The Impact of Health Insurance on Health-care Utilisation and Out-of-Pocket Payments in South Africa

Ataguba, John E.; Goudge, Jane

doi:10.1057/gpp.2012.35

Cited by 33 publications

(34 citation statements)

References 51 publications

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Section: Introductionmentioning

confidence: 99%

“…Supply- and demand-side factors affect the utilization of health care services [ 1 ]. In some circumstances, the seeking of health care is mainly explained by the capacity to pay rather than the need for health care [ 1 ]. The reduction of social inequalities and the fight against poverty requires everyone to be able to access quality health services without incurring large financial burdens [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

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Does the type of health insurance enrollment affect provider choice, utilization and health care expenditures?

Atake

2020

BMC Health Serv Res

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Background Two of the objectives of Universal Health Coverage are equity in access to health services and protection from financial risks. This paper seeks to examine whether the type of health insurance enrollment affects the utilization of health services, choice of provider and financial protection of households in Togo. Methods Data were obtained from a cross-sectional, representative household survey involving 1180 insured households that had reported either illness in the household in the 4 weeks preceding the survey or hospitalization in the 12 months preceding the survey. A nested logit model was used to account for the utilization of health services and provider choice, and methods of assessing catastrophic health care expenditures were used to analyze the level of household financial protection. Results Policyholders of private health insurance use private health care facilities more than policyholders of public health insurance. The main reasons for not using health centers among households with public insurance were out-of-pocket payments (49.19%), waiting time (36.80%), and distance to the nearest health center (36.76%). Furthermore, on average, households with public insurance spent a higher proportion of their total monthly nonfood expenditures on health care than those with private insurance. We find that the type of insurance, share of expenditures allocated to food, distance to the nearest health center, and waiting time significantly impact the choice of provider. Regardless of the type of health insurance, elderly individuals avoid using private health centers and referral hospitals due to the high cost. Conclusion We found that a multiple health insurance system results in a multilevel health system that is not equitable for everyone. The capacity of the health insurance system to provide equitable health care services and protect its members from catastrophic health care expenditures should be at the core of health care reform. This study recommends raising awareness of the criteria for the reimbursement of medical procedures within the framework of public insurance and promoting specific health insurance mechanisms for elderly individuals. Careful attention should be paid to ensuring universal education and literacy as a means of improving access to and the use of health care.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Does the type of health insurance enrollment affect provider choice, utilization and health care expenditures?

Atake

2020

BMC Health Serv Res

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“…South Africa has a relatively low burden of health financing through OOP payments in that only 12% of total health care expenditure is financed through OOP payments, which is lower than in many other lowand middle-income countries. However, it is important to avoid increasing the burden of OOP payments, either in the form of user fees at public sector facilities or in the form of co-payments by the insured (Ataguba and Goudge, 2012). This is because about 60% of OOP payments are attributable to medical scheme members at present, due to co-payments on certain benefits (such as acute medicine prescriptions) and for services that are either not covered by medical schemes or where annual benefits are so limited that they are exhausted rapidly.…”

Section: Discussionmentioning

confidence: 99%

The incidence of health financing in South Africa: findings from a recent data set

Ataguba

McIntyre

2017

HEPL

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There is an international call for countries to ensure universal health coverage. This call has been embraced in South Africa (SA) in the form of a National Health Insurance (NHI). This is expected to be financed through general tax revenue with the possibility of additional earmarked taxes including a surcharge on personal income and/or a payroll tax for employers. Currently, health services are financed in SA through allocations from general tax revenue, direct out-of-pocket payments, and contributions to medical scheme. This paper uses the most recent data set to assess the progressivity of each health financing mechanism and overall financing system in SA. Applying standard and innovative methodologies for assessing progressivity, the study finds that general taxes and medical scheme contributions remain progressive, and direct out-of-pocket payments and indirect taxes are regressive. However, private health insurance contributions, across only the insured, are regressive. The policy implications of these findings are discussed in the context of the NHI.

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“…With debilitating or persistent symptoms, women eventually presented to a private or public clinic for advice (where we met them). Choice of clinic depended on income and whether or not they had private health insurance, the latter factor determining the quality of care in the private sector that was available to employed middle class patients, compared with resort to the public sector by the majority of the population, most on a low income or unemployed (Ataguba & Goudge, 2012;Fusheini et al, 2018;Girdwood et al, 2019). Those without health insurance or sufficient money to pay out-of-pocket presented to a community health clinic or hospital outpatient department, often leaving home early in the morning to be in a queue by eight am with hope of being seen by midday (see, for example, Sastry et al, 2015).…”

Section: Methodsmentioning

confidence: 99%

Prescribing, care and resistance: antibiotic use in urban South Africa

Manderson

2020

Humanit Soc Sci Commun

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patients' and providers' expectations of transactions in health services converge in consultations for acute respiratory tract infections with the prescription of antibiotics. To explore this, a qualitative study was undertaken at community health centres and private general practice surgeries in four areas of metropolitan South Africa, selected purposively to allow for wide variability in terms of socioeconomic status and ethnicities/race of patient populations. With permission, clinic waiting rooms and patient/provider consultations were observed, and 65 in-depth interviews were undertaken with patients or parents or guardians presenting with children. These interviews were complemented by interviews with health providers (26) and key informants (12). All interviews were recorded, transcribed and imported into NVivo 12 for management. Data were open coded, with individual interviews and observational data compared and contrasted to highlight understandings and practices of care, antibiotic precription and use. In this article, I illustrate how the social context of patient and provider interactions in primary care settings influenced treatment. Community health centres and clinics were (and are) stretched for resources, and there were long wait times before patients can be seen; consultations were brief, with relatively little verbal exchange on the management of coughs and colds. Providers' decisions of treatment were informed by clinical assessment, concern about the risks of bacterial infection, and perceptions of patient ability to seek further care and advice-a mix of clinical and social considerations. While patients did not always request antibiotics and were willing to discuss how to manage acute conditions without them, doctors in private practice still often provided a prescription, sometimes postdated to discourage use but with the option for medication if needed. In the public sector, the provision of a prescription also reflected clinicans' appreciation of economic constraint and vulnerability. As described, patients understood principles of the appropriate use and storage of antibiotics, in contrast to other medications, and they were largely open to discussions with their providers about whether or not to use an antibiotic. However, their own and their prescribing providers had varied understandings of the mechanisms of resistance to antibiotics and so the need for antibiotic stewardship.

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The Impact of Health Insurance on Health-care Utilisation and Out-of-Pocket Payments in South Africa

Cited by 33 publications

References 51 publications

Does the type of health insurance enrollment affect provider choice, utilization and health care expenditures?

Does the type of health insurance enrollment affect provider choice, utilization and health care expenditures?

The incidence of health financing in South Africa: findings from a recent data set

Prescribing, care and resistance: antibiotic use in urban South Africa

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