Up to 80% of South Africa’s radiologists are considering emigrating, according to a new Radiology Society of SA survey, cited in the Financial Mail.
The National Health Insurance (NHI) numbers don’t stack up, writes Katharine Child in a Financial Mail cover story. Research by Fitch estimates that government spending on health care will more than double to R450bn by 2028, two years after the NHI is meant to be up and running. Where will this money come from? The report says Mkhize’s answer is: The taxpayer, who will be asked to not only give up their private medical aid, but pay more in personal income tax and in VAT.
Also, the report says, an alarming new study shows that as much as 80% of a representative sample of 384 South African radiologists are “considering emigrating”. Professor Richard Tuft, head of the Radiology Society of SA (RSSA), says that nearly all the society’s members are writing international exams in the UK, Australia and New Zealand to qualify to work abroad. “Radiology, like pathology, is required by every branch of medicine. You close them down, you close the whole of medicine down,” says Tuft.
The report says Jonathan Broomberg, CEO of Discovery Health, was quoted as saying recently that the country’s largest medical aid was particularly worried about emigration. “There is tremendous anxiety among the doctors we speak to, there is chatter about leaving. And I think that filters all the way down: young kids now may, at the margin, not go to med school,” he said,
Two weeks ago, RMB Global Markets Research released a report on this issue entitled “NHI: the cost of emigration”. RMB head of research Nema Ramkhelawan-Bhana sought to quantify how many of South Africa’s 530,226 medical professionals may emigrate. By RMB’s calculations, 4,519 medical professionals could leave South Africa by 2019/2020, rising to 15,202 by 2025. Their departure will also hurt tax collections – money which will be sorely needed to finance the NHI. “The annual migration rates … will reduce personal income tax receipts by between R5.2bn and R23.3bn,” she says.
The report says that’s a lot of tax money that the government can scarcely do without. But while health department officials don’t seem to have bothered to examine this, the Treasury is deeply aware of these trends.
Before the NHI Bill was released, Treasury officials saw the document and insisted on numerous disclaimers being added about the new taxes. The report says this is why, unlike earlier drafts, the final Bill says that “due to the current fiscal condition, tax increases may come at a later stage of NHI implementation”.
Health actuary Barry Childs says: “The memo accompanying the Bill mentions that no new taxes will be considered, until economic conditions are more favourable at a later stage of NHI implementation.” When the NHI Bill was launched in August, Mkhize was asked where the Treasury’s “money bill” was that would provide the fiscal skeleton to the ambitious plan. He had no answer.
The report says other experts had already reached the same conclusion. “There is no R100bn (extra) a year … I teach public financing … there is no money,” said Wits University professor and health economist Alex van den Heever.
The report says the only people likely to see their lives improve markedly from Mkhize’s grand plan are the lawyers preparing to fight it.Financial Mail report RMB Global Markets Research report analysis