SAHR 2007 - Health Systems Trust

The use of the uninsured population as a denominator
when considering the adequacy of public sector facilities
or personnel is sometimes challenged. The data from the
General Household Survey do show that many uninsured
patients seek care in the private sector. The type of health
worker consulted varies considerably, as shown in Table 41.
In more rural provinces (such as EC and LP), the majority of
consultations are with a nurse, whereas in the WC nearly
85% of encounters are with a medical practitioner. The
General Household Survey does present these data by
ethnic group, but the national figures for Africans are not
significantly different from those of the entire sample.
Table 42 shows where care was sought in each of the
sectors, as well as the percentage of those seeking care who
used the private sector, per province. As could be seen from
the previous table, the percentage seeking care at private
community pharmacies was low, and in many cases too low
to allow any reliable estimate (where the total number of
encounters in a provinces was 10 000 or lower the sample
size was too small to allow for reliable estimates). A total of
101 000 such consultations were estimated to have occurred
nationally, out of a total of 4 938 000 consultations in the
month before the survey. The use of traditional practitioners
was particularly low, estimated as only 50 000 consultations
nationally. While most who used the public sector accessed
care from a primary health care facility (clinic), those who
used the private sector generally consulted medical practitioners
(Table 42).
This health-seeking behaviour can be unpacked in two
different ways. Of those who sought care in the public sector,
only 3.3% were beneficiaries of a medical scheme. However,
of those who sought care in the private sector, 59% were not
covered by a medical scheme. This care would, presumably,
have been sought mostly from private medical practitioners
rather than any other private sector facilities. Conversely, of
those who were not covered by a medical scheme, 27.8%
sought care in the private sector. Only 11.4% of those who
were beneficiaries of a medical scheme sought care in
the public sector. Put another way, the presence of private
sector facilities and personnel would be a good measure
of the access enjoyed by insured members of the population.
However, particularly in the more urban provinces (and,
presumably, districts), many patients who may be described
as “public sector dependent” may be using the private sector.
Table 41: Type of health worker (%), of those who consulted a health worker, 2006
Type of health worker
consulted (%)
EC FS GP KZN LP MP NC NW WC SA
Nurse 56.4 38.9 31.1 47.4 55.7 47.1 39.8 45.8 11.1 42.5
Doctor 36.8 52.4 60.5 47.3 37.6 45.9 54.2 46.5 84.6 50.5
Medical specialist 3.2 4.0 3.0 - 3.3 2.5 - 4.2 3.5 3.0
Pharmacist 1.9 4.0 2.8 - - - - 3.1 - 2.0
Other (including dentists, traditional
or spiritual healers)
1.7 0.7 2.7 5.2 3.5 4.5 6.0 0.4 0.8 2.0
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Source:
StatsSA GHS 2006. Calculated.
Table 42: Sector and place of consultation (%), of those who consulted a health worker, 2006
Public sector
EC FS GP KZN LP MP NC NW WC SA
Hospital 24.5 22.9 37.7 38.3 28.1 26.7 25.4 27.9 48.6 31.8
Clinic 73.6 76.6 61.9 60.8 72.2 72.9 72.9 71.3 44.5 67.0
Other public sector 1.9 - - - - - - - 7.3 1.3
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Private sector
Hospital - 5.1 10.4 18.2 11.1 - - 8.2 14.6 9.5
Clinic - 6.1 9.4 - 8.9 - - - - 5.6
Private doctor/specialist 85.2 77.6 73.9 68.8 70.4 79.3 87.0 79.1 80.8 76.6
Other (including health facilities
offered by employers, pharmacists,
alternative and traditional healers)
14.8 11.2 6.3 13.0 9.6 20.7 13.0 12.6 4.6 8.3
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
% using private sector 32.8 48.1 50.6 30.8 29.7 33.9 28.0 40.1 40.9 38.6
Source:
StatsSA GHS 2006. Calculated.
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