Abstract
In South Africa, anticipated health sector reforms aim to achieve universal health coverage for all citizens. Success will depend on social solidarity and willingness to pay for health care according to means, while benefitting on the basis of their need. In this study, we interviewed 1330 health and education sector civil servants in four South African provinces, about potential income cross-subsidies and financing mechanisms for a National Health Insurance. One third was willing to cross-subsidize others and half favored a progressive financing system, with senior managers, black Africans, or those with tertiary education more likely to choose these options than lower-skilled staff, white, Indian or Asian respondents, or those with primary or less education. Insurance- and health-status were not associated with willingness to pay or preferred type of financing system. Understanding social relationships, identities, and shared meanings is important for any reform striving toward universal coverage.
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Acknowledgements
We would like to thank Diane McIntyre for her conceptual input into the design of the social solidarity-related survey questions and framework underpinning this article. This research was funded by the International Development Research Centre (IDRC) (Grant number 103457) and the European Commission (Sixth Framework Programme; Specific Targeted Research Project no: 32289).
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This paper examines the willingness of South African civil servants to cross-subsidize the health care costs of others. The authors recommend that health sector reforms must consider social relationships, and identities, as well as technical and financing details.
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Harris, B., Nxumalo, N., Ataguba, J. et al. Social solidarity and civil servants’ willingness for financial cross-subsidization in South Africa: Implications for health financing reform. J Public Health Pol 32 (Suppl 1), S162–S183 (2011). https://doi.org/10.1057/jphp.2011.23
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DOI: https://doi.org/10.1057/jphp.2011.23