Distance decay and persistent health care disparities in South Africa
| dc.contributor.author | McLaren, Zoe | |
| dc.contributor.author | Ardington, Cally | |
| dc.contributor.author | Leibbrandt, Murray | |
| dc.date.accessioned | 2021-12-02T19:58:51Z | |
| dc.date.available | 2021-12-02T19:58:51Z | |
| dc.date.issued | 2014-11-04 | |
| dc.description.abstract | Background Access to health care is a particular concern given the important role of poor access in perpetuating poverty and inequality. South Africa’s apartheid history leaves large racial disparities in access despite post-apartheid health policy to increase the number of health facilities, even in remote rural areas. However, even when health services are provided free of charge, monetary and time costs of travel to a local clinic may pose a significant barrier for vulnerable segments of the population, leading to overall poorer health. Methods Using newly available health care utilization data from the first nationally representative panel survey in South Africa, together with administrative geographic data from the Department of Health, we use graphical and multivariate regression analysis to investigate the role of distance to the nearest facility on the likelihood of having a health consultation or an attended birth. Results Ninety percent of South Africans live within 7 km of the nearest public clinic, and two-thirds live less than 2 km away. However, 14% of Black African adults live more than 5 km from the nearest facility, compared to only 4% of Whites, and they are 16 percentage points less likely to report a recent health consultation (p < 0.01) and 47 percentage points less likely to use private facilities (p < 0.01). Respondents in the poorest income quintiles live 0.5 to 0.75 km further from the nearest health facility (p < 0.01). Racial differentials in the likelihood of having a health consultation or an attended birth persist even after controlling for confounders. Conclusions Our results have two policy implications: minimizing the distance that poor South Africans must travel to obtain health care and improving the quality of care provided in poorer areas will reduce inequality. Much has been done to redress disparities in South Africa since the end of apartheid but progress is still needed to achieve equity in health care access. | en_US |
| dc.description.sponsorship | McLaren, Ardington and Leibbrandt acknowledge funding from the William and Flora Hewlett Foundation/Population Reference Bureau Research program on Population, Reproductive Health, and Economic Development. McLaren gratefully acknowledges funding from the University of Michigan Global Public Health Faculty Pilot Grant. Ardington gratefully acknowledges funding from the National Institutes of Health Fogarty Internal Centre under grant R01 TW008661-01. Leibbrandt acknowledges the Research Chairs Initiative of the Department of Science and Technology and National Research Foundation for funding his work. | en_US |
| dc.description.uri | https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-014-0541-1 | en_US |
| dc.format.extent | 9 pages | en_US |
| dc.genre | journal articles | en_US |
| dc.identifier | doi:10.13016/m2xlfr-ms7i | |
| dc.identifier.citation | McLaren, Zoe; Ardington, Cally; Leibbrandt, Murray; Distance decay and persistent health care disparities in South Africa; BMC Health Services Research, volume 14, Article number: 541, 4 November, 2014; https://doi.org/10.1186/s12913-014-0541-1 | en_US |
| dc.identifier.uri | https://doi.org/10.1186/s12913-014-0541-1 | |
| dc.identifier.uri | http://hdl.handle.net/11603/23510 | |
| dc.language.iso | en_US | en_US |
| dc.publisher | BioMed Central | en_US |
| dc.relation.isAvailableAt | The University of Maryland, Baltimore County (UMBC) | |
| dc.relation.ispartof | UMBC School of Public Policy Collection | |
| dc.rights | This item is likely protected under Title 17 of the U.S. Copyright Law. Unless on a Creative Commons license, for uses protected by Copyright Law, contact the copyright holder or the author. | en_US |
| dc.rights | Attribution 4.0 International (CC BY 4.0) | * |
| dc.rights.uri | https://creativecommons.org/licenses/by/4.0/ | * |
| dc.title | Distance decay and persistent health care disparities in South Africa | en_US |
| dc.type | Text | en_US |
| dcterms.creator | https://orcid.org/0000-0003-2515-9731 | en_US |