Moving towards universal coverage in South Africa? Lessons from a voluntary government insurance scheme

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dc.contributor.authorGovender, Veloshnee
dc.contributor.authorChersich, Matthew F
dc.contributor.authorHarris, Bronwyn
dc.contributor.authorAlaba, Olufunke
dc.contributor.authorAtaguba, John E
dc.contributor.authorNxumalo, Nonhlanhla
dc.contributor.authorGoudge, Jane
dc.date.accessioned2021-10-08T07:04:10Z
dc.date.available2021-10-08T07:04:10Z
dc.date.issued2013
dc.description.abstractBackgroundIn 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.
dc.identifier.apacitationGovender, V., Chersich, M. F., Harris, B., Alaba, O., Ataguba, J. E., Nxumalo, N., & Goudge, J. (2013). Moving towards universal coverage in South Africa? Lessons from a voluntary government insurance scheme. <i>Global Health Action</i>, 6(1), 19253 - 177. http://hdl.handle.net/11427/34441en_ZA
dc.identifier.chicagocitationGovender, Veloshnee, Matthew F Chersich, Bronwyn Harris, Olufunke Alaba, John E Ataguba, Nonhlanhla Nxumalo, and Jane Goudge "Moving towards universal coverage in South Africa? Lessons from a voluntary government insurance scheme." <i>Global Health Action</i> 6, 1. (2013): 19253 - 177. http://hdl.handle.net/11427/34441en_ZA
dc.identifier.citationGovender, V., Chersich, M.F., Harris, B., Alaba, O., Ataguba, J.E., Nxumalo, N. & Goudge, J. 2013. Moving towards universal coverage in South Africa? Lessons from a voluntary government insurance scheme. <i>Global Health Action.</i> 6(1):19253 - 177. http://hdl.handle.net/11427/34441en_ZA
dc.identifier.issn1654-9716
dc.identifier.issn1654-9880
dc.identifier.ris TY - Journal Article AU - Govender, Veloshnee AU - Chersich, Matthew F AU - Harris, Bronwyn AU - Alaba, Olufunke AU - Ataguba, John E AU - Nxumalo, Nonhlanhla AU - Goudge, Jane AB - 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. DA - 2013 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - Global Health Action LK - https://open.uct.ac.za PY - 2013 SM - 1654-9716 SM - 1654-9880 T1 - Moving towards universal coverage in South Africa? Lessons from a voluntary government insurance scheme TI - Moving towards universal coverage in South Africa? Lessons from a voluntary government insurance scheme UR - http://hdl.handle.net/11427/34441 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/34441
dc.identifier.vancouvercitationGovender V, Chersich MF, Harris B, Alaba O, Ataguba JE, Nxumalo N, et al. Moving towards universal coverage in South Africa? Lessons from a voluntary government insurance scheme. Global Health Action. 2013;6(1):19253 - 177. http://hdl.handle.net/11427/34441.en_ZA
dc.language.isoeng
dc.publisher.departmentHealth Economics Unit
dc.publisher.facultyFaculty of Health Sciences
dc.sourceGlobal Health Action
dc.source.journalissue1
dc.source.journalvolume6
dc.source.pagination19253 - 177
dc.source.urihttps://dx.doi.org/10.3402/gha.v6i0.19253
dc.subject.otherpublic health
dc.subject.otherhealth economics
dc.subject.otherhealth systems
dc.subject.otherDOAJ:Health Sciences
dc.subject.otherTANZANIA
dc.subject.otherhealth insurance
dc.subject.otherMedicine and Health Sciences
dc.subject.otherDEVELOPING-COUNTRIES
dc.subject.otherENROLLMENT
dc.subject.otherCARE
dc.subject.otherBuilding New Knowledge Supplement
dc.subject.otherPublic aspects of medicine
dc.subject.otherDEMAND
dc.subject.otheruniversal coverage
dc.subject.otherhealth insurance
dc.subject.othercivil servants
dc.subject.otherhealth-finance reforms
dc.subject.otheruniversal coverage
dc.subject.otherSouth Africa
dc.subject.otherWEST-AFRICA
dc.subject.otherhealth-finance reforms
dc.subject.othercivil servants
dc.subject.otherRA1-1270
dc.subject.otherGHANA
dc.subject.otherR
dc.subject.otherMedicine
dc.subject.otherSouth Africa
dc.subject.otherDOAJ:Public Health
dc.subject.otherNATIONAL-HEALTH INSURANCE
dc.titleMoving towards universal coverage in South Africa? Lessons from a voluntary government insurance scheme
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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