Despite the postapartheid health system development program of district-based PHC developed through the legacy of the progressive public health movement in South Africa and enshrined in principle in the 1995 White Paper on the transformation of the Health system, and a specific policy of shifting from curative to preventative care, this study of three provincial hospitals found disparities between them that favored the more specialized hospitals. These disparities also correlated with neoliberal health policy principles: the private/public partnership that shifts public health spending to the private sector and efforts to recoup Medical Aide funds in the private sector led to dynamism and system support in the better resourced settings.