Paying for and receiving benefits from health services in South Africa

Is the health system equitable

Bibliographic Data

ID11490611
AuthorsJohn Ele-Ojo Ataguba (0000-0002-7746-3826, University of Cape Town, corresponding author), J E Ataguba, D Mcintyre (0000-0003-4892-4491), Di Mcintyre (0000-0001-6319-4111, University of Cape Town)
Year2012
Volume27
Issuesuppl 1
Pagesi35-i45
Publication date2012-03-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueHealth Policy and Planning (JOURNAL)
Journal identifiersISSN: 0268-1080 • E-ISSN: 1460-2237
PublisherOxford University Press (PUBLISHER • GB)
DOI10.1093/heapol/czs005
PMID22388498
OpenAlexW2153535381
LanguageEN
Citations received42
References cited19

There is a global challenge for health systems to ensure equity in both the delivery and financing of health care. However, many African countries still do not have equitable health systems. Traditionally, equity in the delivery and the financing of health care are assessed separately, in what may be termed 'partial' analyses. The current debate on countries moving toward universal health systems, however, requires a holistic understanding of equity in both the delivery and the financing of health care. The number of studies combining these aspects to date is limited, especially in Africa. An assessment of overall health system equity involves assessing health care financing in relation to the principles of contributing to financing according to ability to pay and benefiting from health services according to need for care. Currently South Africa is considering major health systems restructuring toward a universal system. This paper examines together, for both the public and the private sectors, equity in the delivery and financing of health care in South Africa. Using nationally representative datasets and standard methodologies for assessing progressivity in health care financing and benefit incidence, this paper reports an overall progressive financing system but a pro-rich distribution of health care benefits. The progressive financing system is driven mainly by progressive private medical schemes that cover a small portion of the population, mainly the rich. The distribution of health care benefits is not only pro-rich, but also not in line with the need for health care; richer groups receive a far greater share of service benefits within both public and private sectors despite having a relatively lower share of the ill-health burden. The importance of the findings for the design of a universal health system is discussed.

Business · Developing country · Economic growth · Economics · Environmental health · Health care · Health services · Population · Global Health Care Issues · Healthcare Policy and Management · Healthcare Systems and Reforms · Medicine · Health Policy