Have public health spending and access in South Africa become more equitable since the end of apartheid?

Figures & data

Figure 1: Distribution of utilisation of public hospitals, by per capita household expenditure quintile, 1993–2008

Figure 2: Distribution of utilisation of public clinics, by per capita household expenditure quintile, 1993–2008

Figure 3: Share of clinics in total utilisation of public health facilities, by per capita household expenditure quintile, 1993–2008

Figure 4: Share of public health care facilities in total health care utilisation, by per capita household expenditure quintile, 1993–2008

Table 1: Prevalence of reported illness and injury and proportion of those ill and injured who reported consulting a health worker over the last month by per capita household expenditure quintile, 1993–2003

	Prevalence of reported illness and injury over the last month (%)			Proportion of those ill/injured who reported consulting a health worker over the last month (%)
Per capita household expenditure quintile	1993	1995	2003	1993	1995	2003
Poorest 20%	10.8	7.2	8.2	71.9	78.3	83.3
Quintile 2	13.5	8.5	9.0	77.8	80.4	83.3
Quintile 3	16.7	9.3	11.4	83.3	82.1	82.5
Quintile 4	18.9	11.4	13.5	85.6	86.5	82.7
Most affluent 20%	24.2	12.1	13.8	84.0	87.9	86.4
Total	16.8	9.7	11.2	80.5	83.0	83.6
Sources: 1993 PSLSD, 1995 IES/OHS and 2003 GHS.

Figure 5: Concentration curves for public clinics, 1995–2008

Figure 6: Concentration curves for public hospitals, 1995–2008

Figure 7: Concentration curves for public health spending (public clinics and public hospitals combined), 1995–2008

Table 2: Concentration indices for hospital and clinic spending, 1993–2008

	1993	1995	2003	2008
Hospitals	–0.027	0.026	0.032	–0.091
Clinics	–0.076	–0.069	–0.090	–0.175
Sources: 1995 IES/OHS, 2003 GHS and 2008 NIDS

Figure 8: Percentage of users who paid for their visit to public clinics by per capita household expenditure quintile, 1993–2008

Figure 9: Percentage of users who paid for their visit to public hospitals by per capita household expenditure quintile, 1993–2008

Table 3: Average affordability ratios for the uninsured by per capita household expenditure quintile, 1993–2008 (%)

Per capita household expenditure quintile	1993	1995	2000	2005	2008
Poorest 20%	1.5	1.0	1.1	2.8	4.0
Quintile 2	0.8	0.9	1.3	2.4	2.9
Quintile 3	0.7	0.8	1.3	2.2	2.1
Quintile 4	1.0	0.8	1.2	1.7	2.0
Most affluent 20%	2.4	1.3	1.2	1.5	1.7
Total	1.3	0.9	1.2	2.3	2.7
Notes: Affordability ratios estimate health expenditure as a share of non-food expenditure. This analysis uses the 1993 PSLSD, the 1995, 2000 and 2005 IES surveys and the 2008 NIDS. Estimates do not include health insurance and thus only reflect direct out-of-pocket payments for health services, medicine and medical supplies. It thus excludes transport costs.

Table 4: Prevalence of catastrophic expenditure for the uninsured by per capita expenditure quintiles, 1993–2008 (%)

Per capita household expenditure quintile	1993	1995	2000	2005	2008
Poorest 20%	2.8	1.2	1.6	4.0	8.3
Quintile 2	2.7	1.2	2.2	2.1	6.6
Quintile 3	2.9	0.7	1.8	2.2	8.0
Quintile 4	4.3	0.7	1.5	1.7	5.7
Most affluent 20%	7.6	2.0	2.1	0.8	4.7
Total	4.1	1.1	1.8	2.3	7.1
Notes: Catastrophic expenditure is here defined as health expenditure's share of non-food expenditure exceeding 10%. This analysis uses the 1993 PSLSD, the 1995, 2000 and 2005 IESs and the 2008 NIDS. Estimates of health expenditure do not include health insurance and thus only reflect direct out-of-pocket payments for health services, medicine and medical supplies. They also exclude transport costs.

