What do we know about health service utilisation in South Africa?

Figures & data

Table 1: Questions relating to health service utilisation in the GHS

Questions	Options
During the past month, did … suffer from any illnesses or injuries?	1= Yes
	2= No
What sort of illnesses or injuries did … suffer from?	01 = Flu or acute respiratory tract infection
	02 = Diarrhoea
	03 = Severe trauma (e.g. due to violence, motor vehicle accident, gunshot, assault, beating)
	04 = TB or severe cough with blood
	05 = Abuse of alcohol or drugs
	06 = Depression or mental illness
	07 = Diabetes
	08 = High or low blood pressure
	09 = HIV/AIDS
	10 = Other sexually transmitted disease
	11 = Other illness or injury
During the past month, did … consult a health worker such as a nurse, doctor or traditional healer as a result of illness or injury?	1= Yes
	2= No
For …'s most recent consultation, what kind of health worker did he/she consult?	1 = Nurse
	2 = Doctor
	3 = Medical specialist
	4 = Pharmacist/Chemist
	5 = Dentist
	6 = Spiritual healer (Church related)
	7 = Traditional healer
	8 = Any other health care provider (including psychologist, physiotherapist, chiropractor, homeopath, optometrist)
	9 = Don't know
Where did the consultation take place?	Public sector (i.e. government, provincial or community institution)
If more than one consultation, ask about the most recent one	01 = Hospital
	02 = Clinic
	03 = Other in public sector (specify)
	Private sector (including private clinics, surgery, private hospitals and sangomas)
	04 = Hospital
	05 = Clinic
	06 = Private doctor/ specialist
	07 = Traditional healer
	08 = Pharmacy/ chemist
	09 = Health facility provided by employer
	10 = Alternative medicine, e.g. homeopath
	11 = Other in private sector (specify)
	12 = Don't know

Table 2: Questions relating to health service utilisation in the SACBIA survey

Questions	Options
19. During the past month, did … visit any of the following:	1 = Public hospital (specify name of hospital)
(Show card. Record all facilities/providers visited and number of visits to each.)	2 = Public clinic/Community health centre
(If not visited code 0, if visited then record the number of visits, e.g. 1 for one visit, 2 for two visits and so on.)	3 = Clinic at workplace
	4 = Private general practitioner
	5 = Private specialist
	6 = Private hospital
	7 = Private dentist
	8 = Private pharmacy
	9 = Mental health worker in public hospital
	10 = Private psychologist or psychiatrist
	11 = Community health worker
	12 = Midwife
	13 = Traditional birth attendant
	14 = Traditional healer or sangoma
	15 = Other (specify)
(Ask for each household member who visited a medical practitioner/hospital, that is not code 0.)	1 = Public hospital (specify name of hospital)
Which of these did … visit most recently?	2 = Public clinic/Community health centre
	3 = Clinic at workplace
	4 = Private general practitioner
	5 = Private specialist
	6 = Private hospital
	7 = Private dentist
	8 = Private pharmacy
	9 = Mental health worker in public hospital
	10 = Private psychologist or psychiatrist
	11 = Community health worker
	12 = Midwife
	13 = Traditional birth attendant
	14 = Traditional healer or sangoma
	15 = Other (specify)
In the past year, that is since … 2007, has … been admitted to a hospital for one night or more?	1= Yes
	2= No
(Ask if yes.)	Public hospital (specify name of hospital)
In the past year, (that is since … 2007) how many different times has … been admitted to a hospital for one night or more?	Private hospital (specify name of hospital)
(Write the number of admissions in each type of hospital. Code 0 if no visits, otherwise specify number of visits.)

