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Primary healthcare seeking behaviour of low-income patients across the public and private health sectors in South Africa
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...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8431853/ https://www.ncbi.nlm.nih.gov/pubmed/34503478 http://dx.doi.org/10.1186/s12889-021-11678-9 |
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author | Govender, Kerensa Girdwood, Sarah Letswalo, Daniel Long, Lawrence Meyer-Rath, G. Miot, J. |
author_facet | Govender, Kerensa Girdwood, Sarah Letswalo, Daniel Long, Lawrence Meyer-Rath, G. Miot, J. |
author_sort | Govender, Kerensa |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-8431853 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-84318532021-09-10 Primary healthcare seeking behaviour of low-income patients across the public and private health sectors in South Africa Govender, Kerensa Girdwood, Sarah Letswalo, Daniel Long, Lawrence Meyer-Rath, G. Miot, J. BMC Public Health Research 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. BioMed Central 2021-09-09 /pmc/articles/PMC8431853/ /pubmed/34503478 http://dx.doi.org/10.1186/s12889-021-11678-9 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Govender, Kerensa Girdwood, Sarah Letswalo, Daniel Long, Lawrence Meyer-Rath, G. Miot, J. Primary healthcare seeking behaviour of low-income patients across the public and private health sectors in South Africa |
title | 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_short | 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 |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8431853/ https://www.ncbi.nlm.nih.gov/pubmed/34503478 http://dx.doi.org/10.1186/s12889-021-11678-9 |
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