Investigating the affordability of key health services in South Africa
Date
2013
Journal Title
Journal ISSN
Volume Title
Publisher
Elsevier
Abstract
This paper considers the affordability of using public sector health services for three tracer conditions
(obstetric care, tuberculosis treatment and antiretroviral treatment for HIV-positive people), based on
research undertaken in two urban and two rural sites in South Africa. We understand affordability as the
‘degree of fit’ between the costs of seeking health care and a household’s ability-to-pay. Exit interviews
were conducted with over 300 patients for each of the three tracer conditions in each of the four sites
(i.e. a total sample of over 3600). Total direct costs for the service used at the time of the interview, as
well as other health related costs incurred during the preceding month either for self-care or the use of
plural providers were assessed, as were a range of indicators of ability-to-pay. The percentage of
households incurring direct costs exceeding 10% of household consumption expenditure and those
borrowing money or selling assets as a mechanism for coping with the burden of direct costs were
calculated. Logistic regressions were also conducted to identify factors that were significantly associated
with these indicators of affordability. There were significant differences in affordability between rural
and urban sites; costs were higher, ability-to-pay was lower and there was a greater proportion of
households selling assets or borrowing money in rural areas. There were also significant differences
across tracers, with a higher percentage of households receiving tuberculosis and antiretroviral treatment
borrowing money or selling assets than those using obstetric services. As these conditions require
expenses to be incurred on an ongoing basis, the sustainability of such coping strategies is questionable.
Policy makers need to explore how to reduce direct costs for users of these key health services in the
context of the particular characteristics of different treatment types. Affordability needs to be considered
in relation to the dynamic aspects of the costs of treating different conditions and the timing of treatment
in relation to diagnosis. The frequently high transport costs associated with treatments involving
multiple consultations can be addressed by initiatives that provide close-to-client services and subsidised
patient transport for referrals.
Description
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Journal Article (peer-reviewed)
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Text
Keywords
AFFORDABILITY, ACCESS, OBSTETRIC SERVICES, TUBERCULOSIS, ANTIRETROVIRAL TREATMENT, SERVICE COSTS, ABILITY TO PAY, SOUTH AFRICA, HEALTH SERVICES, ACCESS TO HEALTH CARE, HEALTH EXPENDITURE, TUBERCULOSIS, ANTIRETROVIRAL THERAPY, HIGHLY ACTIVE, HIV, AIDS
Citation
Cleary, S., Birch, S., Chimbindi, N., Silal, S., & McIntyre, D. (2013). Investigating the affordability of key health services in South Africa. Social Science & Medicine, 80, 37-46. http://dx.doi.org/10.1016/j.socscimed.2012.11.035