Faculty of Commerce, Law and Management (ETDs)

Permanent URI for this communityhttps://hdl.handle.net/10539/37778

Browse

Has files: YesSubject: search.filters.subject.Equity

Search Results

Now showing 1 - 4 of 4
  • Thumbnail Image
    Item
    Health Financing and its Effect on the Equity of Healthcare Systems and Universal Coverage in Sub-Saharan Africa
    (University of the Witwatersrand, Johannesburg, 2023) Okaka, Damianus Ochieng; Ojah, Kalu
    This work examines the contribution of different arrangements for financing healthcare to health systems’ equity in Sub-Saharan Africa (SSA); with equity of the health system measured as health outcomes. More specifically, the study explores: 1) How financing of healthcare using domestic resources affects health outcomes. The effect of increased budgetary allocation to healthcare on health outcomes. And the effect of financial pooling and financial risk mitigation on the health systems’ equity. The concept of health production, based on Grossman’s (1972 & 2017) health capital theory, serves as the framework for empirical analysis of this work, using balanced panel data from 47 SSA countries, over 19 years. The dataset is pulled from relevant governments’ and multi-lateral organizations’ databases. Broadly, descriptive statistics and multivariate regression analysis are deployed in assessing the hypothesized relationships between the study’s relevant variables – financing of countries’ healthcare systems and various forms of health outcomes (i.e., life expectancy at birth, 5-year mortality rate, crude death mortality rate, and rate of infant mortality). The results indicate that financing healthcare using domestic public resources does relate insignificantly or negatively to health outcomes, but financing healthcare using domestic private resources relates significantly well with health outcomes. An increase in budgetary allocation to healthcare per capita relates beneficially to health outcomes. However, an increase in budgetary allocation as a percentage of total government expenditure affects the region’s health outcomes adversely; however, further tests of this relationship reveal that a reduction in indirect investment in healthcare could be responsible for the adverse effects. Thus, pointing to the need to balance the effects of the increase in both direct and indirect healthcare investments (expenditures). Lastly, apart from financial pooling using the private health insurance method, which affects health outcomes negatively, all the other pooling methods of healthcare financing affect the region’s health outcomes favorably. However, the social health insurance (SHI) effect on the region’s health outcomes is largely insignificant. Which may call into question its appropriateness as a vehicle for universal health coverage (UHC). The main conclusion of the study is that governments’ participation in healthcare financing is necessary for the SSA region’s health systems. However, increased government allocation should not be done at the expense of allocation to health-related activities (like the provision of clean water, sanitary services, etc.). We also found that domestic private healthcare funding methods associate favorably with health outcomes while domestic public healthcare funds do not. We argue that the reason for these confounding results is because of allocation problems, and recommend redistributive policies with a focus on the indigent and rural areas. Further diagnostic tests show that domestic public financing methods increase access to healthcare but not health outcomes. This shows that a financing method can increase access to healthcare but fail to improve population health status. Our findings also show that SSA health systems still need external financial assistance to be equitable. We recommend a gradual weaning from external assistance. On risk pooling, we recommend an increase in pool sizes and more accurate actuarial data to improve the performance of SHI and, to make it appropriate for UHC. Finally, governments of the SSA region should increase funding of healthcare by using public resources, ensure healthcare financing risk mitigation by increasing pool sizes of public financial pooling methods, and enact requisite legal and regulatory frameworks to guide the administration of private non-profit healthcare finance pooling schemes. Importantly, these governments should consider policies that correct for imbalances in the distribution of healthcare between the rich and the poor, and between rural and urban areas
  • Thumbnail Image
    Item
    VAT Policy Reform in South Africa: An Equitable Redress to Income Inequality
    (University of the Witwatersrand, Johannesburg, 2022) Mabunda, Sibongiseni Sharon-rose; Kolitz, Maeve
    The purpose of this research report is to discuss how VAT reform can reduce inequality and bridge the gap between the rich and the poor. It comprises a review of quantitative and qualitative evidence and provides an overview of VAT as a consumption tax and its role in the economy and social equity.
  • Thumbnail Image
    Item
    Measuring equity in public health financing across provinces in South Africa
    (2021) Maake, Marumo
    The post 1994 government in South Africa has been struggling over the years to address the socio-economic imbalances that existed during the apartheid period. In that period public health services were severely fragmented. While efforts were made over the years to address the inequalities, health indicators suggest that huge challenges still exist. Therefore, this research assesses whether the allocation of public health resources are equitably distributed, using expenditure as a proxy. The methodology used entailed the development of a needs-based formula to measure if the public health expenditure is allocated based population needs across provinces. The formula requires the weighting of the public sector population for its different need factors such as age and sex characteristics, burden of disease and socio-economic indicators such as deprivation indices. The findings of the research revealed that the distribution of public health resources are skewed towards certain provinces. This means that there is an inequitable distribution of health services across provinces and therefore the health allocations are not based on the needs of the population. Critical priority areas such as medicines, medical supplies and laboratory services are worst affected by the skewed distribution.
  • Thumbnail Image
    Item
    Assessing the feasibility of replacing the current income-based tax system with a consumption-based tax system for individuals in South Africa
    (2021) Khan, Mohsin
    In South Africa, a small and continuously declining individual taxpayer base is a significant issue. For the 2018 tax year-end, 4,337,923 taxpayers were assessed.1 Relative to an estimated population of 59,620,0002, a small portion bears a disproportionate tax burden. Unfortunately, South Africans have gained notoriety for spending while saving very little.3 Therefore, this research examines the feasibility of replacing the tax system from income-based to consumption-based. The current income-based tax system is assessed regarding its equity, the costs to comply, and the extent to which tax evasion is prevalent. Against this, a consumption-based tax system is assessed to understand its ability to sustain existing tax revenue and positively impact tax evasion while addressing its most significant critique (i.e., being regressive). The outcomes of this research suggest that this proposed change will exacerbate South Africa’s disproportionate distribution of wealth, and the current political climate in South Africa will probably prevent any meaningful support