Improving the public health sector in South Africa

Improving the public health sector in South Africa: eliciting public preferences using a discrete choice experiment

The proposed introduction of a national health insurance (NHI) scheme in South Africa is the most important issue currently on the health policy agenda in that country, with implications for the whole health system. The scheme aims to achieve universal health coverage. To date there has been little opportunity for public engagement in the development of health policy around this scheme. This study aimed to better understand the community’s preferences in relation to key aspects of healthcare services when selecting healthcare providers, in order to identify priority areas for reform in the supply of public healthcare. It used a discrete choice experiment to elicit public preferences of the community in the Western and Eastern Cape.

Outcome and Translation

Communities are prepared to tolerate public sector health service characteristics such as a long waiting time, poor staff attitudes and lack of direct access to doctors if they receive the medicine they need, a thorough examination and a clear explanation of the diagnosis and prescribed treatment from health professionals. These findings prioritise issues that the South African government must address in order to meet their commitment to improve public sector health-care service provision.

HERU researchers involved in this research project: Mandy Ryan

External collaborators: A Honda, D McIntyre (Health Economics Unit, University of Cape Town, South Africa) and R Van Nierkerk (Rhodes University)

Publications

McIntyre, D., Honda, A., Ryan, M. and Van Niekerk, R. (2011) Community preferences in terms of public sector health services in South Africa : what aspects of public sector health service quality improvements should be prioritised? Health Economic Unit Policy Brief, Cape Town: Health Economic Unit, University of Cape Town.

Honda, A., Ryan, M., van Niekerk, R. and McIntyre, D. (2015) 'Improving the public health sector in South Africa: eliciting public preferences using a discrete choice experiment', Health Policy and Planning, 30(5), 600-611.

Presentations

Honda, A., McIntyre, D. and Ryan, M. (2011) 'Discrete Choice Experiments for eliciting public preferences for health system changes in South Africa', [poster] International Health Economic Association Conference, Toronto, July 2011.

Honda, A., McIntyre, D. and Ryan, M. (2012) 'Community prioritisation of reforms to public sector health services in South Africa : findings from a household level discrete choice experiment', [poster] Symposium on Health Systems Research, Beijing, November 2012.