Doc­tor ex­o­dus feared as NHI pro­poses bold cure

Sunday Times - - News | Burning Issues - By KATHARINE CHILD

● 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.

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