Coverage and predictors of medical aid ownership among households in poor urban communities in Johannesburg in 2012

Abstract

Background: The trend in health spending and medical aid coverage in South Africa relative to the populations served reflects huge gaps in equitable and universal coverage of healthcare. Medical aid ownership in South Africa is predicated on income and wealth. Objectives: To estimate the coverage of medical aid ownership and to identify predictors of medical aid ownership among households in poor urban communities in Johannesburg in 2012. Methods: This was a cross-sectional analysis of the 2012 Health Environment and Development (HEAD) survey data for 543 households in five poor settlements m Johannesburg. Univariable and multivariable logistic regression modeling were used to estimate the odds ratio (OR) and 95% confidence interval (CI) of the association between household ownership of medical aid with socio-economic factors and other health-related factors. Results: The coverage of household ownership of medical aid was 10.9% (n=59) among the 543 households were surveyed in the five settlements in 2012. In multivariable analysis, the odds of household ownership of medical aid were associated with a single increase in the number of people employed in the household (AOR 3.42; 95% CI 1.12-10.44) and those aged 18 years and above (AOR 1.84; 95% CI 1.06-3.21 ), households with middle SES (AOR 3.40; 95% Cl l.48-7.81) and high SES (AOR 9.37; 95% CI 3.93-22.33), households that use the services of a private doctor to access healthcare (AOR 4.87; 95% CI 2.26-10.53) and those who rated their overall health as good (AOR 5.96; 95% CI 1.11-32.10). Conclusion: In these poor urban communities, ownership of medical aid is low. Given the role of poor access in perpetuating poverty and inequality, and its effect on morbidity and mortality, it is imperative to tackle these profound social disparities through innovative healthcare financing and policies such as the National Health Insurance to reduce inequalities in access to healthcare particularly across different socio-economic strata in South Africa.