Investigating the affordability of key health services in South Africa

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dc.contributor.authorCleary, Susan
dc.contributor.authorBirch, Steve
dc.contributor.authorChimbindi, Natsayi
dc.contributor.authorSilal, Sheetal
dc.contributor.authorMcIntyre, Di
dc.date.accessioned2015-03-05T16:24:52Z
dc.date.available2015-03-05T16:24:52Z
dc.date.copyright2013
dc.date.issued2013
dc.description.abstractThis 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.en
dc.formatTexten
dc.format.extent1 digital file (p. 37-46)en
dc.format.mimetypeapplication/pdf
dc.identifier.citationCleary, 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.2012.11.035en
dc.identifier.issn0277-9536
dc.identifier.urihttp://hdl.handle.net/10625/53816
dc.language.isoen
dc.publisherElsevieren
dc.subjectAFFORDABILITYen
dc.subjectACCESSen
dc.subjectOBSTETRIC SERVICESen
dc.subjectTUBERCULOSISen
dc.subjectANTIRETROVIRAL TREATMENTen
dc.subjectSERVICE COSTSen
dc.subjectABILITY TO PAYen
dc.subjectSOUTH AFRICAen
dc.subjectHEALTH SERVICESen
dc.subjectACCESS TO HEALTH CAREen
dc.subjectHEALTH EXPENDITUREen
dc.subjectTUBERCULOSISen
dc.subjectANTIRETROVIRAL THERAPY, HIGHLY ACTIVEen
dc.subjectHIVen
dc.subjectAIDSen
dc.titleInvestigating the affordability of key health services in South Africaen
dc.typeJournal Article (peer-reviewed)en
idrc.copyright.holderElsevier Ltd.
idrc.dspace.accessIDRC Onlyen
idrc.noaccessDue to copyright restrictions the full text of this research output is not available in the IDRC Digital Library or by request from the IDRC Library. / Compte tenu des restrictions relatives au droit d'auteur, le texte intégral de cet extrant de recherche n'est pas accessible dans la Bibliothèque numérique du CRDI, et il n'est pas possible d'en faire la demande à la Bibliothéque du CRDI.en
idrc.project.componentnumber106439002
idrc.project.number106439
idrc.project.titleEquity in Health and Health Financing: Building and Strengthening Developing Country Networksen
idrc.recordsserver.bcsnumberIC01-4451-42
idrc.rims.adhocgroupIDRC SUPPORTEDen

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