Determinants of Healthcare Services in South Africa: A Demographic analysis

Abstract

Healthcare access and utilisation in South Africa continue to show significant inequalities, as well as disparities in cost and service quality, despite global health service development. The purpose of this study is to examine the underlying deficiencies in dual healthcare access and utilisation, how people from different socioeconomic backgrounds access and afford the necessary healthcare services, which will then determine the shape of the care they receive. The study used secondary data derived from the nationally representative South African National HIV Prevalence, Incidence, Behaviour and Communication Survey (SABSSM V) to evaluate the underlying weaknesses in the healthcare access and utilisation system. For data analysis, STATA version 18 was used to address the research objectives and questions by performing three statistical techniques, namely the univariate, bivariate, and multivariate methods. The findings of the study established that younger, unemployed, and less-educated South Africans who rely on public facilities face healthcare access challenges because these facilities have insufficient staff members, combined with outdated infrastructure and extended waiting periods. In contrast, the private healthcare system primarily caters to elderly patients from higher- income brackets who have the financial ability to pay medical premiums and co-payments, along with additional healthcare expenses. Medical aid membership functions as the primary factor that enables private healthcare access, yet the covered population reaches only 16%, and besides, they spend half of the total national health expenditure, while public facilities, which serve most citizens, remain overwhelmed and underserved. Lastly, the study findings found that healthcare accessibility in South Africa remains fragmented because socioeconomic disparities, together with racial and spatial inequalities of the past, still play a critical role in affording one access to equitable healthcare. The study further discovered that employment, level of education, and population group differences are the leading contributing factors to healthcare access and utilisation.