Healthcare satisfaction and healthcare utilisation in South Africa

Zvawada, Tanaka
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Background: In trying to assess the performance and delivery of quality healthcare services in South Africa, this study examines the association between healthcare satisfaction (a commonly used opinion based proxy to evaluate the quality of healthcare services), and healthcare utilisation in the public and private healthcare sectors. In addition, the study investigates how experiences of unmet health needs are associated with perceived healthcare satisfaction. Objectives: The analysis has four main objectives which are, determining the level of overall satisfaction with healthcare services in South Africa. Identify the services attributes/features associated with dissatisfaction with healthcare services. Explore sectorial differences in satisfaction levels between the public health sector and private health sector, and to assess the association between unmet health need and healthcare satisfaction. Methodology: The analysis uses weighted cross-sectional data from the South African National Health and Nutrition Examination Survey (SANHANES) (2011/2012). The dataset includes information for 14,938 participants. The study estimates the association between healthcare satisfaction and healthcare utilisation using the following quantitative approaches. First, univariate analysis is conducted, followed by bivariate analysis using the Analysis of Variance (ANOVA) approach. Next, Multivariate Ordinary Least Squares (OLS) and multivariate Probit regression techniques are employed to assess these associations, followed by the application of Inverse Probability Weighted Regression Adjustment (IPWRA) treatment effects models. Results: The level of overall satisfaction with healthcare was 72%. Satisfaction levels between private sector care and public sector care, from the ATET results, showed private sector care had higher levels of satisfaction for both inpatient (96.7%) and outpatient care (90.6%) than public sector care with (60.3%) and (89.6%) for inpatient and outpatient care, respectively. Long waiting times, lack of involvement in decision making and availability of medication were the top three sources of dissatisfaction with healthcare service. There was no significant correlation between experiences of unmet health need with satisfaction with healthcare services. Conclusion: The levels of overall satisfaction levels of with healthcare services, for user and non-users combined were quite high. The satisfaction levels were even higher for participants who used health services for inpatient or outpatient care, during the past 12 months. The study identified underlying key factors that influenced satisfaction outcomes, and choice of health sector used, for different individuals, such as race, access to medical insurance, struggles with affording healthcare costs and differences in levels of wealth. White participants, participants with access to medical insurance, less struggles with paying healthcare costs and being the wealthiest, all experienced higher satisfaction levels. There is need to work towards improving the provision of quality healthcare especially in the public health sector (specifically inpatient care facilities) to bridge the gap the two main health sectors, so that everyone can have access to good quality health care
A research report submitted in partial fulfilment of the requirements for the degree of Master of Commerce (Economics)-50% to the Faculty of Commerce, Law and Management, School of Economics and Finance, University of the Witwatersrand, Johannesburg, 2021