Equity in financing and use of health care in Ghana, South Africa, and Tanzania: implications for paths to universal coverage

Universal coverage of health care is now receiving substantial attention, but debate continues on the best mix of financing mechanisms. This article reports a whole-system analysis integrating both public and private sectors—of the equity of health-system financing and service use in Ghana, South Africa, and Tanzania. Overall health-care financing was progressive in all three countries, as were direct taxes. Indirect taxes were regressive in South Africa but progressive in Ghana and Tanzania. Out-of-pocket payments were regressive in all three countries. Health-insurance contributions by those outside the formal sector were regressive in both Ghana and Tanzania. The overall distribution of service benefits in all three countries favoured richer people, although the burden of illness was greater for lower-income groups. Access to needed, appropriate services was the biggest challenge to universal coverage in all three countries.