy schedules as the reason for their unavailability. It is assumed that such resistance is against

research generally and not specifically this study, since doctors declined to participate

even before ascertaining what the study was about. This is regrettable since research is indispensable for the upgrading and improvement of health care.

5.2.3 Patient population

In sharp contrast to hospital administrators and doctors, only 6% of patients refused to participate in the study. It appears that the study population was a selection of middle and upper income class patients (see 5.4 Demographic profile and socio economic status of patients). Statistics South Africa 2006 reports that only 48.4% make up the middle and upper income class in South Africa ( The Media Magazine 2009) and only seven million people in South Africa make use of private health care facilities (Burger 2007). It should thus be apparent that the sample group for this study is a minority group.

5.2.4 Relevance of the study

Despite these obstacles as well as the opinion of a leading stroke expert discussed under the pilot study in 3.9, the researcher continues to be confident in the relevance of this study. First, the research has been conducted in the private health care sector, where greater funds ensure the provision of a quality service. Because these patients pay for themselves (either directly or through a Medical Aid), they expect and often demand impeccable treatment. It is therefore critical to ascertain whether the private sector is able to deliver what the paying customer expects of it. Second, the private sector represents the “golden standard” which the entire South African health care system should strive to uphold (Health System Trust 2007). In 2004 the Minister of Health highlighted the fact that the private health sector has a significant role to play in the health system of South Africa (Health System Trust 2007). That is another important reason for constantly reassessing the service delivered. Third, the majority of medical practitioners (62%) and particularly specialists (75%) practising in South Africa work in the private sector (Health System Trust 2007). Since much of the study focuses on doctors’ practices and opinions regarding various aspects of stroke management, the private sector is the optimal place to perform a study of this nature. Finally, many literature reviews (Rudd & Matchar 2004; Forster, Young, Patterson, Wanklyn, Smith, Murray, Wild, Bogle, Lowson 2009) point out that there is an enormous need for further research on stroke issues. Any valid and reliable research project on stroke-related issues will contribute to the endless battle against what remains one of the leading causes of disability - both nationally and internationally.