Table 3: Percentage distribution of utilisation of public and private providers

	GHS 2008		SACBIA
	Public	Private	Public	Private
Socioeconomic status
Quintile 1 (poorest)	81	19	87	13
Quintile 2	74	26	83	17
Quintile 3	69	31	78	22
Quintile 4	43	57	65	35
Quintile 5 (richest)	29	71	28	72
‘Race’ group
African	68	32	77	23
Coloured	58	42	67	33
Asian	40	60	37	63
White	16	84	20	80
Medical scheme membership
Not a medical scheme member	74	26	81	19
Medical scheme member	12	88	11	89
Province
Eastern Cape	67	33	80	20
Free State	54	46	66	34
Gauteng	50	50	57	43
KwaZulu-Natal	73	27	72	28
Limpopo	73	27	84	16
Mpumalanga	60	40	73	27
North West	63	37	78	22
Northern Cape	67	33	88	12
Western Cape	52	48	61	39

Figure 1: Age–sex standardised utilisation of outpatient services by province and type of area (2008)

Figure 2: Age–sex standardised utilisation of outpatient services by medical scheme membership status, socioeconomic group and race group (2008)

Figure 3: Age–sex standardised utilisation of inpatient services by province and type of area (2008)

Figure 4: Age–sex standardised utilisation of inpatient services by medical scheme membership status, socioeconomic group and ‘race’ group (2008)

Table 4: Multivariate regression of outpatient utilisation (total, public and private services; average number of visits per person per year)

Variable	Total visits	Public sector visits	Private sector visits
Age category: Senior citizens (60 years and above)
Infants (<5 years)	–0.408***	–0.330***	–0.662***
	(0.0695)	(0.0786)	(0.165)
Children (5–14 years)	–1.437***	–1.515***	–1.412***
	(0.0725)	(0.0803)	(0.170)
Adults (15–49 years)	–0.888***	–1.018***	–0.605***
	(0.0578)	(0.0645)	(0.130)
Senior adults (50–59 years)	–0.0546	–0.172**	0.0736
	(0.0683)	(0.0762)	(0.152)
Gender: Female
Male	–0.375***	–0.475***	–0.188**
	(0.0386)	(0.0498)	(0.0808)
Medical scheme: Non-member
Member	0.523***	–1.040***	1.617***
	(0.0970)	(0.160)	(0.109)
Race group: White
African	0.0751	0.850***	–0.347**
	(0.129)	(0.215)	(0.171)
Coloured	0.290**	1.237***	–0.289
	(0.132)	(0.226)	(0.219)
Asian	0.318**	0.567**	0.304
	(0.142)	(0.246)	(0.208)
Province: Western Cape
Eastern Cape	–0.195*	–0.0230	–0.152
	(0.107)	(0.139)	(0.230)
Free State	0.0590	0.0533	0.556**
	(0.115)	(0.149)	(0.239)
Gauteng	0.303***	0.424***	0.362*
	(0.117)	(0.150)	(0.216)
KwaZulu-Natal	0.332***	0.567***	0.285
	(0.110)	(0.140)	(0.227)
Limpopo	0.431***	0.456***	0.723**
	(0.144)	(0.156)	(0.359)
Mpumalanga	0.0194	0.0556	0.517
	(0.137)	(0.149)	(0.320)
North West	–0.118	0.0253	–0.270
	(0.115)	(0.143)	(0.261)
Northern Cape	–0.635***	–0.388***	–1.670***
	(0.111)	(0.131)	(0.290)
Type of area: Formal urban
Rural	0.133	0.118	0.175
	(0.0919)	(0.0983)	(0.190)
Informal urban	0.0778	0.0967	0.129
	(0.0824)	(0.1000)	(0.150)
Quintiles: Quintile 5
Quintiles 1	0.233	0.504***	–0.364
	(0.159)	(0.190)	(0.241)
Quintiles 2	0.137	0.394**	–0.319
	(0.152)	(0.183)	(0.233)
Quintiles 3	0.0992	0.366**	–0.358**
	(0.135)	(0.168)	(0.168)
Quintiles 4	0.0619	0.353**	–0.0981
	(0.125)	(0.164)	(0.142)
Constant	1.833***	0.566**	0.779***
	(0.148)	(0.239)	(0.258)
lnalpha	2.475***	2.804***	3.643***
	(0.0206)	(0.0235)	(0.0363)
Log likelihood	–34 209.43	–26 336.35	–13 322.4
Observations	20 914	20 914	20 914
Notes: ***p < 0.01, **p < 0.05, *p <0.1. Comparison categories in italics.

