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Abstract
ABSTRACT Background: More than a billion people, mainly in low- and middle-income countries, are unable to access needed health-care services for a variety of reasons. Possible factors influencing health-care utilization include socio-demographic and economic factors such as age, sex, education, employment and income. However, different studies have showed mixed results. Moreover, there are limited studies on health-care utilization. Objective: This study aimed to determine health-care utilization and associated factors among all residents aged 18 or over in Gauteng province, South Africa. Methods: A cross-sectional study was conducted from data collected for a Quality of Life survey which was carried out by Gauteng City-Region Observatory in 2013. Simple random sampling was used to select participants. A total of 27,490 participants have been interviewed. Data were collected via a digital data collection instrument using an open source system called Formhub. Coarsened Exact Matching (CEM) was used to improve estimation of causal effects. Stepwise multiple logistic regression was employed to identify factors associated with health-care utilization. Results: Around 95.7% reported usually utilizing health-care services while the other 4.3% reported not having sought health-care services of any type. Around 75% of participants reported reduced quality of public health services as a major reason not to visit them. Higher odds of reported health-care utilization were associated with being female (OR = 2.18, 95% CI: 1.88–2.53; p < 0.001), being White compared to being African (OR = 2.28, 95% CI: 1.84–2.74; p < 0.001), and having medical insurance (OR = 5.41, 95% CI: 4.06–7.23; p < 0.001). Lower odds of seeking health-care were associated with being an immigrant (OR = 0.61, 95% CI: 0.53–0.70; p < 0.001). Conclusions: The results indicated that there is a need to improve the quality of public health-care services and perception towards them as improved health-care quality increases the choice of health-care providers.
Highlights
More than a billion people, mainly in low- and middle-income countries, are unable to access needed health-care services for a variety of reasons
Our study showed that immigration status is significantly associated with health-care utilization in that immigrants are less likely to seek health-care services compared to those who were born in South Africa
This study indicated that the majority of study participants sought health-care for all types of illnesses and few respondents reported traditional healers as a choice of health-care
Summary
More than a billion people, mainly in low- and middle-income countries, are unable to access needed health-care services for a variety of reasons. More than a billion people, mainly in low- and middle-income countries (LMICs), are unable to access needed health-care services for a variety of reasons [1] Utilization of health-care services, public or private, depends on socio-economic factors, cultural beliefs and practices, and most importantly the health system itself [2] Immigration status, distance from health-care services, availability, affordability and quality of health-care are other important determinants that influence health-care utilization [3,4]. Health-care seeking behaviour is measured by the utilization of healthcare services, rather than other ways in which people behave in relation to their health. There has been little monitoring and evaluation of the impact of the new policies on the access by individuals of a lower socio-economic status to health-care [8]
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