School of Economics and Finance, University of the Witwatersrand, Johannesburg, South Africa.
PLoS One. 2020 Feb 7;15(2):e0228034. doi: 10.1371/journal.pone.0228034. eCollection 2020.
South Africa has a dual system of healthcare model differentiated across socio-economic lines. While on the one hand there exists high quality private facilities that is expensive and accessible to the minority, on the other is the free but stretched and over-crowded public healthcare that the rest of the population relies on. Accessing private facilities requires private medical insurance or requires coping strategies that can lead to household vulnerability.
The objective of this study is to analyse the relationship between health shocks and household vulnerability in the South African context of high poverty and low medical insurance penetration rate.
The study employs data from waves three to five of South Africa's nationally representative National Income Dynamics Study (NIDS) conducted between the period 2012-2017 in approximately two-year intervals.
Using food expenditure shock as an indicator for vulnerability, the study utilises a range of econometric techniques from panel logit regression to quasi-experimental design based difference in difference regressions to assess the association between health shocks, medical insurance and household vulnerability.
The main finding of the study is that a significant proportion of households in the upper income quintile utilise private healthcare even when not covered by private medical insurance. This preference for private over public health facilities make them vulnerable to health shocks as they cope by sacrificing food consumption to incur additional health expenditure. In contrast, lower income households that are unable to access the high-cost private healthcare tend to rely on the strained public healthcare system. They are not able to use their constrained food expenditure as a coping strategy for private or out-of-pocket medical expenses because their food consumption is already at a bare minimum.
The results confirm that access to quality healthcare is a privilege in South Africa, available only to the minority of the population. The study paints a grim picture of household vulnerability in South Africa and underlines the need for a National Health Insurance that would enable universal access to quality healthcare in the country.
南非的医疗保健体系存在双重模式，根据社会经济地位而有所区分。一方面，存在着高质量的私人医疗机构，但价格昂贵，只有少数人能够负担得起；另一方面，公共医疗体系虽然免费，但资源紧张且过度拥挤，其余人只能依赖于此。要获得私人医疗机构的服务，要么需要私人医疗保险，要么需要采取可能导致家庭脆弱的应对策略。
本研究旨在分析在南非这种贫困程度高、医疗保险普及率低的情况下，健康冲击与家庭脆弱性之间的关系。
本研究使用了南非全国代表性的国家收入动态研究（NIDS）在 2012 年至 2017 年期间进行的第三至第五波数据，这些数据大约每两年收集一次。
本研究使用食物支出冲击作为脆弱性的指标，利用面板逻辑回归等一系列计量经济学技术，以及基于差分的准实验设计差异回归，来评估健康冲击、医疗保险与家庭脆弱性之间的关联。
研究的主要发现是，即使没有私人医疗保险覆盖，上收入五分位数的相当一部分家庭仍然选择使用私人医疗保健。这种对私人医疗保健的偏好，使他们在面临健康冲击时变得脆弱，因为他们不得不通过牺牲食物消费来支付额外的医疗费用。相比之下，无法获得高成本私人医疗保健的低收入家庭往往依赖紧张的公共医疗保健系统。他们无法利用有限的食物支出作为应对私人或自付医疗费用的策略，因为他们的食物消费已经处于最低水平。
结果证实，在南非，获得高质量的医疗保健是一种特权，只有少数人能够享受到。该研究描绘了南非家庭脆弱性的严峻图景，强调了建立国家医疗保险的必要性，以实现该国全民获得高质量医疗保健的目标。
