[go: up one dir, main page]
IDEAS home Printed from https://ideas.repec.org/p/sza/wpaper/wpapers26.html
   My bibliography  Save this paper

Have pro-poor health policies improved the targeting of spending and the effective delivery of health care in South Africa?

Author

Listed:
  • Ronelle Burger

    (Department of Economics, Stellenbosch University)

  • Christelle Swanepoel

    (Bureau of Economic Research, Stellenbosch University)

Abstract
Since 1994 there have been a number of radical changes in the public health care system in South Africa. Budgets have been reallocated, decision making was decentralised, the clinic network was expanded and user fees for primary health care were abolished. The paper examines how these recent changes have affected the incidence of spending and the accessibility and quality of health care. The paper finds that between 1995 and 2003 there have been advances in the pro-poor spending incidence of both clinics and hospitals. The increased share of the health budget allocated to the more pro-poor clinic services has contributed further to the improvement in the targeting of overall health spending. Also, it appears that the elimination of user fees for clinics and the expansion of the clinic network have helped to make health services more affordable and geographically accessible to the poor and were associated with a notable rise in health service utilisation for individuals in the bottom two expenditure quintiles. South Africa’s spending on clinics and hospitals is well targeted and more progressive than other developing country public health systems. Unfortunately, it appears that to a considerable extent this result is driven by perceptions that services offered in public hospitals and clinics are of a low and variable quality. These perceptions seem to be encouraging most of those who can afford to pay more for health services to opt out of the public health system, thereby increasing the pro-poor incidence of public health spending. Complaints by users of public health facilities include long waiting times, staff rudeness and problems with drug availability. Dissatisfaction with health services is significantly higher in the public sector than in the private sector and the gap has expanded slightly over time. It is consequently not surprising that a substantial and increasing share of individuals – also including the very poorest – prefer to consult private providers.

Suggested Citation

  • Ronelle Burger & Christelle Swanepoel, 2006. "Have pro-poor health policies improved the targeting of spending and the effective delivery of health care in South Africa?," Working Papers 12/2006, Stellenbosch University, Department of Economics.
    • Handle: RePEc:sza:wpaper:wpapers26
    as

