The crude statement by the Health Professions Council of SA’s Dr Tebogo Letlape that medical aid schemes are a ‘crime against humanity’, should be taken whence it comes. But Letlape’s statements about the public health system pre-1994 needs some enlightenment, writes Dr Reinhardt Sieberhagen from Namibia.
The Editor Medical Brief
Medical Aid Schemes a Crime Against Humanity: Letlape
A crude statement like this does not really warrant comment and one can argue that it should be taken from whence it comes. But Dr Letlape’s statements about the public health system pre-’94 needs some enlightenment.
My peers and I worked in a large, all-black academic hospital during the seventies and eighties. Patients paid R2.00 admission fee, if they had it. If not, nothing, there was no limit to the level of care. CT scans, cardiothoracic surgery, ICU care, high tech neonatal care, long term physio, the whole spectrum – all headed up by dedicated academic specialists who expected, and got, nothing less than total commitment from their staff.
The similarly run all-white hospital required patients to pay for services according to a sliding scale applied to taxable income. Due to the difference in patient numbers the budget of the all black hospital were greater than that of the all-white hospital by a factor of 10, as were the workload. In the rural areas, at the time you mention, district surgeons employed by the state serviced district hospitals, clinics and sick rooms. All of this of course came out of the taxpayers’ pocket.
In the Free State a community mental health system was developed over many years with ultimately clinics for all, with direct access to specialist services which were run by highly trained specialised nursing staff and doctors from the medical school complex. This system was highly efficient and was published in accredited journals and presented at international congresses. And no, this system was not biased to privilege whites. In fact, the majority of patients were black by far, as were staff.
I don’t have to tell you what happened in the Free State since ’94, What is left of a health system which served its white and black society well is today a dismal failure, with a medical school on the verge of collapse and closure.
The National Health Insurance (NHI) plan certainly has merit. It will in essence be a big medical aid fund, with the same administrative challenges as any fund. There will be administrative leakage, mismanagement and poor service delivery, if your government’s track record is anything to go by.
If Dr Letlape and his peers can stop blaming the previous system and staff owning up to their own mistakes they may just gain the credibility needed to launch the NHI. Until that happens my guess is that those medical aid members who make up the medical aids he wants to abolish will keep on paying their membership fees and will continue to be the taxpayers upon whom your government is dependent for its income and will keep on staying healthy out of their own pockets, at no cost to the government.
Dr Letlape, I wish you well with your drive to abolish private funds. It is certainly going to make exciting news – contravening the constitutional right to freedom of choice, collapse of the private health industry, another nail in the government’s coffin and so on.
Dr R Sieberhagen