Progressivity of out-of-pocket payments and its determinants decomposed over time

Figures & data

Table 1. Summary statistics of analysis data.

	IES 2005		IES 2010–11 3
	Wtd Mean	95% Confidence	Wtd Mean	95% Confidence
Household (HH) head age	46.550	(46.34,46.76)	46.364	(46.17,46.55)
Household head is male	0.611	(0.60,0.62)	0.606	(0.60,0.61)
Number of children in HH	1.222	(1.20,1.24)	1.207	(1.19,1.22)
Children under 5 in HH	0.411	(0.40,0.42)	0.396	(0.39,0.40)
Number of adults in HH	2.579	(2.56,2.60)	2.637	(2.62,2.66)
Elderly adults in HH	0.294	(0.29,0.30)	0.294	(0.29,0.30)
Urban residence	0.651	(0.64,0.66)	0.673	(0.67,0.68)
Medical aid coverage	0.184	(0.18,0.19)	0.210	(0.21,0.22)
Flush toilet on site	0.569	(0.56,0.58)	0.608	(0.60,0.61)
HH head with no schooling	0.137	(0.13,0.14)	0.097	(0.09,0.10)
HH head with some primary school	0.268	(0.26,0.27)	0.244	(0.24,0.25)
HH head completed primary	0.324	(0.32,0.33)	0.348	(0.34,0.35)
HH head completed secondary	0.228	(0.22,0.23)	0.245	(0.24,0.25)
HH head completed tertiary	0.043	(0.04,0.05)	0.066	(0.06,0.07)
Household head is African	0.769	(0.76,0.77)	0.766	(0.76,0.77)
HH head is Coloured	0.078	(0.07,0.08)	0.085	(0.08,0.09)
HH head is Asian	0.025	(0.02,0.03)	0.025	(0.02,0.03)
HH head is White	0.128	(0.12,0.13)	0.124	(0.12,0.13)
HH from the Western Cape	0.102	(0.10,0.11)	0.108	(0.10,0.11)
HH from the Eastern Cape	0.139	(0.13,0.14)	0.127	(0.12,0.13)
HH from the Northern Cape	0.024	(0.02,0.03)	0.018	(0.02,0.02)
HH from the Free State	0.072	(0.07,0.08)	0.060	(0.06,0.06)
HH from KwaZulu-Natal	0.178	(0.17,0.18)	0.182	(0.18,0.19)
HH from the North West	0.073	(0.07,0.08)	0.076	(0.07,0.08)
HH from Gauteng	0.238	(0.23,0.24)	0.260	(0.25,0.27)
HH from Mpumalanga	0.071	(0.07,0.07)	0.065	(0.06,0.07)
HH from Limpopo	0.104	(0.10,0.11)	0.104	(0.10,0.11)
HH Assets (normalised)	5.74	(5.69,5.79)	5.48	(5.44,5.53)
HH out-of-pocket payments (ZAR)	85.59	(78.23,92.95)	89.89	(84.17,95.61)
WHO capacity-to-pay (ZAR)	4891.07	(4760.30,5021.84)	6250.92	(6108.97,6392.86)
Adult equivalent total expenditure (ZAR)	2560.55	(2495.07,2626.03)	3054.49	(2988.93,3120.05)
Adult equivalent nonfood expenditure (ZAR)	2354.06	(2286.26,2421.86)	2611.61	(2549.22,2674.00)
Total household expenditure (ZAR)	5703.63	(5568.18,5839.08)	7088.71	(6943.29,7234.14)
Total nonfood expenditure (ZAR)	5210.84	(5070.86,5350.81)	6040.86	(5901.61,6180.12)
Total income (ZAR)	7647.97	(7424.73,7871.22)	8910.83	(8729.38,9092.28)

Notes: Weighted means and 95% confidence intervals around those means. Data from the 2005–06 and 2010–11 South African Income and Expenditure Survey: (Statistics South Africa, 2008b, 2012b). The total number of observations for 2005–06 and 2010–11 are 20 994 and 25 124, respectively.

