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APHA Scientific Session and Event Listing

John H. Romani, PhD, School of Public Health, University of Michigan, 2125 Nature Cove Court #108, Ann Arbor, MI 48104, 734 973-9042, jhromani@umich.edu, Barbara A. Anderson, PhD, Department of Sociology and Population Studies Center, University of Michigan, 2125 Nature Cove Court #108, Ann Arbor, MI 48104, Marie Wentzel, MA, Urban, Rural and Economic Development, Human Sciences Research Council, Private Bag X41, Pretoria, 0001, South Africa, and Heston Phillips, PhD, Integrative Analysis, Statistics South Africa, Private Bag X44, Pretoria, 0001, South Africa.

PURPOSE: To estimate trends in private/public medical care use and satisfaction by race and rural-urban residence in South Africa 1995-2005. BACKGROUND: Since the founding of new South Africa in 1994, a governmental goal has been equity in health care. Under apartheid, the white population had one of the best medical care systems in the world, while the non-white population, especially the African population, had much inferior medical care. One of the first actions of the new South African government was extension of free prenatal care and care for children under five years of age. METHODS: Large national surveys in 1995, 1998, and 2002-2005 collected information on whether each person was ill/injured in the past month, whether the ill/injured person received medical care, the kind of medical care provider and the type of facility seen, whether it was public or private, whether the person was covered by a medical aid scheme, whether the person paid for medical care and the amount of money paid. Since 1998, these surveys asked about the level of satisfaction with the medical care received, and since 2002, these surveys additionally asked for specific complaints about the medical care received (facilities not clean, long waiting time, opening times inconvenient, too expensive, needed drugs not available, staff rude, incorrect diagnosis). Examining changing patterns of private/public medical care use, the determinants of such use and sources of dissatisfaction with medical care received can contribute to understanding of the selection of private or public care. RESULTS: There are small differences by race and rural-urban residence in the percentage of the population that was ill or injured recently and small differences in whether medical care was sought. Over time, every population subgroup has increased its tendency to use private medical care, even though the proportion of the population covered by a medical scheme has not increased. Satisfaction with private medical care is greater than with public medical care in every area except cost. The public medical care system has substantial deficiencies, which has led all South Africans to increasingly turn to private care, despite the often increasing costs. CONCLUSIONS: The growing use of private medical care in South Africa, along with increases in income inequality, raises serious questions about equity in health care. Unless public medical care improves substantially in the future, it will increasingly become a source of care that is not willingly chosen by any segment of the population.

Learning Objectives: At the conclusion of the session, the participants in the session with be able to

• Describe the changing use of private/public primary care by race and rural-urban residence in South Africa.
• Describe the reasons for these changes.
• Discuss factors related to satisfaction with private/public primary care in South Africa.
• Assess the implications of the factors related to private/public primary care use and likely changes in the future in South Africa.

Keywords: Health Care Delivery, Primary Care

Presenting author's disclosure statement:

Any relevant financial relationships? No