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Who benefits from health services in South Africa?

Published online by Cambridge University Press:  02 April 2012

John Ele-Ojo Ataguba  and
Di McIntyre
John Ele-Ojo Ataguba*
Affiliation:
Lecturer, Health Economics Unit, University of Cape Town, Cape Town, South Africa
Di McIntyre
Affiliation:
South African Research Chair in ‘Health and Wealth’, Health Economics Unit, University of Cape Town, Cape Town, South Africa
*
*Correspondence to: John Ele-Ojo Ataguba, Health Economics Unit, School of Public Health and Family Medicine, Falmouth Annex, Medical Campus, Observatory, Cape Town, 7925, South Africa. Email: John.Ataguba@uct.ac.za
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Abstract

South Africa is considering major health service restructuring to move towards a universal system. This calls for understanding the challenges in the existing health system. The paper, therefore, comprehensively evaluates an aspect of current health system performance – the benefit incidence of health services. It seeks to understand how the benefits from using health services in South Africa are currently distributed across socio-economic groups. Using a nationally representative household survey, results show that lower socio-economic groups benefit less than their richer counterparts from both public and private sector health services, and that the distribution of service benefits is not in line with their need for care.

Type
Articles
Information
Health Economics, Policy and Law , Volume 8 , Issue 1 , January 2013 , pp. 21 - 46
Copyright
Copyright © Cambridge University Press 2012