Figure 1. Concentration Curves for out-of-pocket payment concentration and out-of-pocket payment as a share of the capacity-to-pay for the years 2005-06 and 2010. Note: Out-of-pocket payment share denominators are determined by different capacities to pay: adult equivalent total expenditure (AETE), adult equivalent nonfood expenditure (AENFE) and non-subsistence expenditure (NSE). Socioeconomic status is determined by household income per adult equivalent, and all data is weighted. (a) Concentration in 2005. (b) Concentration in 2010.

Table 2. Estimated concentration indexes and standard errors for out-of-pocket payments and shares relative to capacity-to-pay.

	NSE	AETE	AENFE	OOP
Concentration in 2005	−0.1111 (0.007)	−0.1324 (0.008)	−0.2013 (0.008)	0.5355 (0.025)
Concentrtation in 2010	−0.0887 (0.007)	−0.0941 (0.008)	−0.1667 (0.007)	0.4976 (0.018)

Note: Out-of-pocket payment share denominators are determined by different capacities to pay: adult equivalent total expenditure (AETE), adult equivalent nonfood expenditure (AENFE) and non-subsistence expenditure (NSE). Socioeconomic status is determined by household income per adult equivalent, and all data is weighted.

Table 3. Concentration index decomposition (2005), where socioeconomic status is based on adult equivalent household income.

