It must be emphasised that the above findings did not account for foregone earnings or travel costs. More than three-quarters of South Africans who report that public healthcare is unaffordable believe that it’s due to travel costs 39. It’s not hard to imagine that seeking healthcare would add the cost of lost income for many poor South Africans who work informally.
Expenditure in absolute terms In absolute terms, OOP health expenditure per capita was $80 in South Africa in 2013 40. Compared to other BRICS countries, this level was relatively low, with OOP expenditure amounting to $762 per capita in Russia, $435 in Brazil, $219 in China and $125 in India in the same year. An earlier study reported that the average OOP payment per person per annum for outpatient care was R695.57 in 2008 41. When disaggregating this average by sector, OOP expenditure for outpatient care in the public sector was far lower than OOP expenditure in the private sector (see Table 21). This is mainly because of exemptions and subsidised care in the public health sector. Medically insured South Africans are not exempt from OOP health expenditure. Cairncross et al. 42 found that in 2019, insured South Africans paid an annual average of R3,914 per capita for OOP health expenditure (see Table 21). This amount roughly has an 80:20 split when disaggregated into out-of-hospital and in-hospital expenditure.
Table 21: OOP health expenditure in South Africa Author, Year
Data Source
OOP health expenditure indicator
Sector Private
Public
Nonspecific
Koch and
South African
% of population facing catastrophic health
2010 j
Setshe-
Income and Ex-
expenditure from OOP health expenditure at
≥40%:
getso
penditure Survey
various thresholds of household’s non-sub-
0.07%
2020
sistence expenditure (WHO method)
33
Mills et al.
South African
% of population facing catastrophic health
2006
2012 37
Income and Ex-
expenditure from OOP health expenditure
≥40%:
penditure Survey
at ≥40.0% of household’s non-subsistence
0.09%
expenditure (WHO method) Xu et al.
South African
% of population facing catastrophic health
1995
2003
Income and Ex-
expenditure from OOP health expenditure
≥40%:
penditure Survey
at ≥40.0% of household’s non-subsistence
0.03%
38
expenditure (WHO method) Cairncross et al. 2020
42
Annual statutory
OOP expenditure per capita for medical
2019
return data
scheme members (current Rand values)
Out-of-hos-
(Council for
pital:
Medical Schemes)
R3178.66
In-hospital: R735.29 Total: R3,913.94
43 | TRADE-OFFS ON THE ROAD TO UHC: A QUANTITATIVE ASSESSMENT OF ALTERNATIVE PATHWAYS FOR SOUTH AFRICA