Figure 10: Private provider share of out-of-pocket expenditure by per capita household expenditure quintile, 1993 and 2008

Table 5: Prohibitive cost cited as reason for not consulting a health worker, 1993–2009 (%)

Wealth quintile	1993	2002	2005	2008
Poorest 20%	8.9	8.7	5.1	3.7
Quintile 2	8.7	6.5	4.0	2.5
Quintile 3	7.5	5.7	3.8	2.6
Quintile 4	5.2	5.3	3.7	3.4
Wealthiest 20%	2.7	3.3	1.4	1.2
Total	6.2	5.9	3.6	2.7
Notes: Due to the lack of expenditure data in the GHS surveys, an asset index was estimated in the PSLSD and the GHSs using a set of 10 overlapping household assets and characteristics to create asset quintiles. The 2002, 2005 and 2008 estimates are from the GHS and from identical questions, but the 1993 estimates are from the PSLSD, where the question was different and other response categories were provided.

Figure 11: Percentage of respondents reporting more than 30 minutes travel time to the closest public health facility, 1993 and 2008

Table 6: Percentage of respondents reporting the following complaints about public facilities, 2002–2008

Wealth quintile	Waiting time	Prescribed drugs unavailable	Rudeness of staff	Too expensive	Incorrect diagnosis
Poorest 20%	37.0	14.4	8.6	3.2	1.6
Quintile 2	38.5	14.3	9.5	3.7	1.9
Quintile 3	42.7	12.9	12.1	3.1	2.2
Quintile 4	45.8	14.1	13.1	3.2	3.3
Wealthiest 20%	43.7	15.2	13.4	4.8	4.3
Total	40.7	14.1	10.7	3.4	2.3
Source: Pooled version of the GHS surveys 2002–2008.

Table B1: Predictive accuracy of expenditure model tested in IES/LFS 2000

	Estimated expenditure per capita quintile allocation (%)
Actual expenditure per capita quintile allocation	1	2	3	4	5	Total
1	91.3	8.7	0.0	0.0	0.0	100.0
2	8.6	81.0	10.4	0.0	0.0	100.0
3	0.0	10.3	79.1	10.6	0.0	100.0
4	0.0	0.0	10.4	84.5	5.2	100.0
5	0.0	0.0	0.0	5.1	94.9	100.0
Total	99.9	99.9	99.9	100.2	100.1
Notes: The columns do not sum to 100 because these expenditure quintiles have been constructed on the basis of the model estimates, but using the boundaries of the actual expenditure quintiles.

Table C1: Average payment in South African rand (2000 prices) for visit to public hospitals and to public clinics by per capita household expenditure quintile, 1993–2008

Per capita household expenditure quintile	1993	1995	2003	2008
Public hospitals
Poorest 20%	117.29	1.75	3.86	2.85
Quintile 2	126.92	2.10	6.95	12.35
Quintile 3	135.89	3.77	9.01	3.12
Quintile 4	139.64	5.18	8.66	10.91
Most affluent 20%	1278.96	22.80	25.93	15.78
Total	359.74	7.12	10.88	3.66
Public clinics
Poorest 20%	8.60	1.01	0.98	0.21
Quintile 2	7.27	1.49	1.66	0.56
Quintile 3	9.19	2.31	2.11	0.33
Quintile 4	49.18	2.21	1.45	2.62
Most affluent 20%	278.32	15.86	6.12	1.33
Total	70.51	4.58	2.46	1.01
Notes: This analysis uses the 1993 PSLSD, the 1995 IES/OHS, the 2003 GHS (with an expenditure model from the 2000 IES/LFS that also allows it to be linked to this dataset and the 2008 NIDS). Estimates for 1993 and 2008 were derived from questions that asked about the cost of the facility visit, while estimates for 1995 and 2003 were constructed from questions about household expenditure using the method outlined in Appendix C. No distinction between visits to private and public facilities was made in the 1993 survey; as most facilities at the time were public, all such expenditures were taken to be for public facilities.