Moving towards universal coverage in South Africa? Lessons from a voluntary government insurance scheme

Figures & data

Table 1. Associations between health insurance, demographic characteristics and income level among public-sector employees in South Africa

		Insurance scheme (%)
		Government scheme
Variable (n)	Insured% (n)	Newly insured	Previously insured	Other schemes	p
Age (years)
20–29 (141)	53.9 (76)	39.5	19.7	40.8	<0.001
30–39 (402)	74.4 (299)	18.7	26.4	54.9
40–49 (468)	78.6 (368)	6.3	31.3	62.5
50–59 (268)	76.5 (205)	5.9	35.1	59.0
≥60 (46)	80.5 (37)	2.7	27.0	70.3
Sex
Female (778)	78.8 (613)	13.4	28.2	58.4	0.317
Male (548)	67.7 (371)	10.8	31.8	57.4
Marital status
Married/cohabiting (806)	77.8 (627)	7.3	30.6	62.1	<0.001
Div./sep./widow (149)	77.2 (115)	8.7	38.3	53.0
Single (375)	65.6 (246)	26.8	22.8	50.4
Education level
None/prim. comp (168)	48.8 (82)	18.3	30.5	51.2	<0.001
Incomp. secondary (102)	66.7 (68)	14.7	33.8	51.5
Comp. secondary (184)	63.0 (116)	23.3	39.7	37.0
Diploma (360)	79.2 (285)	14.7	27.7	57.6
Degree (516)	84.7 (437)	6.4	27.2	66.4
Housing
Formal (1272)	75.9 (966)	11.8	29.8	58.4	0.003
Informal (50)	40.0 (20)	40.0	20.0	40.0
Race
Black African (858)	71.1 (610)	16.1	27.9	56.0	<0.001
Coloured (253)	70.7 (179)	10.0	33.0	57.0
Indian/Asian (77)	87.0 (67)	6.0	34.3	59.7
White (132)	93.9 (124)	0.8	31.5	67.7
Salary category
Lower skilled (168)	42.3 (71)	31.0	22.5	46.5	<0.001
Skilled (246)	60.6 (149)	27.5	37.6	34.9
Highly-skilled (709)	81.2 (576)	9.6	28.3	62.1
Supervisory and Senior Management (206)	92.7 (191)	2.1	29.8	68.1
Province
Gauteng (344)	70.4 (242)	17.7	32.3	50.0	<0.001
KwaZulu-Natal (310)	72.6 (225)	17.3	24.9	57.8
North West (329)	82.4 (271)	5.9	29.2	64.9
Western Cape (343)	72.6 (249)	9.6	31.8	58.6
Self-assessed health status
Excellent (320)	71.3 (228)	17.6	29.8	52.6	0.021
Good (633)	75.8 (480)	10.2	31.0	58.8
Average (342)	74.5 (255)	11.0	25.5	63.5
Poor (34)	73.5 (25)	20.0	40.0	40.0
Individual on chronic medication
Yes (385)	86.7 (334)	8.1	32.3	59.6	0.013
No (923)	69.5 (641)	14.4	27.9	57.7
Total	74.3 (988)	12.4	29.5	58.1

Table 2. Multivariate logistic regression analysis of factors associated with uptake of the government insurance scheme (newly insured and previously insured by other schemes)

	Adjusted odds ratio	(95% CI)
Age
20–29	1.0
30–39	0.83	0.47–1.48
40–49	0.57*	0.32–1.03
50–59	0.62	0.33–1.17
≥60	0.28*	0.11–0.74
Sex
Female	1.0
Male	0.69*	0.51–0.93
Marital status
Married/cohabiting	1.0
Divorced/separated/widowed	1.60*	1.03–2.48
Single	1.35	0.97–1.90
Housing
Formal	1.0
Informal	1.73	0.63–4.72
Salary category
Lower skilled	1.0
Skilled	1.51	0.82–2.75
Highly-skilled	0.48**	0.28–0.81
Supervisory and Senior Management	0.39**	0.22–0.71
Province
Gauteng	1.0
KwaZulu-Natal	0.69*	0.46–1.01
North West	0.58**	0.40–0.85
Western Cape	0.76	0.52–1.11
Individual on chronic medication
Yes	1.0
No	0.94	0.69–1.27

CI, confidence interval.

*p<0.1; **p<0.05.

Table 3. Choice of government scheme's benefit options

	Salary category(%)
Benefit option chosen	Lower skilled	Skilled	Highly-skilled	Supervisory and Senior Management	Total
Option 1: Low cost	19.4	9.4	0.5	1.7	4.4
Option 2: Low Cost	13.9	7.3	0.5	0.0	3.2
Option 3: Mid-range savings	11.1	5.2	11.1	5.0	8.8
Option 4: Comprehensive	55.6	75.0	80.6	65.0	74.8
Option 5: Comprehensive	0.0	3.1	7.4	28.3	8.8
Total	100 (36)	100 (96)	100 (216)	100 (60)	100 (408)

Table 4. Factors influencing the decision to join the subsidised government scheme

Factors	Salary category(%)
Affordability	Lower skilled	Skilled	Highly-skilled	Supervisory and Senior Management	Overall(%)
Insured joined because scheme affordable	57.9	65.0	70.2	67.2	67.4
Uninsured did not join because scheme expensive	40.2	40.2	27.1	33.3	34.8
Uninsured would join if scheme more affordable	34.0	32.0	34.6	13.3	32.8
Benefit options and coverage
Insured joined as scheme offered better benefits and covered more dependents	36.8	41.2	33.5	49.2	37.9
Uninsured would join if more dependents were covered	2.1	2.1	0.0	0.0	1.2
Administrative complexity of scheme
Insured joined as administrative procedures easy	2.6	10.3	6.0	11.5	7.5
Uninsured did not join as administrative procedures complex	28.9	21.7	17.3	20.0	21.9
Information about scheme
Uninsured did not join scheme as lacked information	23.7	23.7	15.8	6.7	19.9
Uninsured would join if more information provided	2.1	2.1	0.0	0.0	1.2
Need for health insurance
Uninsured did not join as insurance not needed	10.3	15.5	17.3	26.7	15.2
Uninsured would join if there was a health need	41.2	44.3	31.6	33.3	38.0

Multiple-response questions.

Table 5. Employee contributions (percent of monthly salary) towards monthly insurance contributions

	Salary category
Benefit option	Lower skilled	Skilled	Highly-skilled	Supervisory	Senior Management
Low-cost option 1	0.0	0.0	3.5	1.6	0.5
Low-cost option 2	7.6	6.5	4.1	2.7	0.9
Mid-range savings option 1	13.0	10.2	7.0	5.2	1.7
Comprehensive option 2	13.5	10.5	8.0	5.8	1.9
Comprehensive option 3	34.5	27.0	16.9	10.7	3.4

1US$=7.5 South African Rand.

Financial contributions calculations assume a family of three (member, and an adult and child dependant). Percent monthly contribution is calculated as a proportion on the lowest level in each salary category. Income from other household members is unknown, and hence not included in the calculation.