Equity in Private Health Insurance Coverage in South Africa: 2002-2007

South Africa, which allowed complete suffrage in 1994, for the first time, has committed itself to improved health outcomes through equitable economic and social development. However, South Africa fares poorly in the World Health Organization’s ranking of health system performance, while spending a large proportion of its Gross Domestic Product on health care, suggesting that inequities in health opportunities and outcomes remain. This paper reports on medical aid scheme coverage rates estimated from a series of nationally representative surveys undertaken in South Africa by Statistics South Africa between 2002 and 2007. The individual’s age group, population group and gender were all used to assess coverage to examine inequalities in health care opportunities. The estimates show that coverage rates are quite low, and differ by age group, population group and gender. Despite government efforts to improve health outcomes for the previously disadvantaged population groups, medical aid access for the most disadvantaged, under apartheid, have not improved over the analyzed time period. The study provides important information related to equitable health care financing, noting that a universal national health insurance plan would need to cover an extremely large proportion of the population, as well as the failure, heretofore, of equalizing access to medical aid schemes across population groups in South Africa.