Distance decay and persistent health care disparities in South Africa

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dc.contributor.authorMcLaren, Zoë M
dc.contributor.authorArdington, Cally
dc.contributor.authorLeibbrandt, Murray
dc.date.accessioned2015-07-30T04:01:05Z
dc.date.available2015-07-30T04:01:05Z
dc.date.issued2014-11-04
dc.date.updated2015-01-15T17:58:07Z
dc.description.abstractAbstract Background Access to health care is a particular concern given the important role of poor access in perpetuating poverty and inequality. South Africa’s apartheid history leaves large racial disparities in access despite post-apartheid health policy to increase the number of health facilities, even in remote rural areas. However, even when health services are provided free of charge, monetary and time costs of travel to a local clinic may pose a significant barrier for vulnerable segments of the population, leading to overall poorer health. Methods Using newly available health care utilization data from the first nationally representative panel survey in South Africa, together with administrative geographic data from the Department of Health, we use graphical and multivariate regression analysis to investigate the role of distance to the nearest facility on the likelihood of having a health consultation or an attended birth. Results Ninety percent of South Africans live within 7 km of the nearest public clinic, and two-thirds live less than 2 km away. However, 14% of Black African adults live more than 5 km from the nearest facility, compared to only 4% of Whites, and they are 16 percentage points less likely to report a recent health consultation (p < 0.01) and 47 percentage points less likely to use private facilities (p < 0.01). Respondents in the poorest income quintiles live 0.5 to 0.75 km further from the nearest health facility (p < 0.01). Racial differentials in the likelihood of having a health consultation or an attended birth persist even after controlling for confounders. Conclusions Our results have two policy implications: minimizing the distance that poor South Africans must travel to obtain health care and improving the quality of care provided in poorer areas will reduce inequality. Much has been done to redress disparities in South Africa since the end of apartheid but progress is still needed to achieve equity in health care access.
dc.identifier.apacitationMcLaren, Z. M., Ardington, C., & Leibbrandt, M. (2014). Distance decay and persistent health care disparities in South Africa. <i>BMC Health Services Research</i>, http://hdl.handle.net/11427/13612en_ZA
dc.identifier.chicagocitationMcLaren, Zoë M, Cally Ardington, and Murray Leibbrandt "Distance decay and persistent health care disparities in South Africa." <i>BMC Health Services Research</i> (2014) http://hdl.handle.net/11427/13612en_ZA
dc.identifier.citationMcLaren, Z. M., Ardington, C., & Leibbrandt, M. (2014). Distance decay and persistent health care disparities in South Africa. BMC health services research, 14(1), 541.
dc.identifier.ris TY - Journal Article AU - McLaren, Zoë M AU - Ardington, Cally AU - Leibbrandt, Murray AB - Abstract Background Access to health care is a particular concern given the important role of poor access in perpetuating poverty and inequality. South Africa’s apartheid history leaves large racial disparities in access despite post-apartheid health policy to increase the number of health facilities, even in remote rural areas. However, even when health services are provided free of charge, monetary and time costs of travel to a local clinic may pose a significant barrier for vulnerable segments of the population, leading to overall poorer health. Methods Using newly available health care utilization data from the first nationally representative panel survey in South Africa, together with administrative geographic data from the Department of Health, we use graphical and multivariate regression analysis to investigate the role of distance to the nearest facility on the likelihood of having a health consultation or an attended birth. Results Ninety percent of South Africans live within 7 km of the nearest public clinic, and two-thirds live less than 2 km away. However, 14% of Black African adults live more than 5 km from the nearest facility, compared to only 4% of Whites, and they are 16 percentage points less likely to report a recent health consultation (p < 0.01) and 47 percentage points less likely to use private facilities (p < 0.01). Respondents in the poorest income quintiles live 0.5 to 0.75 km further from the nearest health facility (p < 0.01). Racial differentials in the likelihood of having a health consultation or an attended birth persist even after controlling for confounders. Conclusions Our results have two policy implications: minimizing the distance that poor South Africans must travel to obtain health care and improving the quality of care provided in poorer areas will reduce inequality. Much has been done to redress disparities in South Africa since the end of apartheid but progress is still needed to achieve equity in health care access. DA - 2014-11-04 DB - OpenUCT DO - 10.1186/s12913-014-0541-1 DP - University of Cape Town J1 - BMC Health Services Research LK - https://open.uct.ac.za PB - University of Cape Town PY - 2014 T1 - Distance decay and persistent health care disparities in South Africa TI - Distance decay and persistent health care disparities in South Africa UR - http://hdl.handle.net/11427/13612 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/13612
dc.identifier.urihttp://dx.doi.org/10.1186/s12913-014-0541-1
dc.identifier.vancouvercitationMcLaren ZM, Ardington C, Leibbrandt M. Distance decay and persistent health care disparities in South Africa. BMC Health Services Research. 2014; http://hdl.handle.net/11427/13612.en_ZA
dc.language.rfc3066en
dc.publisher.departmentSALDRUen_ZA
dc.publisher.facultyFaculty of Commerceen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution License*
dc.rights.holderMcLaren et al.; licensee BioMed Central Ltd.
dc.rights.urihttp://creativecommons.org/licenses/by/4.0*
dc.sourceBMC Health Services Researchen_ZA
dc.source.urihttp://www.biomedcentral.com/bmchealthservres/
dc.subject.otherHealth care utilizationen_ZA
dc.subject.otherInequalityen_ZA
dc.subject.otherSouth Africaen_ZA
dc.subject.otherDistance decayen_ZA
dc.titleDistance decay and persistent health care disparities in South Africa
dc.typeJournal Articleen_ZA
uct.type.filetype
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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