Four years into implementing National Health Insurance (NHI), the Department of Health has failed to persuade significant numbers of private sector general practitioners (GPs) to work in its facilities, raising doubts about its feasibility, reports Business Day.
So far only 175 doctors have been contracted to work in state clinics in 10 of the 11 NHI pilot districts, a far cry from the target of 900 the department had hoped to reach by the end of this month. The sign-up rate has been so slow that the Treasury cut the funding for the NHI pilot programme through the National Health Grant by R767m over the next three years.
The department’s official line is upbeat, with officials claiming they have signed all the doctors who have time available in all but one of the 11 NHI pilot districts. "You cannot speak of a slow pace of sign-up any more since we have signed up all the doctors who are available," primary healthcare head Jeanette Hunter is quoted in the report as saying. "The GPs sign up for the time they have available over and above the time they spend in their own practices. This varies from five to 50 hours a week. This programme is not intended to draw GPs away from their own practices, but is asking GPs who are not fully occupied at their own practices to use their available time to provide services in public … clinics."
But SA's biggest doctors' union, the South African Medical Association (Sama), said the department was overstating the response from GPs in private practice. "The problem is GPs who own independent practices did not sign up. Mostly newly qualified doctors took these posts," said the head of Sama's private practice committee, Jacob Mphatswe. "These were not GPs. These were actually public sector candidates who resigned. Private sector GP participation in NHI has been insignificant."
Mphatswe said private sector GPs were willing to work with the NHI pilot programme but wanted to see patients in their own consulting rooms, rather than working in government clinics. "The NHI pilots are intended to test how NHI might work. The Department of Health must try different models, but it hasn't tested contracting GPs (in their own rooms). We want all the models to be tested so we have evidence."
[link url="http://www.bdlive.co.za/national/health/2015/03/16/concern-over-nhis-failure-to-woo-doctors"]Full Business Day report[/link]