Cited by 209Healthcare Systems and ReformsPublic Health and Social InequalitiesHealth disparities and outcomes

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

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Gordon, Tanja, Booysen, Frederik, Mbonigaba, Josue·2020·BMC Public Health

DOI 10.1186/s12889-020-8368-7PMC PMC7057636

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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.

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Fig. 1 Dimensions of access to healthcare: a conceptual frameworkCC BY · PubMed Central

Fig. 2 Most common reasons for households postponing healthcareCC BY · PubMed Central

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Authors: Gordon, T., Booysen, F., & Mbonigaba, J.
Affiliations: Human Sciences Research Council (ZA)
University of the Witwatersrand (ZA)
University of KwaZulu-Natal (ZA)
Corresponding author: Gordon, Tanja
ORCID: Gordon, Tanja
Booysen, Frederik
Mbonigaba, Josue
Venue: BMC Public Health
Publisher: Springer Science and Business Media LLC
Published: 2020-03-04
Volume: 20
Issue: 1
Pages: 289-289
ISSN: 1471-2458 (ISSN-L)
DOI: 10.1186/s12889-020-8368-7
PMC: PMC7057636
OpenAlex: W3012082939
Cited by: 209
References: 74
Citations by year: 2026: 37 · 2025: 45 · 2024: 51 · 2023: 26 · 2022: 21 · 2021: 26 · 2020: 3
FWCI: 19.76
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (tdm)
creativecommons.org/licenses/by/4.0/ (vor)
Locations: BMC Public Health (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders: Department for International Development
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Reforms
Social Sciences › Health › Public Health and Social Inequalities
Social Sciences › Health › Health disparities and outcomes
Keywords: socioeconomic inequalities in health, health care access, universal health coverage, health care utilization, health care affordability, health care satisfaction, national health insurance, health literacy, decomposition analysis, concentration index, South Africa
MeSH terms: Adult, Female, Humans, Male, Nutrition Surveys, Socioeconomic Factors, South Africa, Healthcare Disparities

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

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