Overview
The aim of this study is to undertake a detailed empirical investigation of the market for public and private primary care services in Soweto, Johannesburg. It will focus on the determinants of provider performance on the one hand, and demand for private services from uninsured cash-paying patients on the other.
Following a detailed description and mapping of the local market for primary care services, the project will use standardised patients to compare the performance of private and public providers in terms of accessibility to services, technical quality of care and cost of treatment recommended. Next, the project will conduct a randomised field experiment to determine the key role that price and quality play in the demand for private care services by uninsured patients. The study will provide important information on whether the private primary care market can contribute to better health system access, quality and efficiency. The results are relevant to many low- and middle-income countries trying to expand UHC within mixed health care systems.
The private sector provides many healthcare services in many low- and middle-income countries, particularly for primary health care. But the role of the private sector in expanding universal health coverage in LMICs is contentious. Supporters of private care provision argue that competitive pressures make private providers more responsive, exert more effort and provide better quality care. Yet the empirical evidence supporting this is mixed. There is also limited evidence that the demand for care is responsive to quality or costs, a pre-condition for a functioning competitive market. These questions are central to current policy proposals in South Africa, where the government plans to expand access to quality primary care services by contracting private providers.
This study aims to address these questions and inform current policy debates by undertaking a detailed investigation of a self-contained market for primary care services among the urban poor in South Africa. The study has five components:
The Univeristy of Witwatersrand is situated in Johannesburg, South Africa. The mission of the University is to grow its global stature as a leading research-intensive university, and to be a gateway to research engagement and intellectual achievement in Africa.
The Centre for Health Policy (CHP) is one of the few multi-disciplinary health policy units in South Africa and has over 20 years of research experience. CHP seeks to contribute to excellence in health policy and systems research, and to be a critical participant in health policy processes.