Health Care Inequity in South Africa and the Public/private Mix

This working paper presents information and analyses of health care inequity in South Africa, with specific reference to what health economists term the publicprivate mix in health care. The paper identifies the apartheid legacy of disadvantage in terms of health status and inequitable access to health care, and outlines health policy initiatives since 1994.It draws together household survey data and other evidence to highlight three aspects of the South African health system since that date: 1. increased use of the private sector (all forms of provider) across population groups; 2. stagnation of government funding for publicly-provided health care, which has implications for quality of care and household utilisation preferences; 3. cost escalation in, growth of, and attraction of health personnel to, the private sector, and the implications this has for the sustainability of the overall health system, given household utilisation preferences. This working paper largely draws upon existing sources and material, but also includes a new analysis of health care utilisation data. The paper provides background material for further assessment of the potential for public-private interactions to support greater cross-subsidy between population groups.