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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].”
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Citations
Cites
Transforming Our World: The 2030 Agenda for Sustainable Development
Desa, U. (2018) · Springer Publishing Company eBooks · doi:10.1891/9780826190123.ap02 · Cited by 19,478
Levesque, J.-F., Harris, M. F., & Russell, G. (2013) · International Journal for Equity in Health · doi:10.1186/1475-9276-12-18 · Cited by 3,484
The Concepts and Principles of Equity and Health
Whitehead, M. (1992) · International Journal of Health Services · doi:10.2190/986l-lhq6-2vte-yrrn · Cited by 2,284
On the measurement of inequalities in health
Wagstaff, A., Paci, P., & van Doorslaer, E. (1991) · Social Science & Medicine · doi:10.1016/0277-9536(91)90212-u · Cited by 1,810
Health disparities and health equity: Concepts and measurement
Braveman, P. (2006) · Annual Review of Public Health · doi:10.1146/annurev.publhealth.27.021405.102103 · Cited by 1,570
The health and health system of South Africa: Historical roots of current public health challenges
Coovadia, H., Jewkes, R., Barron, P., Sanders, D., & McIntyre, D. (2009) · The Lancet · doi:10.1016/s0140-6736(09)60951-x · Cited by 1,413
Socioeconomic inequalities in health: Measurement, computation, and statistical inference
Kakwani, N., Wagstaff, A. R., & van Doorslaer, E. K. A. (1997) · Journal of Econometrics · doi:10.1016/s0304-4076(96)01807-6 · Cited by 1,382
Health systems financing and the path to universal coverage
EVANS, D. B., & Etienne, C. F. (2010) · Bulletin of the World Health Organization · doi:10.2471/blt.10.078741 · Cited by 1,286
Analyzing Health Equity Using Household Survey Data: A Guide to Techniques and their Implementation
O'Donnell, O., van Doorslaer, E., Wagstaff, A., & Lindelow, M. (2007) · doi:10.1596/978-0-8213-6933-3 · Cited by 1,156
Wagstaff, A. R., van Doorslaer, E. K. A., & Watanabe, N. (2002) · Journal of Econometrics · doi:10.1016/s0304-4076(02)00161-6 · Cited by 1,099
Correcting the Concentration Index
Erreygers, G. (2008) · Journal of Health Economics · doi:10.1016/j.jhealeco.2008.02.003 · Cited by 870
Self-Reported Utilization of Health Care Services: Improving Measurement and Accuracy
Bhandari, A., & Wagner, T. H. (2006) · Medical Care Research and Review · doi:10.1177/1077558705285298 · Cited by 754
Explaining income‐related inequalities in doctor utilisation in Europe
van Doorslaer, E. K. A., Koolman, X., & Jones, A. M. (2004) · Health Economics · doi:10.1002/hec.919 · Cited by 728
Income-related inequalities in health: some international comparisons
van Doorslaer, E. K. A., Wagstaff, A. R., Han Bleichrodt, A., Calonge, S., Gerdtham, U., Gerfin, M., Geurts, J. J., Gross, L., Häkkinen, U., Leu, R. E., et al. (1997) · Journal of Health Economics · doi:10.1016/s0167-6296(96)00532-2 · Cited by 695
Access to health care in developing countries: breaking down demand side barriers
O'Donnell, O. (2007) · Cadernos de Saúde Pública · doi:10.1590/s0102-311x2007001200003 · Cited by 567
Health and Health Care in South Africa — 20 Years after Mandela
Mayosi, B. M., & Benatar, S. R. (2014) · New England Journal of Medicine · doi:10.1056/nejmsr1405012 · Cited by 533
Inequities in access to health care in South Africa
Harris, B., Goudge, J., Ataguba, J. E.-O., McIntyre, D., Nxumalo, N., Jikwana, S., & Chersich, M. (2011) · Journal of Public Health Policy · doi:10.1057/jphp.2011.35 · Cited by 507
Conindex: Estimation of Concentration Indices
