The DOI matches its Crossref record; 73 of the 74 references it cites were found in a registry or an index.
Socio-economic inequalities in the multiple dimensions of access to healthcare: the case of South Africa
Open accessAbstract
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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“Additionally, the observed drop-off when analyzing the cascade of respondents who express symptoms, to those who seek facility-based care, to those who are treated by a trained healthcare provider, is also observed in similar research contexts [30–32].”
From Community and facility-level barriers to achieving UHC in Kono District, Sierra Leone and Maryland County, Liberia (2023) · cites this paper as [30]
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“External results from studies conducted in similar research contexts cite high visit costs as a primary deterrent from seeking medical care [30, 33, 34].”
From Community and facility-level barriers to achieving UHC in Kono District, Sierra Leone and Maryland County, Liberia (2023) · cites this paper as [30]
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Ndwamai, R. M. (2026) · International Journal of Development and Sustainability · doi:10.63212/ijds25111301
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Mawoyo, T. L., Laurenzi, C. A., Toit, S. D., Luitel, N. P., Trafford, Z., Jordans, M. J. D., Chideya, Y., Tomlinson, M., & Skeen, S. (2026) · Vulnerable Children and Youth Studies · doi:10.1080/17450128.2026.2737203
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Understanding parental trauma in caring for children with down syndrome within LSEN school settings
Adewuyi, H. O., & Dwarika, V. M. (2026) · Frontiers in Child and Adolescent Psychiatry · doi:10.3389/frcha.2026.1926429
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Metadata
- 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
- Venue
- BMC Public Health
- Published
- 2020-03-04
- Volume
- 20
- Issue
- 1
- Pages
- 289-289
- ISSN
- 1471-2458 (ISSN-L)
- 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
- 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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