Expenditure in absolute terms

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.

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 Setshegetso 2020 33 South African Income and Expenditure Survey % of population facing catastrophic health expenditure from OOP health expenditure at various thresholds of household’s non-subsistence expenditure (WHO method)

Mills et al. 2012 37 South African Income and Expenditure Survey % of population facing catastrophic health expenditure from OOP health expenditure at ≥40.0% of household’s non-subsistence expenditure (WHO method)

Xu et al. 2003 38 South African Income and Expenditure Survey % of population facing catastrophic health expenditure from OOP health expenditure at ≥40.0% of household’s non-subsistence expenditure (WHO method)

Cairncross et al. 2020 42 Annual statutory return data (Council for Medical Schemes) OOP expenditure per capita for medical scheme members (current Rand values) 2010 j ≥40%: 0.07%

2006 ≥40%: 0.09%

1995 ≥40%: 0.03%

2019 Out-of-hospital: R3178.66 In-hospital: R735.29 Total: R3,913.94

Jakovljevic et al. 2017 40

Ataguba and Goudge 2012 41 South African Consortium for Benefit Incidence Analysis Survey Average OOP payments per person per annum for outpatient care (current Rand values) 2008 GP: R1,285.05 Specialist: R2,937.94 Hospital: R4,620.98 Dentist: R1,304.47 Pharmacy: R1,045.57 2008 Hospital: R1,93.61 2013 $80

2008 Total: R695.57

j Only included percentages for the most recent year reported in the study. k Only included amount for the most recent year reported in the study.