	NSE				AETE				AENFE				OOP
	CI	η	Total	%	CI	η	Total	%	CI	η	Total	%	CI	η	Total	%
Health payment concentration	−0.111				−0.132				−0.201				0.536
Adult Equivalent Income	0.691	−0.010	−0.007	6.08	0.691	0.002	0.001	−0.96	0.691	0.002	0.001	−0.57	0.691	0.278	0.192	35.89
Age of household (hh) head	−0.016	0.361	−0.006	5.06	−0.016	0.242	−0.004	2.85	−0.016	0.208	−0.003	1.61	−0.016	0.570	−0.009	−1.66
Male hh head	0.126	−0.072	−0.009	8.14	0.126	−0.057	−0.007	5.37	0.126	−0.045	−0.006	2.81	0.126	0.104	0.013	2.45
Kids in hh	−0.257	−0.015	0.004	−3.38	−0.257	0.146	−0.038	28.33	−0.257	0.162	−0.042	20.71	−0.257	0.206	−0.053	−9.87
Kids under 5 in hh	−0.264	0.060	−0.016	14.33	−0.264	0.060	−0.016	11.88	−0.264	0.067	−0.018	8.78	−0.264	−0.028	0.007	1.40
Adults in hh	−0.081	−0.137	0.011	−9.95	−0.081	0.582	−0.047	35.51	−0.081	0.558	−0.045	22.42	−0.081	0.033	−0.003	−0.50
Adults over 60 in hh	−0.058	0.044	−0.003	2.30	−0.058	0.055	−0.003	2.40	−0.058	0.050	−0.003	1.44	−0.058	0.073	−0.004	−0.79
Urban residence	0.166	−0.082	−0.014	12.31	0.166	−0.094	−0.016	11.83	0.166	−0.110	−0.018	9.07	0.166	−0.027	−0.005	−0.84
Access to medical aid	0.678	0.000	0.000	−0.13	0.678	0.029	0.019	−14.64	0.678	−0.000	−0.000	0.02	0.678	0.146	0.099	18.46
Flush toilet on-site	0.247	−0.128	−0.032	28.49	0.247	−0.055	−0.014	10.28	0.247	−0.103	−0.025	12.57	0.247	−0.030	−0.007	−1.39
HH head some schooling	−0.263	0.001	−0.000	0.19	−0.263	0.020	−0.005	3.92	−0.263	−0.011	0.003	−1.43	−0.263	0.065	−0.017	−3.19
HH head completed primary	−0.007	−0.022	0.000	−0.14	−0.007	0.023	−0.000	0.12	−0.007	−0.033	0.000	−0.12	−0.007	0.124	−0.001	−0.16
HH head completed secondary	0.406	−0.034	−0.014	12.48	0.406	0.010	0.004	−3.00	0.406	−0.035	−0.014	7.06	0.406	0.086	0.035	6.50
HH head completed tertiary	0.798	−0.003	−0.003	2.37	0.798	0.004	0.003	−2.63	0.798	−0.005	−0.004	1.86	0.798	0.128	0.102	19.03
HH head: mixed ethnicity	0.127	−0.008	−0.001	0.88	0.127	−0.015	−0.002	1.43	0.127	−0.013	−0.002	0.84	0.127	0.011	0.001	0.26
HH head: asian ethnicity	0.388	0.000	0.000	−0.02	0.388	0.003	0.001	−1.00	0.388	−0.001	−0.000	0.22	0.388	0.013	0.005	0.92
HH head: white ethnicity	0.748	0.008	0.006	−5.09	0.748	0.002	0.002	−1.27	0.748	−0.001	−0.000	0.22	0.748	0.217	0.162	30.27
Eastern Cape	−0.180	0.009	−0.002	1.52	−0.180	0.010	−0.002	1.30	−0.180	0.003	−0.001	0.31	−0.180	0.006	−0.001	−0.20
Northern Cape	−0.090	−0.000	0.000	−0.03	−0.090	0.002	−0.000	0.11	−0.090	−0.000	0.000	−0.01	−0.090	0.001	−0.000	−0.02
Free State	0.015	0.015	0.000	−0.20	0.015	0.023	0.000	−0.27	0.015	0.014	0.000	−0.10	0.015	0.042	0.001	0.12
KwaZulu-Natal	−0.105	0.069	−0.007	6.49	−0.105	0.067	−0.007	5.31	−0.105	0.064	−0.007	3.36	−0.105	0.031	−0.003	−0.61
North West	−0.034	−0.007	0.000	−0.22	−0.034	0.002	−0.000	0.06	−0.034	−0.006	0.000	−0.10	−0.034	0.009	−0.000	−0.06
Gauteng	0.215	−0.008	−0.002	1.49	0.215	−0.009	−0.002	1.44	0.215	−0.018	−0.004	1.98	0.215	0.091	0.020	3.66
Mpumalanga	−0.124	−0.002	0.000	−0.18	−0.124	0.000	−0.000	0.00	−0.124	−0.005	0.001	−0.30	−0.124	0.011	−0.001	−0.25
Limpopo	−0.225	−0.033	0.007	−6.61	−0.225	−0.028	0.006	−4.83	−0.225	−0.039	0.009	−4.37	−0.225	0.006	−0.001	−0.25
Residual			−0.026	23.83			−0.009	6.46			−0.024	11.73			0.004	0.82

Wagstaff and van Doorslaer (2003) decomposition, where $\eta =\text{β}{\overline{X}}_k/\mu$ is the elasticity, Total is the contribution to the index from that determinant and % is the percent of the total. NSE refers to non-subsistence expenditure, as defined by Xu (2005). In all cases out-of-pocket expenditure follows (Xu, 2005). AETE refers to adult equivalent total expenditure as defined by O'Donnell et al. (2008). AENFE refers to adult equivalent nonfood expenditure as defined by Wagstaff and van Doorslaer (2003).

Table 4. Concentration index decomposition (2010), where socioeconomic status is based on adult equivalent household income.