    Download full text from publisher

    File URL: https://www.ekon.sun.ac.za/wpapers/2006/wp122006/wp-12-2006.pdf
    File Function: First version, 2006
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. R Havemann & S van der Berg, 2003. "The Demand for Health Care in South Africa," Studies in Economics and Econometrics, Taylor & Francis Journals, vol. 27(3), pages 1-27, December.
    2. Gabriel Demombynes & Chris Elbers & Jean O. Lanjouw & Peter Lanjouw & Johan A. Mistiaen & Berk Özler, 2002. "Producing an Improved Geographic Profile of Poverty: Methodology and Evidence from Three Developing Countries," WIDER Working Paper Series DP2002-39, World Institute for Development Economic Research (UNU-WIDER).
    3. Magnus Lindelow, 2005. "The Utilisation of Curative Healthcare in Mozambique: Does Income Matter?," Journal of African Economies, Centre for the Study of African Economies, vol. 14(3), pages 435-482, September.
    4. David E. Sahn & Stephen D. Younger, 2000. "Expenditure incidence in Africa: microeconomic evidence," Fiscal Studies, Institute for Fiscal Studies, vol. 21(3), pages 329-347, September.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Steven F. Koch, 2012. "The Abolition of User Fees and the Demand for Health Care: Re-Evaluating the Impact," Working Papers 201219, University of Pretoria, Department of Economics.
    2. Ronelle Burger, 2007. "Policy Brief: How pro-poor is the South African Health System?," Working Papers 06/2007, Stellenbosch University, Department of Economics.
    3. World Bank, 2011. "Accountability in Public Services in South Africa," World Bank Publications - Reports 29723, The World Bank Group.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Ronelle Burger, 2007. "Policy Brief: How pro-poor is the South African Health System?," Working Papers 06/2007, Stellenbosch University, Department of Economics.
    2. Christelle Grobler & Ian C. Stuart, 2007. "Health Care Provider Choice," South African Journal of Economics, Economic Society of South Africa, vol. 75(2), pages 327-350, June.
    3. Coulombe, Harold & Wodon, Quentin, 2008. "Assessing the geographic impact of higher food prices in Guinea," Policy Research Working Paper Series 4743, The World Bank.
    4. Araujo, M. Caridad & Ferreira, Francisco H.G. & Lanjouw, Peter & Özler, Berk, 2008. "Local inequality and project choice: Theory and evidence from Ecuador," Journal of Public Economics, Elsevier, vol. 92(5-6), pages 1022-1046, June.
    5. Nora Lustig, 2017. "Fiscal Policy, Income Redistribution and Poverty Reduction in Low and Middle Income Countries," Commitment to Equity (CEQ) Working Paper Series 54, Tulane University, Department of Economics.
    6. Demombynes, Gabriel & Ozler, Berk, 2005. "Crime and local inequality in South Africa," Journal of Development Economics, Elsevier, vol. 76(2), pages 265-292, April.
    7. Martine Audibert & Yong He & Jacky Mathonnat, 2013. "Two-Period Comparison of Healthcare Demand with Income Growth and Population Aging in Rural China: Implications for Adjustment of the Healthcare Supply and Development," Working Papers halshs-00846088, HAL.
    8. Tabi Atemnkeng Johannes & Tafah Akwi & Peter Etoh Anzah, 2006. "The Distributive Impact of Fiscal Policy in Cameroon: Tax and Benefit Incidence," Working Papers PMMA 2006-16, PEP-PMMA.
    9. Ghazala Mansuri, 2004. "Community-Based and -Driven Development: A Critical Review," The World Bank Research Observer, World Bank, vol. 19(1), pages 1-39.
    10. Bourguignon, Francois & Rogers, F. Halsey, 2007. "Distributional effects of educational improvements: Are we using the wrong model?," Economics of Education Review, Elsevier, vol. 26(6), pages 735-746, December.
    11. Nora Lustig, 2016. "Fiscal Policy, Inequality and the Poor in the Developing World," Working Papers 1612, Tulane University, Department of Economics, revised Aug 2017.
    12. Datta, Pritam & Dubey, Jay Dev & Choudhury, Mita, 2022. "Progressivity of Public Spending on Health care at the Sub-state Level in India: An Empirical Investigation in Tamil Nadu and Bihar," Working Papers 22/375, National Institute of Public Finance and Policy.
    13. Elbers, Chris & Fujii, Tomoki & Lanjouw, Peter & Ozler, Berk & Yin, Wesley, 2007. "Poverty alleviation through geographic targeting: How much does disaggregation help?," Journal of Development Economics, Elsevier, vol. 83(1), pages 198-213, May.
    14. Martine Audibert & Yong He & Jacky Mathonnat, 2013. "Two-Period Comparison of Healthcare Demand with Income Growth and Population Aging in Rural China: Implications for Adjustment of the Healthcare Supply and Development," CERDI Working papers halshs-00846088, HAL.
    15. Pradhan, Menno & Sahn, David E. & Younger, Stephen D., 2003. "Decomposing world health inequality," Journal of Health Economics, Elsevier, vol. 22(2), pages 271-293, March.
    16. Dang, Hai-Anh & Lanjouw, Peter & Luoto, Jill & McKenzie, David, 2014. "Using repeated cross-sections to explore movements into and out of poverty," Journal of Development Economics, Elsevier, vol. 107(C), pages 112-128.
    17. David E. Sahn, 2012. "Health Inequality across Populations of Individuals," African Development Review, African Development Bank, vol. 24(4), pages 316-326, December.
    18. Cuesta, Jose & Kabaso, Pamela & Suarez-Becerra, Pablo, 2012. "How pro-poor and progressive is social spending in Zambia ?," Policy Research Working Paper Series 6052, The World Bank.
    19. Li,Yue - SARCE & Rama,Martin G., 2015. "Households or locations ? cities, catchment areas and prosperity in India," Policy Research Working Paper Series 7473, The World Bank.
    20. John Ataguba, 2012. "Alcohol policy and taxation in South Africa," Applied Health Economics and Health Policy, Springer, vol. 10(1), pages 65-76, January.

    More about this item

    Keywords

    fiscal incidence; South Africa; health;
    All these keywords.

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:sza:wpaper:wpapers26. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Melt van Schoor (email available below). General contact details of provider: https://edirc.repec.org/data/desunza.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.