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The incidence of health financing in South Africa: findings from a recent data set

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  • Ataguba, John E.
  • McIntyre, Di

Abstract

There is an international call for countries to ensure universal health coverage. This call has been embraced in South Africa (SA) in the form of a National Health Insurance (NHI). This is expected to be financed through general tax revenue with the possibility of additional earmarked taxes including a surcharge on personal income and/or a payroll tax for employers. Currently, health services are financed in SA through allocations from general tax revenue, direct out-of-pocket payments, and contributions to medical scheme. This paper uses the most recent data set to assess the progressivity of each health financing mechanism and overall financing system in SA. Applying standard and innovative methodologies for assessing progressivity, the study finds that general taxes and medical scheme contributions remain progressive, and direct out-of-pocket payments and indirect taxes are regressive. However, private health insurance contributions, across only the insured, are regressive. The policy implications of these findings are discussed in the context of the NHI.

Suggested Citation

  • Ataguba, John E. & McIntyre, Di, 2018. "The incidence of health financing in South Africa: findings from a recent data set," Health Economics, Policy and Law, Cambridge University Press, vol. 13(1), pages 68-91, January.
    • Handle: RePEc:cup:hecopl:v:13:y:2018:i:01:p:68-91_00
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    Cited by:

    1. Eleanor Beth Whyle & Jill Olivier, 2024. "Health system reform and path-dependency: how ideas constrained change in South Africa’s national health insurance policy process," Policy Sciences, Springer;Society of Policy Sciences, vol. 57(3), pages 663-690, September.
    2. Lagarde, Mylène & Blaauw, Duane, 2022. "Overtreatment and benevolent provider moral hazard: Evidence from South African doctors," Journal of Development Economics, Elsevier, vol. 158(C).
    3. Lagarde, Mylène & Blaauw, Duane, 2022. "Overtreatment and benevolent provider moral hazard: evidence from South African doctors," LSE Research Online Documents on Economics 115383, London School of Economics and Political Science, LSE Library.
    4. Andrea M. Leiter & Engelbert Theurl, 2021. "Determinants of prepaid systems of healthcare financing: a worldwide country-level perspective," International Journal of Health Economics and Management, Springer, vol. 21(3), pages 317-344, September.
    5. John E. Ataguba, 2021. "The Impact of Financing Health Services on Income Inequality in an Unequal Society: The Case of South Africa," Applied Health Economics and Health Policy, Springer, vol. 19(5), pages 721-733, September.

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