	NSE				AETE				AENFE				OOP
	CI	η	Total	%	CI	η	Total	%	CI	η	Total	%	CI	η	Total	%
Health payment concentration	−0.089				−0.094				−0.167				0.498
Adult Equivalent Income	0.665	−0.057	−0.038	42.41	0.665	−0.038	−0.026	27.12	0.665	−0.031	−0.021	12.55	0.665	0.256	0.170	34.19
Age of household (hh) head	−0.001	0.186	−0.000	0.19	−0.001	0.114	−0.000	0.11	−0.001	0.060	−0.000	0.03	−0.001	−0.036	0.000	0.01
Male hh head	0.115	−0.037	−0.004	4.76	0.115	−0.017	−0.002	2.03	0.115	−0.027	−0.003	1.88	0.115	0.079	0.009	1.83
Kids in hh	−0.209	−0.009	0.002	−2.17	−0.209	0.153	−0.032	33.81	−0.209	0.180	−0.038	22.57	−0.209	0.029	−0.006	−1.21
Kids under 5 in hh	−0.223	0.034	−0.008	8.62	−0.223	0.039	−0.009	9.21	−0.223	0.034	−0.008	4.61	−0.223	0.085	−0.019	−3.81
Adults in hh	−0.058	−0.102	0.006	−6.64	−0.058	0.639	−0.037	39.26	−0.058	0.625	−0.036	21.67	−0.058	0.227	−0.013	−2.64
Adults over 60 in hh	0.029	0.017	0.001	−0.57	0.029	0.021	0.001	−0.66	0.029	0.020	0.001	−0.36	0.029	0.059	0.002	0.35
Urban residence	0.157	0.012	0.002	−2.09	0.157	−0.020	−0.003	3.35	0.157	−0.049	−0.008	4.63	0.157	−0.007	−0.001	−0.23
Access to medical aid	0.649	−0.026	−0.017	18.70	0.649	−0.014	−0.009	9.36	0.649	−0.038	−0.025	14.92	0.649	0.131	0.085	17.07
Flush toilet on-site	0.220	−0.179	−0.039	44.49	0.220	−0.100	−0.022	23.36	0.220	−0.159	−0.035	21.02	0.220	−0.082	−0.018	−3.64
HH head some schooling	−0.301	−0.001	0.000	−0.49	−0.301	−0.015	0.005	−4.92	−0.301	−0.025	0.008	−4.51	−0.301	0.005	−0.002	−0.30
HH head completed primary	−0.067	−0.051	0.003	−3.86	−0.067	−0.035	0.002	−2.46	−0.067	−0.074	0.005	−2.97	−0.067	0.028	−0.002	−0.38
HH head completed secondary	0.353	−0.057	−0.020	22.63	0.353	−0.036	−0.013	13.64	0.353	−0.073	−0.026	15.41	0.353	0.000	0.000	0.02
HH head completed tertiary	0.731	−0.011	−0.008	8.71	0.731	−0.005	−0.004	3.86	0.731	−0.015	−0.011	6.76	0.731	0.061	0.045	8.98
HH head: mixed ethnicity	0.153	0.001	0.000	−0.16	0.153	−0.000	−0.000	0.06	0.153	0.002	0.000	−0.16	0.153	0.019	0.003	0.57
HH head: asian ethnicity	0.484	−0.001	−0.001	0.78	0.484	0.001	0.000	−0.52	0.484	−0.003	−0.001	0.74	0.484	0.019	0.009	1.87
HH head: white ethnicity	0.699	0.039	0.027	−30.69	0.699	0.044	0.031	−32.61	0.699	0.033	0.023	−13.77	0.699	0.265	0.185	37.20
Eastern Cape	−0.224	−0.066	0.015	−16.77	−0.224	−0.067	0.015	−15.98	−0.224	−0.073	0.016	−9.82	−0.224	−0.081	0.018	3.65
Northern Cape	0.024	−0.008	−0.000	0.21	0.024	−0.008	−0.000	0.20	0.024	−0.008	−0.000	0.11	0.024	−0.011	−0.000	−0.05
Free State	−0.036	0.024	−0.001	0.98	−0.036	0.031	−0.001	1.17	−0.036	0.027	−0.001	0.58	−0.036	−0.007	0.000	0.05
KwaZulu-Natal	−0.089	0.007	−0.001	0.69	−0.089	0.007	−0.001	0.62	−0.089	0.005	−0.000	0.25	−0.089	−0.066	0.006	1.18
North West	−0.100	−0.031	0.003	−3.46	−0.100	−0.025	0.003	−2.68	−0.100	−0.032	0.003	−1.94	−0.100	−0.042	0.004	0.85
Gauteng	0.244	−0.020	−0.005	5.58	0.244	−0.006	−0.002	1.66	0.244	−0.022	−0.005	3.23	0.244	0.011	0.003	0.54
Mpumalanga	−0.067	0.006	−0.000	0.46	−0.067	0.010	−0.001	0.69	−0.067	0.004	−0.000	0.17	−0.067	−0.014	0.001	0.19
Limpopo	−0.279	−0.064	0.018	−20.25	−0.279	−0.063	0.017	−18.53	−0.279	−0.076	0.021	−12.63	−0.279	−0.059	0.016	3.31
Residual			−0.025	27.96			−0.008	8.85			−0.025	15.02			0.002	0.39

