Department of Economics, Stellenbosch University, Matieland, South Africa.
Department of Economics, University of the Western Cape, Bellville, South Africa.
Health Econ Policy Law. 2020 Jan;15(1):43-55. doi: 10.1017/S1744133118000300. Epub 2018 Jul 12.
We use a reliable, intuitive and simple set of indicators to capture three dimensions of access - availability, affordability and acceptability. Data are from South Africa's 2009 and 2010 General Household Surveys (n=190,164). Affordability constraints were faced by 23% and are more concentrated amongst the poorest. However, 73% of affordability constraints are due to travel costs which are aligned with findings of the availability constraints dimension. Availability constraints, involving distances and transport costs, particularly in underdeveloped rural areas, and inconvenient opening times, were faced by 27%. Acceptability constraints were noted by only 10%. We approximate acceptability with an indicator measuring the share of community members bypassing the closest health care facility, as we argue that reported health care provider choice is more reliable than stated preferences. However, the indicator assumes a choice of available and affordable providers, which may often not be an accurate assumption in rural areas. We recommend further work on the measurement of acceptability in household surveys, especially considering this dimension's importance for health reform.
我们使用可靠、直观和简单的一组指标来捕捉可及性的三个维度——可及性、可负担性和可接受性。数据来自南非 2009 年和 2010 年的全国家庭调查(n=190164)。23%的人面临可负担性约束,而这些约束在最贫困的人中更为集中。然而,73%的可负担性约束是由于旅行成本造成的,这与可及性约束维度的发现一致。可及性约束涉及距离和交通成本,特别是在欠发达的农村地区,以及不方便的开放时间,有 27%的人面临这些约束。只有 10%的人面临可接受性约束。我们用一个指标来衡量社区成员绕过最近的医疗保健设施的比例来近似可接受性,因为我们认为报告的医疗服务提供者选择比表示的偏好更可靠。然而,该指标假设了对可用和负担得起的提供者的选择,而在农村地区,这可能往往不是一个准确的假设。我们建议在家庭调查中进一步研究可接受性的衡量问题,特别是考虑到这一方面对卫生改革的重要性。
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