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References

Adam, T.Evans, D. B. (2006), ‘Determinants of variation in the cost of inpatient stays versus outpatient visits in hospitals: a multi-country analysis’, Social Science & Medicine, 63(2006): 1700–1710.CrossRefGoogle ScholarPubMed
Adbelkrim, A.Duclos, J.-Y. (2007), DASP: Distributive Analysis Stata Package, Lava, Canada: PEP, CIRPÉE and World Bank, Université Laval.Google Scholar
Ataguba, J. E. (forthcoming). Estimating cost ratios and unit costs of public hospital care in South Africa revisited. African Journal of Health Economics.Google Scholar
Björn, E. (2007), ‘The impact of health insurance on outpatient utilization and expenditure: evidence from one middle-income country using national household survey data’, Health Research Policy and Systems, 5(6): 1–15.Google Scholar
Borghi, J., Ataguba, J., Mtei, G., Akazili, J., Meheus, F., Rehnberg, C.McIntyre, D. (2009), ‘Methodological Challenges in Evaluating Health Care Financing Equity in Data-poor Contexts: Lessons from Ghana, South Africa and Tanzania’, in D. Chernichovsky and K. Hanson (eds), Advances in Health Economics and Health Services Research, Bingley, UK: Emerald Group Publishing Limited.Google Scholar
Bradshaw, D.Steyn, K. (eds) (2001), Poverty and Chronic Diseases in South Africa, Cape Town: South African Medical Research Council.Google Scholar
Briet, O. J. T. (2002), ‘A simple method for calculating mosquito mortality rates, correcting for seasonal variations in recruitment’, Medical and Veterinary Entomology, 16(1): 22–27.Google Scholar
Castro-Leal, F. 1996. ‘The Impact of Public Health Spending on Poverty and Inequality in South Africa’, PSP Discussion Paper Series 102, Washington, DC: World Bank, Poverty and Social Policy Department.Google Scholar
Castro-Leal, F., Dayton, J., Demery, L.Mehra, K. (1999), ‘Public social spending in Africa: do the poor benefit?’, The World Bank Research Observer, 14(1): 49–72.Google Scholar
Castro-Leal, F., Dayton, J., Demery, L.Mehra, K. (2000), ‘Public spending on health care in Africa: do the poor benefit?’, Bulletin of the World Health Organization, 78(1): 66–74.Google ScholarPubMed
Council for Medical Schemes (2009), Annual Report, 2008–9, Pretoria: Council for Medical Schemes.Google Scholar
Demery, L. (2000), Benefit Incidence: A Practitioner's Guide, Washington, DC: The World Bank (Africa Region, Poverty and Social Development Group).Google Scholar
Department of Health (2011), National Health Act (61/2003): Policy on National Health Insurance. Government Gazette 34523, Pretoria: Department of Health.Google Scholar
Doolan, K., Ehrlich, R.Myer, L. (2007), ‘Experience of violence and socioeconomic position in South Africa: a national study’, PloS One, 2(12): e1290.Google Scholar
EQUITAP (2005), Who Benefits From Public Spending on Health Care in Asia?, Colombo: Institute of Policy Studies.Google Scholar
Harling, G., Ehrlich, R.Myer, L. (2008), ‘The social epidemiology of tuberculosis in South Africa: a multilevel analysis’, Social Science & Medicine, 66(2): 492–505.Google Scholar
Harris, B., Goudge, J., Ataguba, J. E., McIntyre, D., Nxumalo, N., Jikwana, S.Chersich, M. (2011), ‘Inequities in access to health care in South Africa’, Journal of Public Health Policy, 32(Supplement 1): S102–S123.Google Scholar
Hart, T. (1971), ‘The inverse care law’, The Lancet, 297(7696): 405–412.CrossRefGoogle Scholar
Jolly, R. (1988), ‘A UNICEF Perspective on the Effects of Economic Crises and What Can Be Done’, in D. E. Bell and M. Reich (eds), Health, Nutrition and Economic Crises: Approaches to Policy in the Third World, Dover, MA, USA: Auburn House.Google Scholar
Kakwani, N., Wagstaff, A.van Doorslaer, E. (1997), ‘Socioeconomic inequalities in health: measurement, computation, and statistical inference’, Journal of Econometrics, 77(1): 87–103.Google Scholar
Lerman, R. I.Yitzhaki, S. (1989), ‘Improving the accuracy of estimates of Gini coefficients’, Journal of Econometrics, 42(1): 43–47.CrossRefGoogle Scholar
Lombard, C., Stegman, J.Barnard, A. (1991), ‘Modelling net expenditure of hospitals in the Cape Province’, South African Medical Journal, 80: 508–510.Google ScholarPubMed
Myer, L., Stein, D. J., Grimsrud, A., Seedat, S.Williams, D. R. (2008), ‘Social determinants of psychological distress in a nationally-representative sample of South African adults’, Social Science & Medicine, 66(8): 1828–1840.Google Scholar
National Treasury (2009), Provincial Budgets and Expenditure Review: 2005/06–2011/12, Pretoria: National Treasury.Google Scholar
O'Donnell, O., Van Doorslaer, E., Wagstaff, A.Lindelow, M. (2008), Analyzing Health Equity Using Household Survey Data: A Guide to Techniques and Their Implementation, Washington DC: World Bank Publications.Google Scholar
Pearson, M. (2002), Benefit Incidence Analysis: How Can it Contribute to Our Understanding of Health Systems Performance, London: DFID Health Systems Resource Center.Google Scholar
Sarma, S.Simpson, W. (2006), ‘A microeconometric analysis of Canadian health care utilization’, Health Economics, 15(3): 219–239.CrossRefGoogle ScholarPubMed
Sauerborn, R., Nougtara, A., Hien, M.Diesfeld, H. J. (1996), ‘Seasonal variations of household costs of illness in Burkina Faso’, Social Science & Medicine, 43(3): 281–290.CrossRefGoogle ScholarPubMed
van den Heever, A. (2009), ‘Fiscal incidence analysis: Healthcare’, Stellenbosch Economic Working Papers: 12/09, Stellenbosch: Bureau for Economic Research, Stellenbosch University.Google Scholar
van der Berg, S. (2000), ‘An Analysis of Fiscal Incidence of Social Spending in South Africa, 1993–97’, Report to the Department of Finance, Pretoria: Department of Finance.Google Scholar
van der Berg, S (2009), ‘Fiscal Incidence of Social Spending in South Africa, 2006’, Report to the Department of Finance. Pretoria: Department of Finance.Google Scholar
van Doorslaer, E.Gerdtham, U. G. (2003), ‘Does inequality in self-assessed health predict inequality in survival by income? Evidence from Swedish data’, Social Science & Medicine, 57(9): 1621–1629.CrossRefGoogle ScholarPubMed
Wagstaff, A.van Doorslaer, E. (1993), ‘Equity in the Finance and Delivery of Health Care: Concepts and Definitions’, in E. van Doorslaer and A. Wagstaff (eds), Equity in the Finance and Delivery of Health Care: An International Perspective, New York: Oxford University Press.Google Scholar
World Health Organization (2005), ‘Sustainable Health Financing, Universal Coverage and Social Health Insurance’, World Health Assembly resolution WHA58.33, Geneva: World Health Organization.Google Scholar
World Health Organization (2010), World Health Report 2010: Health Systems Financing: the Path to Universal Coverage, World Health Report, Geneva: World Health Organization.Google Scholar
Zere, E.McIntyre, D. (2003), ‘Inequities in under-five child malnutrition in South Africa’, International Journal for Equity in Health, 2(1): e7.Google Scholar