Abstract
BackgroundThe 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.MethodsWe 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).ResultsThe 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.ConclusionsIt 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.
Highlights
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
The South African Government is in the process of rolling out a phased implementation of the NHI scheme over 15 years which will fund access for all for a specified basket of services at nonspecialist level private health practitioners as well as public primary healthcare (PHC) facilities from a combined resource pool, expanding access to quality health services for those unable to afford these services while mitigating the financial burden on individuals and their families [3,4,5]
This study has provided a description of health seeking behaviour amongst the low-income predominantly uninsured population who choose to access PHC services at either a public facility, private facility or utilise a mix of facility types in 2 provinces in South Africa
Summary
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. The remainder is spent on the 84% of the population who depend on the under-resourced public sector, lack the means to access care in the private sector and have a higher disease burden [3, 4] To address these inequities, the South African Government is in the process of rolling out a phased implementation of the NHI scheme over 15 years which will fund access for all for a specified basket of services at nonspecialist level private health practitioners as well as public primary healthcare (PHC) facilities from a combined resource pool, expanding access to quality health services for those unable to afford these services while mitigating the financial burden on individuals and their families [3,4,5]. A number of private organisations in South Africa have established innovative models of PHC delivery that aim to provide access to good quality PHC services at affordable rates to the low-income, mostly uninsured and underserved population
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