Published in The Times on 8 June 2016
Doctors’ organisations and NGOs have warned that South Africa could face a mass exodus of doctors if the national health insurance policy is implemented in its present format. They have also warned about the cost, saying how it will be funded has not been made clear.
They were responding to the Health Department’s white paper on the NHI – intended to bridge the gap between private and public healthcare.
More than 100 submissions were received by the May 31 deadline and the department is still responding to those submitted just before the deadline.
The NHI is to be a single state-run medical aid fund that would buy all healthcare services, according to the white paper released in December.
The NHI plan proposes major infrastructure upgradings for hospitals and clinics.
According to the proposal, medical aid scheme cover would be restricted to the treatment of rare diseases and high-cost medicines – which would make medical aid cover prohibitively expensive and destroy private healthcare, say analysts.
Some have torn the plan apart, calling it “long on rhetoric, short on specifics”, with parts “over general and seriously incomplete”.
Many responses have warned that implementation of the plan will force doctors out of South Africa.
The SA Private Practitioners’ Forum, which represents 2700 specialist doctors, is among those warning that many doctors would leave if forced into the NHI.
The forum said: “Despite the massive number of vacancies, the government is unable to retain medical staff, which is an indication that poor work circumstances are leading to the loss of healthcare personnel.”
It added that if the government sets healthcare prices, which the white paper says it intends to do, doctors will go bankrupt.
The Helen Suzman Foundation warned that a restriction on medical aids could devastate the private sector.
The foundation writes: “A choice has to be made between suppression of the private sector and intelligent co-operation with it. The white paper fails to make a clear choice.”
The foundation praised the proposals for focusing on primary healthcare and using the Office of Health Standards Compliance to audit state medical facilities.
The Independent Municipal and Trade Union suggests that medical aids be retained as a “safety valve in case NHI fails to get off the ground or function effectively”.
The union says all patients will be affected by the NHI because they will be forced to go to doctors the government pays for.
“If you like your doctor you can only keep him if he is accredited and contracted by the NHI. This aspect of the NHI might be unconstitutional.”
The white paper suggests that doctors be assigned to locations of the state’s choice so that there is a fair distribution of health professionals in under-serviced areas.
But doctors do not work in these areas because of “poor conditions and lesser compensation”, says AfriBusiness, an NGO.
“Forcing doctors to relocate to areas of greatest need will infringe on their freedom of trade and it will simply make medical practitioners leave the country,” it said. The Private Practitioners’ Forum said that this country does not have sufficient doctors for the plan to be feasible.
It has 3.7 medical graduates per 100000 citizens. Countries in the Organisation for Economic Co-operation and Development with a form of NHI have three times as many at 10.7 per 100 000.
The Free Market Foundation notes that, due to restrictions on private-sector training of doctors, “the number of medical graduates is only fractionally higher than in the early 1970s, in spite of the country’s rising disease burden and a population that has more than doubled”.
Respondents have asked how the NHI will be paid for.
“If developed countries such as Canada and Britain, which have per capita domestic products more than three times greater than South Africa’s, are struggling to meet the demands of patients under their free healthcare for all policies, it is unrealistic to assume South Africa will be able to afford to do so,” said the Free Market Foundation.
The Private Practitioners Forum has urged the Treasury to test the affordability of the NHI proposals.
The white paper foresees tax increases to pay for it.