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. 2020 Mar 4;20(1):289.
doi: 10.1186/s12889-020-8368-7.

Socio-economic inequalities in the multiple dimensions of access to healthcare: the case of South Africa

Tanja Gordon  1 , Frederik Booysen  2 , Josue Mbonigaba  3
Affiliations

Socio-economic inequalities in the multiple dimensions of access to healthcare: the case of South Africa

Tanja Gordon et al. BMC Public Health. .

Abstract

Background: The National Development Plan (NDP) strives that South Africa, by 2030, in pursuit of Universal Health Coverage (UHC) achieve a significant shift in the equity of health services provision. This paper provides a diagnosis of the extent of socio-economic inequalities in health and healthcare using an integrated conceptual framework.

Method: The 2012 South African National Health and Nutrition Examination Survey (SANHANES-1), a nationally representative study, collected data on a variety of questions related to health and healthcare. A range of concentration indices were calculated for health and healthcare outcomes that fit the various dimensions on the pathway of access. A decomposition analysis was employed to determine how downstream need and access barriers contribute to upstream inequality in healthcare utilisation.

Results: In terms of healthcare need, good and ill health are concentrated among the socio-economically advantaged and disadvantaged, respectively. The relatively wealthy perceived a greater desire for care than the relatively poor. However, postponement of care seeking and unmet need is concentrated among the socio-economically disadvantaged, as are difficulties with the affordability of healthcare. The socio-economic divide in the utilisation of public and private healthcare services remains stark. Those who are economically disadvantaged are less satisfied with healthcare services. Affordability and ability to pay are the main drivers of inequalities in healthcare utilisation.

Conclusion: In the South African health system, the socio-economically disadvantaged are discriminated against across the continuum of access. NHI offers a means to enhance ability to pay and to address affordability, while disparities between actual and perceived need warrants investment in health literacy outreach programmes.

Keywords: Access; Concentration index; Decomposition; Health inequality; Healthcare; South Africa.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Dimensions of access to healthcare: a conceptual framework
Fig. 2
Fig. 2
Most common reasons for households postponing healthcare
See this image and copyright information in PMC

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