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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Factors influencing the burden of health care financing and the distribution of health care benefits in Ghana, Tanzania and South Africa
Health Policy and Planning, Volume 27, No. SUPPL.1, Year 2012
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Description
In Ghana, Tanzania and South Africa, health care financing is progressive overall. However, out-of-pocket payments and health insurance for the informal sector are regressive. The distribution of health care benefits is generally pro-rich. This paper explores the factors influencing these distributions in the three countries. Qualitative data were collected through focus group discussions and in-depth interviews with insurance scheme members, the uninsured, health care providers and managers. Household surveys were also conducted in all countries. Flat-rate contributions contributed to the regressivity of informal sector voluntary schemes, either by design (in Tanzania) or due to difficulties in identifying household income levels (in Ghana). In all three countries, the regressivity of out-of-pocket payments is due to the incomplete enforcement of exemption and waiver policies, partial or no insurance cover among poorer segments of the population and limited understanding of entitlements among these groups. Generally, the pro-rich distribution of benefits is due to limited access to higher level facilities among poor and rural populations, who rely on public primary care facilities and private pharmacies. Barriers to accessing health care include medical and transport costs, exacerbated by the lack of comprehensive insurance coverage among poorer groups. Service availability problems, including frequent drug stock-outs, limited or no diagnostic equipment, unpredictable opening hours and insufficient skilled staff also limit service access. Poor staff attitudes and lack of confidence in the skills of health workers were found to be important barriers to access. Financing reforms should therefore not only consider how to generate funds for health care, but also explicitly address the full range of affordability, availability and acceptability barriers to access in order to achieve equitable financing and benefit incidence patterns. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2012; all rights reserved.2012 © Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2012; all rights reserved.
Authors & Co-Authors
Macha, Jane
Unknown Affiliation
Harris, Bronwyn
Unknown Affiliation
Garshong, Bertha Na
Unknown Affiliation
Ataguba, John Ele Ojo
Unknown Affiliation
Akazili, J.
Unknown Affiliation
Kuwawenaruwa, August
Unknown Affiliation
Borghi, Jo
Unknown Affiliation
Statistics
Citations: 129
Authors: 7
Affiliations: 7
Identifiers
Doi:
10.1093/heapol/czs024
e-ISSN:
14602237
Research Areas
Health System And Policy
Study Design
Cross Sectional Study
Cohort Study
Study Approach
Qualitative
Study Locations
Ghana
South Africa
Tanzania