O'Donnell, O., O'Neill, S., Van Ourti, T., & Walsh, B. (2016) · The Stata Journal: Promoting communications on statistics and Stata · doi:10.1177/1536867x1601600112 · Cited by 491
Perceived barriers in accessing food among recent Latin American immigrants in Toronto
Vahabi, M., & Damba, C. (2013) · International Journal for Equity in Health · doi:10.1186/1475-9276-12-1 · Cited by 344
Marten, R., McIntyre, D., Travassos, C., Shishkin, S. V., Longde, W., Reddy, S., & Vega, J. (2014) · The Lancet · doi:10.1016/s0140-6736(14)60075-1 · Cited by 328
Access as a policy-relevant concept in low- and middle-income countries
McIntyre, D., Thiede, M., & Birch, S. (2009) · Health Economics Policy and Law · doi:10.1017/s1744133109004836 · Cited by 323
MILLS, A. J., Ataguba, J. E.-O., Akazili, J., Borghi, J., Garshong, B., Makawia, S., Mtei, G., Harris, B., Macha, J., Meheus, F., et al. (2012) · The Lancet · doi:10.1016/s0140-6736(12)60357-2 · Cited by 313
Inequities in under-five child malnutrition in South Africa
Zere, E., & McIntyre, D. (2003) · International Journal for Equity in Health · doi:10.1186/1475-9276-2-7 · Cited by 305
Analyzing Health Equity Using Household Survey Data
O’Donnell, O., van Doorslaer, E. K. A., Wagstaff, W., & Lindelöw, M. (2008) · University Libraries (University of Maryland) · doi:10.13016/fcm7-vvv1 · Cited by 294
McIntyre, D. (2008) · Bulletin of the World Health Organization · doi:10.2471/blt.08.053413 · Cited by 265
Socioeconomic-related health inequality in South Africa: evidence from General Household Surveys
Ataguba, J. E.-O., Akazili, J., & McIntyre, D. (2011) · International Journal for Equity in Health · doi:10.1186/1475-9276-10-48 · Cited by 247
On correcting the concentration index for binary variables
Kjellsson, G., & Gerdtham, U. (2012) · Journal of Health Economics · doi:10.1016/j.jhealeco.2012.10.012 · Cited by 233
Shisana, O., Labadarios, D., Rehle, T. M., Simbayi, L. C., Zuma, K. K., Dhansay, M. A., Reddy, P., Parker, W. W., Hoosain, E., Naidoo, P., et al. (2014) · Cited by 211
Bias in patient satisfaction surveys: a threat to measuring healthcare quality
Dunsch, F. A., Evans, D. K., Macis, M., & Wang, Q. (2018) · BMJ Global Health · doi:10.1136/bmjgh-2017-000694 · Cited by 162
Das‐Munshi, J., Lund, C., Mathews, C., Clark, C., Rothon, C., & Stansfeld, S. A. (2016) · PLoS ONE · doi:10.1371/journal.pone.0154478 · Cited by 149
Distance decay and persistent health care disparities in South Africa
McLaren, Z. M., Ardington, C., & Leibbrandt, M. (2014) · BMC Health Services Research · doi:10.1186/s12913-014-0541-1 · Cited by 148
Patient experiences and health system responsiveness in South Africa
Peltzer, K. (2009) · BMC Health Services Research · doi:10.1186/1472-6963-9-117 · Cited by 148
Income Inequality, Trust, and Population Health in 33 Countries
Elgar, F. J. (2010) · American Journal of Public Health · doi:10.2105/ajph.2009.189134 · Cited by 147
Macha, J., Harris, B., Garshong, B., Ataguba, J. E.-O., Akazili, J., Kuwawenaruwa, A., & Borghi, J. (2012) · Health Policy and Planning · doi:10.1093/heapol/czs024 · Cited by 137
Socioeconomic Inequalities in Adult Obesity Prevalence in South Africa: A Decomposition Analysis
Alaba, O. A., & Chola, L. (2014) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph110303387 · Cited by 112
Billmeyer, F. W., & Chen, Y. (1985) · Color Research & Application · doi:10.1002/col.5080100410 · Cited by 107
Explaining the role of the social determinants of health on health inequality in South Africa
Ataguba, J. E.-O., Day, C., & McIntyre, D. (2015) · Global Health Action · doi:10.3402/gha.v8.28865 · Cited by 102
