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Health Insurance Coverage Within Households: The Case of Private Health Insurance in South Africa

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Abstract

Private health insurance coverage within households is declining in South Africa (SA). This raises concerns in a context of growing support both in SA and internationally for universal health coverage (UHC). This paper attempts to advance our understanding of coverage patterns within partially insured households (i.e. having at least one, but not all members, being insured). This paper was guided by the following questions: (1) What factors are associated with some household members being insured? And (2) who are excluded? Drawing from a nationally representative household survey, it was found that partially insured households differed from completely insured households across a range of demographic and socio-economic factors. Significantly, there was a relationship bias; relationship with the household head was an important predictor of access to insurance within partially insured households. As the drive towards UHC gains momentum in SA and other countries, there is a need to conduct similar intra-household-level empirical research.

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Notes

  1. In South Africa, private voluntary health insurance is referred to as medical schemes.

  2. McIntyre (2010).

  3. Coovadia et al. (2009).

  4. Burger and van der Berg (2008), McIntyre et al. (2009), Macha et al. (2012).

  5. Council for Medical Schemes (2013).

  6. Ataguba and McIntyre (2012).

  7. Ataguba and McIntyre (2013).

  8. Phaswane and Lissner (2011).

  9. McLeod and Ramjee (2007).

  10. Prescribed Minimum Benefits (PMBs) as defined by the Medical Schemes Act intends to ensure that all medical scheme beneficiaries have access to certain minimum health benefits, regardless of the scheme benefit option they have chosen, their age or the state of their health. In terms of the Act, medical schemes have to cover the costs related to the diagnosis, treatment and care of (1) all emergency medical conditions and (2) a limited set of approximately 270 medical conditions as defined in the Diagnosis Treatment Pairs, which includes 25 chronic conditions as defined in the Chronic Disease List.

  11. Republic of South Africa (1998).

  12. Medical schemes include various benefit options with varying health-care services (inpatient and outpatient) that are covered. If the service is not covered under the benefit option of the scheme, then the member is responsible for the associated costs.

  13. McIntyre and Heever (2007), McLeod and Ramjee (2007).

  14. Helmbold (2007), cited in McLeod and Ramjee.

  15. Chopra et al. (2009), Coovadia et al. (2009).

  16. African National Congress (1994), Government of South Africa (2011).

  17. See for example Ataguba and Goudge (2012).

  18. Cutler and Zeckhauser (2000).

  19. Kirigia et al. (2005), Bhat and Jain (2006), Xu et al. (2006).

  20. Kirigia et al. (2005).

  21. Kaiser Family Foundation and the Health Research & Educational Trust (2011), Vistnes et al. (2012).

  22. Reschovsky et al. (2006), Shen and Long (2006).

  23. DeVoe et al. (2009).

  24. Angier et al. (2013).

  25. Percheski and Bzostek (2013).

  26. United States Department of Health and Human Services (1997).

  27. DeVoe et al. (2014).

  28. World Health Assembly (2005), WHO (2010).

  29. WHO (2010).

  30. The SACBIA (South African Consortium for Benefit Incidence Analysis) survey was a collaborative initiative by the Health Economics Unit, University of Cape Town; Centre for Health Policy, University of the Witwatersrand; the National Department of Health; and the London School of Hygiene and Tropical Medicine. SACBIA was funded by the European Union and data was collected by the Community Agency for Social Enquiry (CASE).

  31. The usage of the terms “black African”, “coloured”, “Indian” and “white” reflects a statutory stratification of the South African population in terms of the former Population Registration Act. The usage of these terms in this paper does not imply any legitimacy of this racist terminology.

  32. Kirigia et al. (2005), Bhat and Jain (2006), Xu et al. (2006), DeVoe et al. (2009), Sarpong et al. (2010), Richardson et al. (2011), Angier et al. (2013).

  33. Montgomery and Peck (1982).

  34. Posel and Rogan (2010).

  35. Posel (2010).

  36. Newacheck et al. (1998).

  37. Linda et al. (2000), Ham and Shore-Sheppard (2005), Hudson and Selden JB (2005), Gruber and Kosali (2008).

  38. Höfter (2006).

  39. Quisumbing and Maluccio (2003), Posel (2010).

  40. Jones and O’Donnell (2002), Meer and Rosen (2004).

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Authors and Affiliations

  1. School of Public Health and Family Medicine, Health Economics Unit, University of Cape Town, Anzio Road, Cape Town, 7925, Western Cape, South Africa

    Veloshnee Govender, John E Ataguba & Olufunke A Alaba

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  1. Veloshnee Govender
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  2. John E Ataguba
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Govender, V., Ataguba, J. & Alaba, O. Health Insurance Coverage Within Households: The Case of Private Health Insurance in South Africa. Geneva Pap Risk Insur Issues Pract 39, 712–726 (2014). https://doi.org/10.1057/gpp.2014.29

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