The medical profession is becoming more outspoken in its criticisms of the National Health Insurance Bill among growing concerns over large-scale emigration. The SA Medical Association says doctors “strongly oppose” the legislation in its current format, with almost 40% saying they would emigrate if it was implemented, while in a Professional Provident Society survey 72% of all professionals said they would leave if the NHI is implemented in its current form, Rapport reports. PPS conducted the survey among more than 3,300 members for its written parliamentary submissions on the NHI Bill.
PPS also isolated the responses of 2,905 medical professionals, noting that 58% of them were negative about the proposals. The biggest concerns were lack of capacity, infrastructure and fears about corruption.
The doctors surveyed by SAMA strongly oppose the NHI Bill, saying that it would lead to “large-scale corruption”. Economists and health experts have echoed the doctors’ concerns.
SAMA said that it has been in support of the principles of Universal Health Coverage and quality care for all within the South African healthcare system since the beginnings of the health reform debates. “However, SAMA has not been able to support the 2019 NHI Bill in its current format. Many aspects of the Bill require clarification before it is signed into law.”
“In 2018, in response to the 2018 Draft NHI Bill, SAMA raised many concerns and queries about unclear aspects of the Bill, and objected to many aspects proposed to be written into law. Examples include contracting and payment mechanisms which have never been implemented in the country before, as well as missing detail on quality of care expectations. There are also concerns about the amount of power which the Bill hands to the Minister of Health.
“SAMA ran a membership survey in November 2019 to gauge the feelings of our membership in relation to the Bill and the NHI proposals. We received over 1000 responses in the short two-week period in which the survey was open. SAMA membership do not think that a single fund is the only answer to securing Universal Health Coverage for the population, and the membership is generally concerned about the lack of detail in contracting mechanisms, accreditation procedures and quality of care in general. The written responses indicate a deep mistrust of the government structures in general and the ability of the Department of Health to implement their plans in realising coverage for all.
“Membership agreed that the proposals for payment arrangements in the Bill are premature, and untested in the South African environment. Overall the Department of Health should pursue quality and finance improvement initiatives already proposed for the public and private sector before fundamentally changing the healthcare delivery system in the country.
“We believe this position and the objections we have will go a long way to ensuring careful consideration of proposals for financing reform in the health sector going forward.”
SAMA spokesperson Dr Mvuyisi Mzukwa is quoted in a Daily News report as saying that he doubted whether the government had a plan on how to deal with doctors emigrating. If there was one, then it had not been expressed publicly, he said. He also questioned the financial viability of the scheme as the South African economy was “shedding jobs” and these employees would have been some of the contributors to the NHI.
Economist Dawie Roodt said the NHI was expensive and there was not enough money to fund it. He said the government did not have the competency to see through its implementation, and this would cause widespread damage.
Michael Settas, independent strategic and technical health-care adviser, said doctors’ concerns about corruption were “very valid” as the proposed governance structure flouted every good governance measure. “The problems with NHI are many. There are no checks and balances and no accountability, so you are virtually guaranteed that corruption and patronage will get worse, and especially considering the amount of money under the control of one entity.
“Unlike now, where funds go to provinces and district health, one centralised fund will determine all procurement and at what price, and the accreditation of hospitals,” Settas said. He said the move was tantamount to nationalisation of the private sector, forcing doctors to work for the state.
According to SAMA’s Mzukwa, a potential brain drain is not the only problem – there is already a trend for the country’s doctors to change careers. He is quoted in an interview on Radio 702: “We’ve got doctors who go into entertainment, we’ve got doctors who go into business because they’re not sure of what is happening, they are not certain about the future of medicine in this country. We needed to make sure that government understands these concerns before you put it into an act.”
He warns that there will be little room for adjustments once the Bill is implemented.SAMA material SAMA submission to Parliament Daily News report Radio 702 interview Rapport report