Have pro-poor health policies improved the targeting of spending and the effective delivery of health care in South Africa?
AbstractSince 1994 there have been a number of radical changes in the public health care system in South Africa. Budgets have been reallocated, decision making was decentralised, the clinic network was expanded and user fees for primary health care were abolished. The paper examines how these recent changes have affected the incidence of spending and the accessibility and quality of health care. The paper finds that between 1995 and 2003 there have been advances in the pro-poor spending incidence of both clinics and hospitals. The increased share of the health budget allocated to the more pro-poor clinic services has contributed further to the improvement in the targeting of overall health spending. Also, it appears that the elimination of user fees for clinics and the expansion of the clinic network have helped to make health services more affordable and geographically accessible to the poor and were associated with a notable rise in health service utilisation for individuals in the bottom two expenditure quintiles. South Africa’s spending on clinics and hospitals is well targeted and more progressive than other developing country public health systems. Unfortunately, it appears that to a considerable extent this result is driven by perceptions that services offered in public hospitals and clinics are of a low and variable quality. These perceptions seem to be encouraging most of those who can afford to pay more for health services to opt out of the public health system, thereby increasing the pro-poor incidence of public health spending. Complaints by users of public health facilities include long waiting times, staff rudeness and problems with drug availability. Dissatisfaction with health services is significantly higher in the public sector than in the private sector and the gap has expanded slightly over time. It is consequently not surprising that a substantial and increasing share of individuals – also including the very poorest – prefer to consult private providers.
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Bibliographic InfoPaper provided by Stellenbosch University, Department of Economics in its series Working Papers with number 12/2006.
Date of creation: 2006
Date of revision:
fiscal incidence; South Africa; health;
Other versions of this item:
- Ronelle Burger & Christelle Grobler, 2007. "Have Pro-Poor Health Policies Improved the Targeting of Spending and the Effective Delivery of Health Care in South Africa?," Working Papers 07122, University of Cape Town, Development Policy Research Unit.
- H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
- I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
This paper has been announced in the following NEP Reports:
- NEP-AFR-2006-09-30 (Africa)
- NEP-ALL-2006-09-30 (All new papers)
- NEP-DEV-2006-09-30 (Development)
- NEP-HEA-2006-09-30 (Health Economics)
- NEP-PBE-2006-09-30 (Public Economics)
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- Roy Havemann & Servaas van der Berg, 2002. "The demand for health care in South Africa," Working Papers 06/2002, Stellenbosch University, Department of Economics.
- David E. Sahn & Stephen D. Younger, 2000. "Expenditure incidence in Africa: microeconomic evidence," Fiscal Studies, Institute for Fiscal Studies, vol. 21(3), pages 329-347, September.
- Magnus Lindelow, 2005. "The Utilisation of Curative Healthcare in Mozambique: Does Income Matter?," Journal of African Economies, Centre for the Study of African Economies (CSAE), vol. 14(3), pages 435-482, September.
- Ronelle Burger, 2007. "Policy Brief: How pro-poor is the South African Health System?," Working Papers 06/2007, Stellenbosch University, Department of Economics.
- Steven F. Koch, 2012.
"The Abolition Of User Fees And The Demand For Health Care: Re-Evaluating The Impact,"
201219, University of Pretoria, Department of Economics.
- Steven F. Koch, 2012. "The Abolition of User Fees and the Demand for Health Care: Re-evaluating the Impact," Working Papers 301, Economic Research Southern Africa.
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