Health Disparities between Racial Groups in South Africa: A Decomposition Analysis
23 Pages Posted: 10 Jul 2004
Date Written: July 9, 2004
This paper explores the sources of self-rated health status inequalities among South Africans. We use data from the October Household Survey conducted in 1999 covering more than 100,000 individuals, which provide valuable information on health as well as structural explanatory variables at the individual as well as at the household level. We apply an ordered probit model to capture the ordinal nature of the response variable. Our results show that Africans and Whites, even if endowed with identical characteristics, are nonetheless facing different health risks, which reveals that some form of discrimination is taking place, Whites enjoying better health risks coverage and receiving more expansive health care of better quality than Africans. We propose a decomposition of observed health disparities between racial groups using an extended version of Oaxaca-Blinder decomposition methods (Oaxaca, 1973; Blinder, 1973) to deal with the ordered probit model. This method allows for a decompositions of differences in self-rated health status between races and isolates what is due to structural socio-economical differences between racial groups ("indirect segregation"), from what is due to a permanent racial segregation phenomenon concerning access to health care and type/quality of treatment ("direct segregation"). We find a strong indirect segregation in favor of Whites. Our analysis of direct segregation tends to show that the issue of racial discrimination on health is very much linked with that of economical discrimination. Our results thus stress the necessity not only to open access for Africans to the more sophisticated sector of health care but also to provide them with the economical possibility to use it.
Keywords: South Africa, Self-rated health, Oaxaca-Blinder decomposition, segregation, discrimination
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