Health Insurance Coverage Within Households: The Case of Private Health Insurance in South Africa

Private health insurance coverage within households is declining in South Africa (SA). This raises concerns in a context of growing support both in SA and internationally for universal health coverage (UHC). This paper attempts to advance our understanding of coverage patterns within partially insured households (i.e. having at least one, but not all members, being insured). This paper was guided by the following questions: (1) What factors are associated with some household members members being insured? And (2) who are excluded? Drawing from a nationally representative household survey, it was found that partially insured households differed from completely insured households across a range of demographic and socio-economic factors. Significantly, there was a relationship bias; relationship with the household head was an important predictor of access to insurance within partially insured households. As the drive towards UHC gains momentum in SA and other countries, there is a need to conduct similar intra-household-level empirical research.