The aim of this study was to undertake a detailed empirical investigation of the market for public and private primary care services in Soweto, Johannesburg. It focused on the determinants of provider performance on the one hand, and demand for private services from uninsured cash-paying patients on the other.
The study will provide important information on whether the private primary care market can contribute to better health system access, quality and efficiency.
Following a detailed description and mapping of the local market for primary care services, the project used 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 conducted 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 provided 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 aimed 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 had five components:
A detailed description of the structure of the market for PHC in Soweto.
An audit study of PHC providers in the market using standardised patients, allowing us to describe the relative performance of public and private providers in terms of access, quality and efficiency of treatment.
An investigation of relationship between measures of market competition and performance.
A study of the determinants of patients’ choices of PHC providers.
A field experiment testing the impact of subsidised care and information about quality on demand.
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.