Myburgh, N. G., Solanki, G. C., Smith, M. J., & Lalloo, R. (2005) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzi062 · Cited by 101
Unmet need as an indicator of health care access
Allin, S. M., & Masseria, C. (2009) · London School of Economics and Political Science Research Online (London School of Economics and Political Science) · Cited by 96
Mondor, L., Cohen, D., Khan, A. I., & Wodchis, W. P. (2018) · International Journal for Equity in Health · doi:10.1186/s12939-018-0800-6 · Cited by 96
Yang, W. Y. L. (2013) · International Journal for Equity in Health · doi:10.1186/1475-9276-12-20 · Cited by 94
Yiengprugsawan, V., Lim, L. L.-Y., Carmichael, G. A., Dear, K. B. G., & Sleigh, A. C. (2010) · BMC Research Notes · doi:10.1186/1756-0500-3-57 · Cited by 89
Mutyambizi, C., Booysen, F., Stokes, A. C., Pavlova, M., & Groot, W. N. J. (2019) · PLoS ONE · doi:10.1371/journal.pone.0211208 · Cited by 85
Self-citationPrice competition and quality differentiation with multiproduct firms
Cheng, Y., & Peng, S. (2013) · Journal of Economics · doi:10.1007/s00712-013-0367-z · Cited by 84
Caron, J., & Liu, A. (2010) · Community Mental Health Journal · doi:10.1007/s10597-010-9306-4 · Cited by 82
Saito, E., Gilmour, S., Yoneoka, D., Gautam, G., Rahman, M. M., Shrestha, P. K., & Shibuya, K. (2016) · Health Policy and Planning · doi:10.1093/heapol/czv137 · Cited by 81
Does the distribution of healthcare utilization match needs in Africa?
Bonfrer, I., van de Poel, E., Grimm, M., & Van Doorslaer, E. (2014) · Health Policy and Planning · doi:10.1093/heapol/czt074 · Cited by 76
Health disparities between racial groups in South Africa: A decomposition analysis
Charasse-Pouélé, C., & Fournier, M. (2006) · Social Science & Medicine · doi:10.1016/j.socscimed.2005.11.020 · Cited by 71
Improving literacy as a means to reducing health disparities
Saha, S. S. (2006) · Journal of General Internal Medicine · doi:10.1111/j.1525-1497.2006.00546.x · Cited by 67
Foulds, J., Wells, J. E., & Mulder, R. (2014) · International Journal of Social Psychiatry · doi:10.1177/0020764014521394 · Cited by 58
Who benefits from health services in South Africa?
Ataguba, J. E.-O., & McIntyre, D. (2012) · Health Economics Policy and Law · doi:10.1017/s1744133112000060 · Cited by 53
Nkonki, L. L., Chopra, M., Doherty, T., Jackson, D. J., & Robberstad, B. (2011) · International Journal for Equity in Health · doi:10.1186/1475-9276-10-13 · Cited by 53
Walsh, B., Silles, M. A., & O’Neill, C. (2011) · Health Economics · doi:10.1002/hec.1784 · Cited by 48
Lifestyle and Income-related Inequality in Health in South Africa
Mukong, A. K., van Walbeek, C., & Ross, H. (2017) · International Journal for Equity in Health · doi:10.1186/s12939-017-0598-7 · Cited by 45
Wabiri, N., Chersich, M., Shisana, O., Blaauw, D., Rees, H., & Dwane, N. (2016) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-016-1048-z · Cited by 44
NATIONAL HEALTH INSURANCE IN SOUTH AFRICA
(1929) · BMJ · doi:10.1136/bmj.2.3581.359 · Cited by 43
Cabieses, B., & Bird, P. (2014) · International Journal of Health Services · doi:10.2190/hs.44.4.j · Cited by 41
Ward, K., Sanders, D. M., Leng, H. M. J., & Pollock, A. M. (2014) · Bulletin of the World Health Organization · doi:10.2471/blt.13.130005 · Cited by 41
Decomposing socioeconomic health inequalities
Speybroeck, N., Könings, P., Lynch, J. W., Harper, S. B., Berkvens, D. L., Lorant, V., Gecková, A. M., & Hosseinpoor, A. R. (2010) · International Journal of Public Health · doi:10.1007/s00038-009-0105-z · Cited by 40
