Doctor exodus feared as NHI proposes bold cure
● While some have welcomed new details of the government’s proposed National Health Insurance legislation, legal and medical experts said many doctors would reject the planned cap on what they can charge for consultations and surgeries.
Some analysts warned that state-regulated fees would drive doctors to emigrate, leaving the health sector worse off than it is now.
Health Minister Aaron Motsoaledi on Thursday released the National Health Insurance and Medical Schemes Amendment bills for comment.
Under the NHI Bill, the health insurance fund would be the biggest purchaser of health services in South Africa and consumers would have to contribute to it.
The bill proposes price controls in the private sector: “The fund may withdraw the accreditation of a service provider if the service provider . . . fails to adhere to the national pricing regimen for services delivered.”
Medical lawyer Neil Kirby of Werksmans said that in view of the scarcity of doctors, it would not be a good strategy to freeze out those who did not stick to NHI rates.
“The prudence of excluding healthcare providers, in an already strained system starving from a lack of available expertise, is highly questionable if not irrational,” he said.
Norton Rose Fulbright director Michelle David said doctors would not want to be told what to charge. “It is not likely to be accepted by all stakeholders [doctors and hospitals] that the largest purchaser of services will also be able to set tariffs.”
David said doctors were likely to challenge NHI in the courts, as they had challenged price control before.
Johann Serfontein of HealthMan, a consultancy that represents doctors in private practice, said: “I think there is an underlying assumption that specialists will be employed by private hospitals.”
This is currently not the case as the law ensures doctors work for themselves but are based at private hospitals.
“A survey done by the South African Private Practitioners Forum showed that 55% of specialists do not want to be employed by hospitals. So one can safely assume those will be the ones considering emigration,” said Serfontein.
Graham Anderson, principal officer of Profmed medical scheme, also warned that if doctors were not happy with the tariffs they had to charge they would emigrate. He said emigration was the main cause of members leaving Profmed, which caters to people in the professions.
“Private healthcare is an essential service. If they are going to trash the private sector in order to get the public sector up and running, doctors are going to go. If the doctors emigrate then other professionals, who can afford to leave, will go because they want healthcare for their children.”
But Brian Ruff, a former medical aid executive and founder of private health group PPO Serve, was positive about the focus of NHI. “Private healthcare is unaffordable. It was developed without adequate planning and regulation of how many hospitals and doctors are needed for the [private] population. Nobody is held accountable for the management of the cost or the quality of outcomes of the patients,” he said.
“South Africa has a very hospital-centred system. So much care happens unnecessarily in a hospital bed that could be done outside hospitals, such as at a GP’s office or day clinics.”
The Board of Healthcare Funders of Southern Africa, an industry body that represents 45 medical aids, also supported the NHI proposals. “We are committed to the NHI as a vehicle that will enable the country to achieve universal health coverage, not just for the 8.9 million lives covered in private healthcare but the 56 million of our entire population,” chairman Ali Hamdulay said.
Some doctors could find the NHI proposals painful.