title: Investigating the affordability of key health services in South Africa.
abstract: This paper considers the affordability of using public sector health services for three tracer conditions (obstetric care, tuberculosis treatment and antiretroviral treatment for HIV-positive people), based on research undertaken in two urban and two rural sites in South Africa. We understand affordability as the 'degree of fit' between the costs of seeking health care and a household's ability-to-pay. Exit interviews were conducted with over 300 patients for each of the three tracer conditions in each of the four sites (i.e. a total sample of over 3600). Total direct costs for the service used at the time of the interview, as well as other health related costs incurred during the preceding month either for self-care or the use of plural providers were assessed, as were a range of indicators of ability-to-pay. The percentage of households incurring direct costs exceeding 10% of household consumption expenditure and those borrowing money or selling assets as a mechanism for coping with the burden of direct costs were calculated. Logistic regressions were also conducted to identify factors that were significantly associated with these indicators of affordability. There were significant differences in affordability between rural and urban sites; costs were higher, ability-to-pay was lower and there was a greater proportion of households selling assets or borrowing money in rural areas. There were also significant differences across tracers, with a higher percentage of households receiving tuberculosis and antiretroviral treatment borrowing money or selling assets than those using obstetric services. As these conditions require expenses to be incurred on an ongoing basis, the sustainability of such coping strategies is questionable. Policy makers need to explore how to reduce direct costs for users of these key health services in the context of the particular characteristics of different treatment types. Affordability needs to be considered in relation to the dynamic aspects of the costs of treating different conditions and the timing of treatment in relation to diagnosis. The frequently high transport costs associated with treatments involving multiple consultations can be addressed by initiatives that provide close-to-client services and subsidised patient transport for referrals.
authors: Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, South Africa. Susan.Cleary@uct.ac.za
authors: Susan
authors: S
authors: Cleary
authors: Steve
authors: S
authors: Birch
authors: Natsayi
authors: N
authors: Chimbindi
authors: Sheetal
authors: S
authors: Silal
authors: Di
authors: D
authors: McIntyre
mesh_terms: D044966:Anti-Retroviral Agents / Q000191:economics / Q000627:therapeutic use; D005260:Female; D005382:Financing, Personal / Q000379:methods / Q000706:statistics & numerical data; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics; D005102:Health Expenditures / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D008427:Maternal Health Services / Q000191:economics*; D011247:Pregnancy; D017150:Public Sector / Q000191:economics*; D012424:Rural Population; D012959:Socioeconomic Factors; D013019:South Africa; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000191:economics / Q000628:therapy*; D014505:Urban Population
chemical_list: D044966:Anti-Retroviral Agents