Distance decay and persistent health care disparities in South Africa.
Distance decay and persistent health care disparities in South Africa.
复制标题
DOI：
10.1186/s12913-014-0541-1
复制
发表时间：
2014-11-04
影响因子：
2.8
通讯作者：
Leibbrandt M
中科院分区：
文献类型：
--
作者：
McLaren ZM;Ardington C;Leibbrandt M
鉴于获得医疗保健的机会在使贫穷和不平等永久化方面发挥的重要作用，获得保健是一个特别令人关切的问题。南非的种族隔离历史留下了巨大的种族差距，尽管种族隔离后的卫生政策旨在增加卫生设施的数量，即使在偏远的农村地区也是如此。然而，即使免费提供医疗服务，前往当地诊所旅行的金钱和时间成本也可能对人口中的弱势群体构成重大障碍，导致整体健康状况变差。使用来自南非第一次具有代表性的全国小组调查的新获得的医疗保健利用数据，以及来自卫生部的行政地理数据，我们使用图形和多元回归分析来调查距离最近的机构对健康咨询或分娩的可能性的作用。90%的南非人居住在距离最近的公共诊所7公里以内，三分之二的人居住在不到2公里的地方。然而，14%的非洲黑人成年人居住在距离最近设施超过5公里的地方，而白人只有4%，而且他们报告最近的健康咨询的可能性降低了16个百分点(p <； 0.01)，使用私人设施的可能性降低了47个百分点(p <； 0.01)。收入最低的五分位数的受访者居住在距离最近的医疗机构0.5至0.75公里的地方(p <； 0.01)。即使在控制了混杂因素之后，进行健康咨询或分娩的可能性方面的种族差异仍然存在。我们的结果有两个政策含义：最大限度地减少南非穷人获得医疗保健的路程，以及改善较贫穷地区提供的医疗质量将减少不平等。自种族隔离制度结束以来，南非为消除不平等现象做了大量工作，但仍需取得进展，以实现医疗保健机会的公平。
Access to health care is a particular concern given the important role of poor access in perpetuating poverty and inequality. South Africa’s apartheid history leaves large racial disparities in access despite post-apartheid health policy to increase the number of health facilities, even in remote rural areas. However, even when health services are provided free of charge, monetary and time costs of travel to a local clinic may pose a significant barrier for vulnerable segments of the population, leading to overall poorer health. Using newly available health care utilization data from the first nationally representative panel survey in South Africa, together with administrative geographic data from the Department of Health, we use graphical and multivariate regression analysis to investigate the role of distance to the nearest facility on the likelihood of having a health consultation or an attended birth. Ninety percent of South Africans live within 7 km of the nearest public clinic, and two-thirds live less than 2 km away. However, 14% of Black African adults live more than 5 km from the nearest facility, compared to only 4% of Whites, and they are 16 percentage points less likely to report a recent health consultation (p < 0.01) and 47 percentage points less likely to use private facilities (p < 0.01). Respondents in the poorest income quintiles live 0.5 to 0.75 km further from the nearest health facility (p < 0.01). Racial differentials in the likelihood of having a health consultation or an attended birth persist even after controlling for confounders. Our results have two policy implications: minimizing the distance that poor South Africans must travel to obtain health care and improving the quality of care provided in poorer areas will reduce inequality. Much has been done to redress disparities in South Africa since the end of apartheid but progress is still needed to achieve equity in health care access.
登录
查看更多内容
影响因子：
5.4
作者：
Tanser, Frank;Gijsbertsen, Brice;Herbst, Kobus
通讯作者：
Herbst, Kobus
影响因子：
3.5
作者：
Bloom, SS;Wypij, D;Das Gupta, M
通讯作者：
Das Gupta, M
影响因子：
5.4
作者：
Rosero-Bixby, L
通讯作者：
Rosero-Bixby, L
影响因子：
168.9
作者：
Coovadia, Hoosen;Jewkes, Rachel;McIntyre, Diane
通讯作者：
McIntyre, Diane
影响因子：
7.7
作者：
Müller, I;Smith, T;Genton, B
通讯作者：
Genton, B