Inequities in access to health care in South Africa

Abstract

Achieving equitable universal health coverage requires the provision of accessible, necessary services for the entire population without imposing an unaffordable burden on individuals or households. In South Africa, little is known about access barriers to health care for the general population. We explore affordability, availability, and acceptability of services through a nationally representative household survey (n = 4668), covering utilization, health status, reasons for delaying care, perceptions and experiences of services, and health-care expenditure. Socio-economic status, race, insurance status, and urban-rural location were associated with access to care, with black Africans, poor, uninsured and rural respondents, experiencing greatest barriers. Understanding access barriers from the user perspective is important for expanding health-care coverage, both in South Africa and in other low- and middle-income countries.

Comparison in the incidence of anorectal malformations between a first- and third-world referral center

“…Access to and completeness of patient records remains difficult in the overfull South African hospitals equipped with little or no electronic documentation systems [29,30]. Moreover, as noted by Wijers et al, detailed definitive diagnosis according to the Krickenbeck criteria are often not denoted, and that together with possible misdiagnoses may account for some of the 'unknown' diagnoses in the South African arm of this study [9,22,28].…”

“…The relative dearth in resources and abject patient poverty as remnants from the former apartheid government are very real challenges that face the South African health system [29,33]. Patients have poor access to referral centers, having to travel vast distances, leaving other dependents and possibly their jobs for relatively long periods during the course of treatment [33][34][35].…”

“…Patients have poor access to referral centers, having to travel vast distances, leaving other dependents and possibly their jobs for relatively long periods during the course of treatment [33][34][35]. Many ARM diagnoses may be missed or delayed in the primary health care settings, rife with overcrowding, under facilitation and lack of specialist backup [29,34]. Referral systems from rural clinics to tertiary facilities are poorly functional and difficult to access [29,30,33,35].…”

“…Many ARM diagnoses may be missed or delayed in the primary health care settings, rife with overcrowding, under facilitation and lack of specialist backup [29,34]. Referral systems from rural clinics to tertiary facilities are poorly functional and difficult to access [29,30,33,35]. Noted by Beudeker et al, Malawian patients that lived closer to tertiary institutions had a better diagnosis and survival rate [25].…”

Cortical bone histomorphology of known‐age skeletons from the Kirsten collection, Stellenbosch university, South Africa

“…Evidence suggests that income poverty and racial inequality intensified during the transition to democracy (Seekings, 2011). In the post‐apartheid era, residential segregation persists in the urban areas (Christopher, 2001), and differential access to both public and private health services underscores the difficulty of changing social policy (Harris et al, 2011). …”