Abstract
Background: In 2005, the South African government introduced a voluntary, subsidised health insurance scheme for civil servants. In light of the global emphasis on universal coverage, empirical evidence is needed to understand the relationship between new health financing strategies and health care access thereby improving global understanding of these issues.Objectives: This study analysed coverage of the South African government health insurance scheme, the population groups with low uptake, and the individual-level factors, as well as characteristics of the scheme, that influenced enrolment.Methods: Multi-stage random sampling was used to select 1,329 civil servants from the health and education sectors in four of South Africa's nine provinces. They were interviewed to determine factors associated with enrolment in the scheme. The analysis included both descriptive statistics and multivariate logistic regression.Results: Notwithstanding the availability of a non-contributory option within the insurance scheme and access to privately-provided primary care, a considerable portion of socio-economically vulnerable groups remained uninsured (57.7% of the lowest salary category). Non-insurance was highest among men, black African or coloured ethnic groups, less educated and lower-income employees, and those living in informal-housing. The relatively poor uptake of the contributory and non-contributory insurance options was mostly attributed to insufficient information, perceived administrative challenges of taking up membership, and payment costs.Conclusion: Barriers to enrolment include insufficient information, unaffordability of payments and perceived administrative complexity. Achieving universal coverage requires good physical access to service providers and appropriate benefit options within pre-payment health financing mechanisms.
Highlights
In 2005, the South African government introduced a voluntary, subsidised health insurance scheme for civil servants
4As brokers could not make any financial gains from enrolling civil servants in the government scheme, we considered them unlikely to have any role or influence on the decision to enrol
Evidence suggests that membership has increased, with 53.8% of civil servants enrolled in the government scheme in 2012 [27], other studies on enrolment in health insurance schemes in Ecuador, Ghana, Mali, Senegal and Uganda, have found similar low levels of enrolment (36Á40)
Summary
In 2005, the South African government introduced a voluntary, subsidised health insurance scheme for civil servants. Objectives: This study analysed coverage of the South African government health insurance scheme, the population groups with low uptake, and the individual-level factors, as well as characteristics of the scheme, that influenced enrolment. Methods: Multi-stage random sampling was used to select 1,329 civil servants from the health and education sectors in four of South Africa’s nine provinces. They were interviewed to determine factors associated with enrolment in the scheme. The relatively poor uptake of the contributory and non-contributory insurance options was mostly attributed to insufficient information, perceived administrative challenges of taking up membership, and payment costs. Achieving universal coverage requires good physical access to service providers and appropriate benefit options within pre-payment health financing mechanisms
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
