Trends and socio-economic inequality in public perceptions of healthcare delivery in South Africa

Objective: To assess trends and inequality in public perceptions of healthcare delivery as reported by South African households. Design: Secondary data analysis of the South African Social Attitudes Survey (SASAS). Setting: Nationally representative weighted sample of South African households. Participants: 28 326 household representatives interviewed during the annual SASAS survey (2007-16). Main Outcome Measures: Adequacy of healthcare services and satisfaction with healthcare delivery. Results: On aggregate, 68.2% only of households reported their healthcare needs as being adequately met, while only 54.3% were satisfied with healthcare delivery. In total, only 41.5% of households was both satisfied with healthcare delivery and adequately provided for in terms of the household's healthcare needs. Adequacy of healthcare provision and satisfaction therewith has however improved rapidly since 2009-10, but overall satisfaction with healthcare delivery has not changed considerably. Public perceptions of healthcare delivery improved with household wealth. Socio-economic inequality in adequacy and satisfaction is pronounced and pro-rich, but inequality in satisfaction has declined significantly since 2009-10. Conclusions: Although public perceptions of healthcare delivery improved, many poor South Africans' healthcare needs are still not adequately met. In addition, many South Africans are not satisfied with government's efforts at healthcare delivery, especially the poor. Further research is required to pinpoint how expectations impact on public perceptions of healthcare delivery and to identify the specific factors that underlie the public opinions expressed in surveys of this nature.