Estimating the demand for health services in four poor districts of Cape Town, South Africa.

In South Africa, differences in healthcare demand may perpetuate inequities in disease incidence, morbidity and survival. This paper presents two models of healthcare demand: one estimating the probability of using any service, and the other modelling the number of visits among users. We find that use is predicted by gender, perceived financial situation, mental and physical health, extra-household resources and the price of a private consultation. The number of visits is predicted by age, physical and mental health, extra-household resources and private provider quality. These findings indicate that demand is not frivolous; extra-household funds enable access; patients may choose not to seek care if they cannot afford private care; and men are less likely to seek care at the same level of ill-health as women. The need for funds to access care suggests that local public services are not fulfilling their 'safety net' function for the most vulnerable. Policy makers should consider whether they can target assistance to households without access to extra funds. Encouraging men to use services before an illness becomes severe may increase early identification of infectious diseases, improving both individual health outcomes and public health consequences