Note: Wagstaff and van Doorslaer (2003) decomposition, where $\eta =\text{β}{\overline{X}}_k/\mu$ is the elasticity, Total is the contribution to the index from that determinant and % is the percent of the total. NSE refers to non-subsistence expenditure, as defined by Xu (2005). In all cases out-of-pocket expenditure follows Xu (2005). AETE refers to adult equivalent total expenditure as defined by O'Donnell et al. (2008). AENFE refers to adult equivalent nonfood expenditure as defined by Wagstaff and van Doorslaer (2003).

Table 5. Concentration index decomposition from 2005-06 to 2010, where socioeconomic status is based on a first principal component asset index.

	NSE				AETE				AENFE				OOP
	$\eta \mathrm{\Delta }C$	$C\mathrm{\Delta }\eta$	Total	Percent	$\eta \mathrm{\Delta }C$	$C\mathrm{\Delta }\eta$	Total	Percent	$\eta \mathrm{\Delta }C$	$C\mathrm{\Delta }\eta$	Total	Percent	$\eta \mathrm{\Delta }C$	$C\mathrm{\Delta }\eta$	Total	Percent
Δ Concentration			0.022	100.0			0.038	100.0			0.035	100.0			−0.038	100.0
Adult Equivalent Income	0.001	−0.032	−0.031	−137.6	0.001	−0.028	−0.027	−69.9	0.001	−0.023	−0.022	−63.6	−0.007	−0.016	−0.022	58.2
Age of household (hh) head	0.003	0.003	0.005	24.3	0.002	0.002	0.004	9.6	0.001	0.002	0.003	9.2	−0.001	0.009	0.009	−23.5
Male hh head	0.000	0.004	0.005	21.5	0.000	0.005	0.005	13.6	0.000	0.002	0.003	7.3	−0.001	−0.003	−0.004	10.6
Kids in hh	−0.000	−0.001	−0.002	−8.2	0.007	−0.002	0.006	14.9	0.009	−0.005	0.004	11.8	0.001	0.045	0.047	−123.4
Kids under 5 in hh	0.001	0.007	0.008	36.9	0.002	0.005	0.007	18.4	0.001	0.009	0.010	28.8	0.004	−0.030	−0.026	69.7
Adults in hh	−0.002	−0.003	−0.005	−23.1	0.015	−0.005	0.010	26.3	0.014	−0.005	0.009	26.0	0.005	−0.016	−0.010	27.5
Adults over 60 in hh	0.002	0.002	0.003	13.6	0.002	0.002	0.004	9.9	0.002	0.002	0.004	10.1	0.005	0.001	0.006	−15.6
Urban residence	−0.000	0.016	0.016	69.3	0.000	0.012	0.013	32.7	0.000	0.010	0.011	30.4	0.000	0.003	0.003	−8.9
Access to medical aid	0.001	−0.017	−0.017	−74.6	0.000	−0.029	−0.028	−73.6	0.001	−0.026	−0.025	−71.6	−0.004	−0.010	−0.014	36.7
Flush toilet on-site	0.005	−0.013	−0.008	−34.8	0.003	−0.011	−0.008	−21.8	0.004	−0.014	−0.010	−28.1	0.002	−0.013	−0.011	28.0
HH head some schooling	0.000	0.001	0.001	2.8	0.001	0.009	0.010	25.6	0.001	0.004	0.005	13.4	−0.000	0.016	0.016	−41.0