Schneider, H. M., Besada, D., Sanders, D. M., Daviaud, E., & Rohde, S. S. (2018) · UWC Research Repository (University of the Western Cape) · Cited by 38
Inequalities in multimorbidity in South Africa
Ataguba, J. E.-O. (2013) · International Journal for Equity in Health · doi:10.1186/1475-9276-12-64 · Cited by 38
Wabiri, N., Chersich, M., Zuma, K. K., Blaauw, D., Goudge, J., & Dwane, N. (2013) · PLoS ONE · doi:10.1371/journal.pone.0073864 · Cited by 36
Income-related inequalities in health care utilization in Mongolia, 2007/2008–2012
Dorjdagva, J., Batbaatar, E., Bayarsaikhan, D., & Kauhanen, J. (2015) · International Journal for Equity in Health · doi:10.1186/s12939-015-0185-8 · Cited by 36
Monitoring and Evaluating Progress towards Universal Health Coverage in South Africa
Ataguba, J. E.-O., Day, C., & McIntyre, D. (2014) · PLoS Medicine · doi:10.1371/journal.pmed.1001686 · Cited by 30
Commercialisation and extreme inequality in health: the policy challenges in South Africa
McIntyre, D., Gilson, L., Wadee, H., Thiede, M., & Okarafor, O. (2006) · Journal of International Development · doi:10.1002/jid.1293 · Cited by 30
Jacobsen, K. H., & Hasumi, T. (2014) · Pan African Medical Journal · doi:10.11604/pamj.2014.18.172.4084 · Cited by 27
Lee, M., & Jones, A. M. (2007) · Health Policy · doi:10.1016/j.healthpol.2007.01.007 · Cited by 25
Healthcare service problems reported in a national survey of South Africans
Hasumi, T., & Jacobsen, K. H. (2014) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzu056 · Cited by 24
Vallejo‐Torres, L., & Stephen Morris, A. (2012) · Health Economics · doi:10.1002/hec.2821 · Cited by 21
Are self reported morbidities deceptive in measuring socio-economic inequalities.
Jain, K., Goli, S., & Arokiasamy, P. (2012) · Europe PMC (PubMed Central) · Cited by 16
Inequity in inpatient healthcare utilisation 10 years after Apartheid
Buisman, L. R., & García‐Gómez, P. (2014) · Development Southern Africa · doi:10.1080/0376835x.2014.984374 · Cited by 13
The Influence of Socioeconomic Status on Psychological Distress in Canadian Adults With ADD/ADHD
Pond, E., Fowler, K., & Hesson, J. (2016) · Journal of Attention Disorders · doi:10.1177/1087054716653214 · Cited by 11
Haughton, D., & Haughton, J. (2011) · Springer eBooks · doi:10.1007/978-1-4614-0385-2_11 · Cited by 1
Research works printed but not linked: 3
- Competition Commission. Health market inquiry. Provisional findings and recommendations report 2018.
- Shisana O, Labadarios D, Rehle T, Simbayi L, Zuma K, Dhansay A, et al. The South African National Health and Nutrition Examination Survey SANHANES-1. Ann Behav Med. 2009;37:45–60.
- Hunter JR, Asmall S, Ravhengani NM, Chandran TM, Tucker J, Mokgalagadi Y. The ideal Clinic in South Africa: progress and challenges in implementation. South African Heal Rev. 2015/16;2016:111–24.
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Rossouw, L., & Ross, H. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18052571 · Cited by 243
Liu, C., He, L. N., Li, Y., Yang, A., Zhang, K., & Luo, B. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1197947 · Cited by 58
Mokwele, R. N., Schellack, N., Bronkhorst, E., Brink, A. J., Schweickerdt, L., & Godman, B. (2021) · JAC-Antimicrobial Resistance · doi:10.1093/jacamr/dlab196 · Cited by 48
Gaffney, H. J., & Hamiduzzaman, M. (2022) · PLoS ONE · doi:10.1371/journal.pone.0269840 · Cited by 39
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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