By Essie Bester
Shifting demographics, cost pressures, consumerism and rapid advances in technology will play a role in the future of health care. It is, however policy changes that will for ever change the face of health care as we know it.
The Solidarity Guild for Health Practitioners, which focuses on tackling problem areas in the health profession with workable solutions, says the government’s proposed National Health Insurance (NHI) is causing great concern about the future of health care in South Africa among practitioners, economists and ordinary citizens.
Many people feel that the NHI is a political initiative to keep up with first-world countries by proving that the governing party is discharging its constitutional duty – medical care for everybody.
Most of us agree that something will have to be done to make efficient medical services and care accessible and more affordable for everybody – about 43,5 million South Africans are at the mercy of extremely inadequate health care. It has become clear, however, that the proposed change in policy is not going to guarantee this.
For this plan to succeed, there has to be enough competent doctors and nursing staff, proper facilities such as hospitals and clinics, enough ambulances and a strong bureaucracy to manage it all. But then again, the poor condition and management of some state hospitals and clinics countrywide are sure indications that the proposed NHI is heading for disaster.
Experts warn that concern about health care in South Africa should not be taken lightly. Apart from the fact that South Africans are being intentionally misinformed about the unaffordability of the proposed national health plan, the tremendous risk that the emigration of practitioners holds for the future of health care in South Africa is a big menace.
Professionals who took part in a study by the Solidarity Research Institute SRI) said they would leave the country if the system was implemented in its present format.
Nicolien Welthagen, a research psychologist at the SRI, says findings indicate that the government is distrusted because of the way in which it wants to implement and manage the NHI.
Some of the factors that can derail our health care are:
- a shortage of specialists, doctors, nursing staff and other health workers;
- financial management of the NHI;
- the purchase and distribution of medicine and equipment; and
- the maintenance of infrastructure and equipment.
Are private doctors going to be part of the plan?
Private healthcare providers and other doctors will be used. Under the NHI doctors will be told exactly which trademarks of medicine they may prescribe and which tests they may request and when.
Although doctors will be able to decide for themselves about treatment in the case of patients who pay for their treatment themselves or who have sick funds, fewer and fewer people will be able to afford it if they have to contribute to the NHI in any case – contributions will be determined according to income. This may leave doctors with no other choice than to become a NHI-contracted doctor.
It is not clear whether private hospitals or private institutions will be used by the NHI. If private hospitals can no longer make decisions regarding the financial, procurement and price decisions essential to their viability, they will close.
Access to specialists
According to the Minister of Health, Dr Zweli Mkhize, everybody must have equal access to specialist’s services. South Africans are not going to have the right to see a specialist or to have an MR scan done because they have money. This means that the state could decide what treatment a patient needs, who is to provide it and where the patient is to receive it.
According to Dr Chris Archer, CEO of the South African Private Practitioners Forum, most specialists are older than 55 years and prefer to practise in urban areas (where they are at present). Also, they do not want to become paid employees of hospital networks.
Rates for specialist services will be determined by the minister of health and the NHI fund, while the SAPPF prefers a non-compulsory rate guideline based on the average cost of a practice, with one or two standard deviations.
Pharmacists’ critical role
According to the health department pharmacists are going to play a critical role as the state is going to provide medicine to all NHI members. In October 2019 an appeal was made to all pharmacists to complete a declaration in which they indicate that they support the NHI.
Not all of them want to because they see how poor the state’s health care is. Morné Malan, a strategic specialist at Solidarity, contacted the South African Pharmacists Council (SAPC) on behalf of Solidarity’s professional guild and found that they were nor compelled to sign the declaration. Apparently this is just a way of sounding pharmacists as to who supported the NHI and who do not.
What will medical funds’ role be?
Medical funds will quite possibly disappear. If the NHI bill is approved, only individuals who can afford a medical fund as well as the additional tax will be able to get by without the NHI. The number of people who can afford a private medical fund will drop drastically.
In the meantime Dr Sipho Kabane, CEO of the Council for Medical Schemes (CMS) has indicated that certain hospital plans and low-cost medical options will no longer be valid from the end of March 2021 – because it would undermine the NHI. With the NHI that only become operative in 2026, these people (an estimated 2 million) will be at the mercy of the worst medical care imaginable.
Are there viable alternatives?
Dr Archer says that there are alternatives, for instance by exempting private medical services from VAT, and tax incentives for doctors practising in rural areas. Competition could also be tightened to improve public service delivery.
The Institute for Race Relations (IRR), which believes that there could be more affordable and efficient sustainable alternatives, warns that the proposed NHI could destroy private health care without succeeding in improving public health services.
Future issues such as an ever-increasing population that lives longer as well as the pressure to make health care more affordable through innovation, highlights the necessity of fast technological progress. This will promote quality health care and make possible greater access to services and the development of innovating health-care models, while health practitioners can keep focusing on efficiency and quality.
Not only is it inadvisable to continue with the NHI process, but also immoral, says Dr Dirk Hermann, CEO of Solidarity. In the interests of all South Africans, Solidarity is going to oppose the proposed NHI even in the highest court, if necessary. Health care can have a bright future in South Africa – in spite of challenges like these.