Browsing by Subject "health economics"

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    Moving towards universal coverage in South Africa? Lessons from a voluntary government insurance scheme
    (2013) Govender, Veloshnee; Chersich, Matthew F; Harris, Bronwyn; Alaba, Olufunke; Ataguba, John E; Nxumalo, Nonhlanhla; Goudge, Jane
    BackgroundIn 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.ObjectivesThis 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.MethodsMulti-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.ResultsNotwithstanding 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.ConclusionBarriers 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.
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    Transforming Health Systems: Case studies of critical health system analyses to support reform
    (2014-08-21) McIntyre, Diane; Gilson, Lucy
    A set of case studies to enhance critical analysis for health system reform. Over the years, the Health Economics Unit (University of Cape Town) and Centre for Health Policy (University of the Witwatersrand) have developed a range of training materials to strengthen critical analysis skills that can support health system reform. One of the case studies considers how national health accounts data can contribute to critically assessing existing health systems to identify key challenges that could potentially be addressed through reforms. The two key areas of health system reform focused on in these training materials are health care financing and decentralisation. These are complemented by case studies on resource allocation between and within health districts. While technical skills are important for health system reform, so are skills to understand and manage key policy actors or stakeholders. The set of materials, therefore, concludes with case studies to develop stakeholder analysis skills.