ArticleApplied health economics and health policy2021
The Impact of Financing Health Services on Income Inequality in an Unequal Society: The Case of South Africa.
Article in Applied health economics and health policy, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Understanding Health Inequality, Disparity and Inequity in Africa: A Rapid Review of Concepts, Root Causes, and Strategic Solutions.Public health challenges · 2025Review
- Tax and noncommunicable diseases attributable to tobacco and alcohol consumption in 5 Sub-Saharan African countries.Frontiers in public health · 2024Article
- Risk Factors Attributable to Hypertension among HIV-Infected Patients on Antiretroviral Therapy in Selected Rural Districts of the Eastern Cape Province, South Africa.International journal of environmental research and public health · 2022Article
- Improving equity in the distribution and financing of health services in Mauritius, a small island state with deeply rooted welfare state standards.BMJ global health · 2021Article
- The Effect of Sex and Wealth on Population Attributable Risk Factors for Dementia in South Africa.Frontiers in neurology · 2021Article
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Authors and funding
1 author.
Funding
Abstract
backgroundEquitable health financing is crucial to attaining universal health coverage (UHC). Health financing, a major focus of the National Health Insurance in South Africa, can potentially affect income distribution.
objectiveThis paper assesses the impact of financing health services on income inequality (i.e. the income redistributive effect [RE]) in South Africa.
methodsData come from the nationally representative Income and Expenditure Survey (2010/2011). A standard approach is used to estimate and decompose RE for the major health financing mechanisms (taxes, insurance and out-of-pocket health spending) into the sum of the vertical effect (i.e. the extent of progressivity or regressivity), horizontal inequity (i.e. the extent to which 'equals' are not treated equally) and reranking effect (i.e. the extent to which individuals or households change ranks after paying for health services).
resultsFinancing health services through direct taxes (RE = 0.0072, P < 0.01) and private health insurance (RE = 0.0103, P < 0.01) significantly reduce income inequality, while indirect taxes (RE = -0.0025, P < 0.01) and out-of-pocket health spending (RE = -0.0009, P < 0.01) lead to significant increases in income inequality. Although private health insurance contributions may reduce income inequality, enrolees are only a small minority, mainly the rich. Also, total taxes (RE = 0.0048, P < 0.01) and total health financing (RE = 0.0152, P < 0.01) contribute to significant reductions in income inequality, with the vertical effect dominating.
conclusionTaxes that contribute to reducing income inequality hold promise for equitable health financing in South Africa. The results are relevant for and support the current National Health Insurance policy in South Africa and the global move towards UHC.
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