Do quality gaps between the public and private sector matter?. Universal Coverage Through National Health Insurance In South Africa:. Okore Okorafor Health Policy Unit Medi-Clinic Southern Africa 15 March 2011. Overview of the Presentation. Setting the context Objectives of the Study
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Health Policy Unit
Medi-Clinic Southern Africa
15 March 2011
Overview of the Presentation matter?
Medical Scheme Contributions
Public healthcare budget
Medical Schemes (PHI)
Out of pocket payments
46% of Total Health Expenditure
54% of Total Health Expenditure
Data Source: 2008 General Household Survey
Palmer N. 1999. Patient choice of primary health care provider. South African Health Review. Durban: Health Systems Trust
Gilson, L. and McIntyre, D. 2007. Post-Apartheid Challenges: Household Access and Use of Health Care in South Africa. International Journal of Health Services, 37 (4): 673-391.
Burger, R and Van der Berg, S. 2008. How well is the South African public health care system serving its people? 2008 Transformation Audit: Risk and Opportunity. Cape Town: Institute of Justice and Reconciliation.
UPHI(QPHI, y – p, µ) > UNPHS(QNPHS, y, µ)
U (QPHI – QNHS) ≥ |U (y – p)|
Level of substitutability
Data source: 2005/2006 Income and Expenditure Survey (21,144 households and 84,978 individuals)
Regression analysis (probit model)
Model 1:PHI = f (α + β1Incomet + β2X2 + ... + βkXk)
Model 2: PHI = f (α + β1Incomet+1+ β2X2 + ... + βkXk)
Incomet+1 = Income less NHI tax and Income subsidy
Other variables: education, presence of child/elderly in household, household size and area of residence
Income tax subsidy should ideally be calculated based on tax-rate of premium payer. Due to lack of information on premium payer, average household tax rate (per household is used)
IES of 2005/06 (5 years old)
SA tax brackets used as boundaries for progressive NHI tax
The magnitude of the change in the medical schemes market indicates a significant quality gap between the public and private sector.
Size of the medical schemes market more responsive to changes in quality within the public sector
Further Implications for the SA health sector!
Additional financial burden – No additional benefit?