The doctor will not see you now

The fightback against the ANC government’s proposed National Health Insurance scheme appears to have begun. This week, the South African Private Practitioners’ Forum warned that one aspect of the NHI proposals – the capping of doctors’ fees – would see a mass exodus of doctors from the health system.

In addition, the organisation threatened legal action should its members be forced to work at fixed rates. It is still not clear how the NHI will function, but indications are that patients will go to NHI-accredited doctors and the NHI will pay those doctors in a similar way to how medical aids currently remunerate them. Many private doctors already charge “out of medical aid” rates and are unlikely to agree to their fees being lowered even further by the NHI.

The Forum has about 3 000 members and its pronouncements – especially about the future of the health system – should be taken very seriously indeed.

According to Dr Nicholas Burger, healthcare consulting analyst at Frost & Sullivan, the threat by the private doctors could plunge our medical sector further into crisis, given the shortage of doctors is already impacting on both government and private healthcare.

The NHI, in its current format, takes an unashamedly socialist approach to medicine, with Health Minister Aaron Motsoaledi saying the rich will subsidise the poor and the healthy will subsidise the sick. In countries in Northern Europe, this works, because they are wealthy and have a vast tax base. South Africa is the opposite.

We agree with Motsoaledi that the current system has to be reformed and medical care made more equitable. However, we cannot run the risk of alienating the very practitioners on whom the whole system relies.

To do so would be to cut off one’s nose to spite one’s face. Without aneasthetic.