Table 5: Multivariate regression of in-patient utilisation (total, public and private services; average number of admissions per 1000 population per year)

Variable	Total admissions	Public sector admissions	Private sector admissions
Age category: Senior citizens (60 years and above)
Infants (<5 years)	–890.4***	–965.3***	–579.9**
	(163.2)	(186.7)	(273.0)
Children (5–14 years)	–1 682***	–1 689***	–1 776***
	(167.9)	(192.4)	(320.1)
Adults (15–49 years)	–519.7***	–512.3***	–590.0***
	(124.2)	(144.4)	(191.5)
Senior adults (50–59 years)	–37.59	–52.78	194.3
	(191.3)	(234.1)	(321.8)
Gender: Female
Male	–367.5***	–471.7***	105.3
	(87.17)	(97.37)	(141.5)
Medical scheme: Non-member
Member	377.9***	–1 255***	3 137***
	(144.3)	(296.2)	(218.6)
Race: White
African	–691.7**	–752.6*	–37.10
	(322.1)	(417.9)	(254.4)
Coloured	–313.8	–294.0	169.7
	(297.7)	(400.7)	(234.2)
Asian	–405.7	–617.2	–15.96
	(318.6)	(439.4)	(305.3)
Province: Western Cape
Eastern Cape	–173.0	–121.1	–334.0
	(163.5)	(185.9)	(337.2)
Free State	51.87	–26.03	349.4
	(173.9)	(192.3)	(349.7)
Gauteng	311.7*	261.0	219.2
	(176.7)	(195.6)	(248.9)
KwaZulu-Natal	–150.1	–157.0	107.9
	(159.7)	(183.7)	(318.4)
Limpopo	–90.40	50.99	–1 164**
	(178.4)	(202.1)	(485.9)
Mpumalanga	348.2	617.6**	–254.2
	(228.5)	(300.6)	(362.9)
North West	–342.5*	–310.0	–359.4
	(186.5)	(203.9)	(380.6)
Northern Cape	–367.1**	–494.6***	80.77
	(147.6)	(166.7)	(358.1)
Type of area: Formal urban
Rural	–495.7***	–613.7***	143.5
	(127.7)	(141.2)	(331.5)
Informal urban	–116.2	–88.37	–747.1**
	(128.5)	(136.0)	(329.4)
Quintiles: Quintile 5
Quintiles 1	617.4***	808.6***	9.013
	(225.1)	(259.2)	(551.7)
Quintiles 2	395.3**	621.1***	–2 238***
	(188.4)	(231.4)	(761.0)
Quintiles 3	420.8**	620.5***	–558.2*
	(191.7)	(234.0)	(324.0)
Quintiles 4	84.04	225.0	–208.4
	(185.5)	(235.9)	(218.3)
Constant	–1 243***	–1 343***	–4 688***
	(308.4)	(407.4)	(312.5)
lnalpha	2 093***	2 317***	1 661***
	(107.8)	(115.3)	(304.0)
Log-likelihood	–5 951.98	–5 048.51	–1 203.58
Observations	20 914	20 914	20 914
Notes: ***p < 0.01, **p < 0.05, *p < 0.1. Comparison categories in italics.

