title: Social solidarity and civil servants' willingness for financial cross-subsidization in South Africa: implications for health financing reform.
abstract: In South Africa, anticipated health sector reforms aim to achieve universal health coverage for all citizens. Success will depend on social solidarity and willingness to pay for health care according to means, while benefitting on the basis of their need. In this study, we interviewed 1330 health and education sector civil servants in four South African provinces, about potential income cross-subsidies and financing mechanisms for a National Health Insurance. One third was willing to cross-subsidize others and half favored a progressive financing system, with senior managers, black Africans, or those with tertiary education more likely to choose these options than lower-skilled staff, white, Indian or Asian respondents, or those with primary or less education. Insurance- and health-status were not associated with willingness to pay or preferred type of financing system. Understanding social relationships, identities, and shared meanings is important for any reform striving toward universal coverage.
authors: Centre for Health Policy & Medical Research Council Health Policy Research Group, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Private Bag X3, Wits 2050, Johannesburg, South Africa. bronwyn.harris@wits.ac.za
authors: Bronwyn
authors: B
authors: Harris
authors: Nonhlanhla
authors: N
authors: Nxumalo
authors: John E
authors: JE
authors: Ataguba
authors: Veloshnee
authors: V
authors: Govender
authors: Matthew
authors: M
authors: Chersich
authors: Jane
authors: J
authors: Goudge
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005378:Financial Support; D005382:Financing, Personal; D018166:Health Care Reform; D006282:Health Personnel; D006801:Humans; D008297:Male; D009313:National Health Programs / Q000191:economics*; D011639:Public Opinion; D044469:Racial Groups; D012959:Socioeconomic Factors; D013019:South Africa; D011795:Surveys and Questionnaires; D013663:Teaching