HH head completed primary	0.003	0.000	0.003	14.6	0.002	0.000	0.002	6.5	0.004	0.000	0.005	13.6	−0.002	0.001	−0.001	2.7
HH head completed secondary	0.003	−0.009	−0.006	−27.7	0.002	−0.019	−0.017	−43.9	0.004	−0.015	−0.011	−33.1	−0.000	−0.035	−0.035	91.4
HH head completed tertiary	0.001	−0.006	−0.005	−22.7	0.000	−0.007	−0.007	−18.6	0.001	−0.009	−0.008	−21.7	−0.004	−0.053	−0.057	150.8
HH head: mixed ethnicity	0.000	0.001	0.001	5.0	−0.000	0.002	0.002	4.8	0.000	0.002	0.002	5.7	0.000	0.001	0.001	−3.8
HH head: asian ethnicity	−0.000	−0.001	−0.001	−3.2	0.000	−0.001	−0.001	−2.2	−0.000	−0.001	−0.001	−2.3	0.002	0.002	0.004	−11.5
HH head: white ethnicity	−0.002	0.023	0.022	96.2	−0.002	0.031	0.029	75.6	−0.002	0.025	0.023	67.4	−0.013	0.036	0.023	−60.6
Eastern Cape	0.003	0.014	0.017	73.9	0.003	0.014	0.017	43.7	0.003	0.014	0.017	48.9	0.004	0.016	0.019	−50.6
Northern Cape	−0.001	0.001	−0.000	−1.0	−0.001	0.001	−0.000	−0.1	−0.001	0.001	−0.000	−0.6	−0.001	0.001	−0.000	0.4
Free State	−0.001	0.000	−0.001	−4.9	−0.002	0.000	−0.001	−3.8	−0.001	0.000	−0.001	−3.4	0.000	−0.001	−0.000	1.0
KwaZulu-Natal	0.000	0.006	0.007	29.4	0.000	0.006	0.006	16.8	0.000	0.006	0.006	18.3	−0.001	0.010	0.009	−24.1
North West	0.002	0.001	0.003	12.6	0.002	0.001	0.003	6.8	0.002	0.001	0.003	8.7	0.003	0.002	0.005	−11.9
Gauteng	−0.001	−0.003	−0.003	−14.7	−0.000	0.001	0.000	0.9	−0.001	−0.001	−0.001	−4.1	0.000	−0.017	−0.017	44.7
Mpumalanga	0.000	−0.001	−0.001	−2.7	0.001	−0.001	−0.001	−1.7	0.000	−0.001	−0.001	−2.6	−0.001	0.003	0.002	−6.0
Limpopo	0.003	0.007	0.011	47.4	0.003	0.008	0.011	28.8	0.004	0.008	0.012	35.3	0.003	0.015	0.018	−46.9
Residual			0.002	7.5			0.000	0.6			−0.001	−4.1			−0.002	6.4

Note: Wagstaff and van Doorslaer (2003) decomposition, where $\eta =\text{β}{\overline{X}}_k/\mu$ is the elasticity, Total is the contribution to the index from that determinant and % is the percent of the total. NSE refers to non-subsistence expenditure, as defined by Xu (2005). In all cases out-of-pocket expenditure follows Xu (2005). AETE refers to adult equivalent total expenditure as defined by O'Donnell et al. (2008). AENFE refers to adult equivalent nonfood expenditure as defined by Wagstaff and van Doorslaer (2003).

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