Table 6: Age–sex standardised utilisation of outpatient services by geographic areas and various groups (2008; average number of visits per person per year)

	Public providers				Private providers
	Clinic	District hospital	Regional hospital	Provincial / central hospital	Private hospital	General practitioner	Pharmacist	Specialist	Dentist
Type of area
Rural	2.84	0.74	0.26	0.04	0.23	0.22	0.11	0.13	0.02
Informal urban	2.22	0.23	0.42	0.28	0.08	0.34	0.24	0.08	0.09
Formal urban	1.61	0.19	0.28	0.28	0.27	0.65	0.39	0.15	0.18
Province
Eastern Cape	1.58	0.55	0.14	0.19	0.07	0.21	0.13	0.14	0.02
Free State	2.14	0.21	0.17	0.01	0.03	0.58	0.31	0.09	0.07
Gauteng	1.74	0.17	0.53	0.36	0.31	0.58	0.46	0.14	0.22
KwaZulu-Natal	3.17	0.54	0.36	0.06	0.46	0.44	0.21	0.23	0.07
Limpopo	2.95	0.95	0.36	0.06	0.13	0.34	0.10	0.11	0.03
Mpumalanga	1.35	0.43	0.26	0.30	0.11	0.41	0.16	0.03	0.04
North West	2.08	0.27	0.02	0.15	0.10	0.34	0.16	0.05	0.06
Northern Cape	1.24	0.24	0.08	0.12	0.05	0.11	0.00	0.06	0.01
Western Cape	1.95	0.11	0.17	0.25	0.15	0.55	0.43	0.06	0.21
Race group
African	2.38	0.48	0.31	0.18	0.21	0.34	0.17	0.13	0.05
Coloured	2.08	0.17	0.16	0.28	0.12	0.55	0.29	0.06	0.15
Asian	1.19	0.09	0.80	0.18	0.62	1.51	0.84	0.31	0.40
White	0.30	0.06	0.06	0.09	0.42	1.00	1.15	0.24	0.61
Socioeconomic quintiles
Quintile 1	2.81	0.65	0.28	0.07	0.33	0.17	0.08	0.14	0.01
Quintile 2	2.72	0.52	0.33	0.13	0.06	0.26	0.15	0.05	0.06
Quintile 3	2.23	0.36	0.34	0.26	0.09	0.33	0.23	0.13	0.03
Quintile 4	1.69	0.22	0.37	0.30	0.23	0.63	0.22	0.09	0.09
Quintile 5	0.99	0.17	0.12	0.19	0.48	0.96	0.76	0.30	0.41
Medical scheme membership status
Non-member	2.43	0.46	0.33	0.18	0.09	0.28	0.16	0.10	0.04
Member	0.43	0.08	0.04	0.19	1.22	1.53	0.96	0.39	0.55
Total	2.20	0.42	0.29	0.18	0.22	0.42	0.25	0.13	0.10

Table 7: Age–sex standardised utilisation of public inpatient services by geographic areas and various groups (2008; average number of admissions per 1000 population per year)

Variable	District hospital	Regional hospital	Provincial / central hospital	Private hospital
Type of area
Rural	35.52	18.15	4.51	5.13
Informal urban	17.07	53.69	26.20	3.75
Formal urban	24.25	34.18	31.16	32.64
Province
Eastern Cape	28.13	21.36	15.28	7.23
Free State	47.40	35.50	4.28	15.72
Gauteng	19.49	50.08	39.64	32.14
KwaZulu-Natal	26.21	34.14	7.25	14.40
Limpopo	38.54	21.44	5.64	3.42
Mpumalanga	39.17	19.71	21.80	12.54
North West	31.19	1.14	19.58	5.74
Northern Cape	41.18	16.39	17.45	10.83
Western Cape	9.37	41.87	33.68	31.14
Race group
African	29.44	31.73	13.80	9.91
Coloured	20.91	43.68	27.17	27.10
Asian	0.80	30.44	20.50	46.45
White	22.84	1.80	82.00	79.88
Socioeconomic quintiles
Quintiles 1	33.66	29.54	9.57	6.24
Quintiles 2	31.82	33.91	9.00	1.34
Quintiles 3	37.62	40.46	21.31	4.51
Quintiles 4	15.37	33.95	31.06	14.70
Quintiles 5	13.05	13.60	34.68	74.94
Medical scheme membership status
Non-member	29.58	34.37	21.21	3.68
Member	12.10	4.69	6.31	116.70
Total	27.58	30.97	19.51	16.68