Primary healthcare seeking behaviour of low-income patients across the public and private health sectors in South Africa
Abstract Background The proposed National Health Insurance (NHI) system aims to re-engineer primary healthcare (PHC) in South Africa, envisioning both private sector providers and public sector clinics as independent contracting units to the NHI Fund. In 2017, 16% of the South African population had...
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doaj-ed3c25df66d74c578752cddf75604ea12021-09-12T11:14:50ZengBMCBMC Public Health1471-24582021-09-0121111010.1186/s12889-021-11678-9Primary healthcare seeking behaviour of low-income patients across the public and private health sectors in South AfricaKerensa Govender0Sarah Girdwood1Daniel Letswalo2Lawrence Long3G. Meyer-Rath4J. Miot5Department of Internal Medicine, Faculty of Health Sciences, University of the WitwatersrandDepartment of Internal Medicine, Faculty of Health Sciences, University of the WitwatersrandHealth Economics and Epidemiology Research Office (HE2RO), Wits Health Consortium, University of the WitwatersrandDepartment of Internal Medicine, Faculty of Health Sciences, University of the WitwatersrandDepartment of Internal Medicine, Faculty of Health Sciences, University of the WitwatersrandDepartment of Internal Medicine, Faculty of Health Sciences, University of the WitwatersrandAbstract Background The proposed National Health Insurance (NHI) system aims to re-engineer primary healthcare (PHC) in South Africa, envisioning both private sector providers and public sector clinics as independent contracting units to the NHI Fund. In 2017, 16% of the South African population had private medical insurance and predominately utilised private providers. However, it is estimated that up to 28% of the population access private PHC services, with a meaningful segment of the low-income, uninsured population paying for these services out-of-pocket. The study objective was to characterise the health seeking behaviour of low-income, patients accessing PHC services in both the public and private sectors, patient movement between sectors, and factors influencing their facility choice. Methods We conducted once-off patient interviews on a random sample of 153 patients at 7 private PHC providers (primarily providing services to the low-income mostly uninsured patient population) and their matched public PHC clinic (7 facilities). Results The majority of participants were economically active (96/153, 63%), 139/153 (91%) did not have health insurance, and 104/153 (68%) earned up to $621/month. A multiple response question found affordability (67%) and convenience (60%) were ranked as the most important reasons for choosing to usually access care at public clinics (48%); whilst convenience (71%) and quality of care (59%) were key reasons for choosing the private sector (32%). There is movement between sectors: 23/76 (30%) of those interviewed at a private facility and 8/77 (10%) of those interviewed at a public facility indicated usually accessing PHC services at a mix of private and public facilities. Results indicate cycling between the private and public sectors with different factors influencing facility choice. Conclusions It is imperative to understand the potential impact on where PHC services are accessed once affordability is mitigated through the NHI as this has implications on planning and contracting of services under the NHI.https://doi.org/10.1186/s12889-021-11678-9Primary healthcarePrivate sectorNHIPreferencesUtilisationHealth care seeking behaviour |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Kerensa Govender Sarah Girdwood Daniel Letswalo Lawrence Long G. Meyer-Rath J. Miot |
spellingShingle |
Kerensa Govender Sarah Girdwood Daniel Letswalo Lawrence Long G. Meyer-Rath J. Miot Primary healthcare seeking behaviour of low-income patients across the public and private health sectors in South Africa BMC Public Health Primary healthcare Private sector NHI Preferences Utilisation Health care seeking behaviour |
author_facet |
Kerensa Govender Sarah Girdwood Daniel Letswalo Lawrence Long G. Meyer-Rath J. Miot |
author_sort |
Kerensa Govender |
title |
Primary healthcare seeking behaviour of low-income patients across the public and private health sectors in South Africa |
title_short |
Primary healthcare seeking behaviour of low-income patients across the public and private health sectors in South Africa |
title_full |
Primary healthcare seeking behaviour of low-income patients across the public and private health sectors in South Africa |
title_fullStr |
Primary healthcare seeking behaviour of low-income patients across the public and private health sectors in South Africa |
title_full_unstemmed |
Primary healthcare seeking behaviour of low-income patients across the public and private health sectors in South Africa |
title_sort |
primary healthcare seeking behaviour of low-income patients across the public and private health sectors in south africa |
publisher |
BMC |
series |
BMC Public Health |
issn |
1471-2458 |
publishDate |
2021-09-01 |
description |
Abstract Background The proposed National Health Insurance (NHI) system aims to re-engineer primary healthcare (PHC) in South Africa, envisioning both private sector providers and public sector clinics as independent contracting units to the NHI Fund. In 2017, 16% of the South African population had private medical insurance and predominately utilised private providers. However, it is estimated that up to 28% of the population access private PHC services, with a meaningful segment of the low-income, uninsured population paying for these services out-of-pocket. The study objective was to characterise the health seeking behaviour of low-income, patients accessing PHC services in both the public and private sectors, patient movement between sectors, and factors influencing their facility choice. Methods We conducted once-off patient interviews on a random sample of 153 patients at 7 private PHC providers (primarily providing services to the low-income mostly uninsured patient population) and their matched public PHC clinic (7 facilities). Results The majority of participants were economically active (96/153, 63%), 139/153 (91%) did not have health insurance, and 104/153 (68%) earned up to $621/month. A multiple response question found affordability (67%) and convenience (60%) were ranked as the most important reasons for choosing to usually access care at public clinics (48%); whilst convenience (71%) and quality of care (59%) were key reasons for choosing the private sector (32%). There is movement between sectors: 23/76 (30%) of those interviewed at a private facility and 8/77 (10%) of those interviewed at a public facility indicated usually accessing PHC services at a mix of private and public facilities. Results indicate cycling between the private and public sectors with different factors influencing facility choice. Conclusions It is imperative to understand the potential impact on where PHC services are accessed once affordability is mitigated through the NHI as this has implications on planning and contracting of services under the NHI. |
topic |
Primary healthcare Private sector NHI Preferences Utilisation Health care seeking behaviour |
url |
https://doi.org/10.1186/s12889-021-11678-9 |
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