NHI: As SA doctors exit, ‘expect an influx of doctors from other African countries’

The National Health Insurance Scheme (NHI), as currently envisaged, will dramatically change the face of South Africa medicine – and many in the healthcare sector don’t believe the changes will be for the better.

While individuals who currently have medical aid may have to pay twice – in premiums to the scheme and in taxation for the NHI – there is a possibility that medical aids may disappear entirely with time or may be forced to deliver much reduced coverage.

Although the government has said it will not prescribe where people can go to a general practitioner (GP), it is probable waiting times will be significantly increased, because, according to Medicare’s Mike van Wyk, GPs will be forced to take on extra patients just to make ends meet.

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“Government will replace medical funders as primary debtor and, in all likelihood, terms of 90 days plus will be implemented.

“At a base price of about R350 per consultation, doctors will be expected to pay salaries, bills and consumables from money that will somehow magically appear, and then, still wait to receive payment from authorities for who knows how long.”

NHI will ‘undermine quality of healthcare’

The Health Funders Association (HFA), which represents at least 73% of open medical schemes and 50% of total medical scheme memberships, believes the NHI “will undermine the quality of healthcare and the objective of moving towards universal health coverage in SA”, the HFA’s Maureen Litchfield said.

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“Once the NHI fund has been fully implemented, medical schemes will only be permitted to offer benefits for services not covered by the NHI.

“HFA believes that adding the nearly nine million lives covered by medical schemes onto an already overburdened and failing public health system would be detrimental to quality of care.”

Van Wyk said the country faces a healthcare disaster, should the NHI Bill be implemented in its current form.

“It is already becoming a challenge to recruit medical personnel for a clinic, because nobody wants to be here when the NHI hits the fan. Because it will, and not only patients will be at the short end of the stick.”

He added: “There is no logic in spending well over a million rands attaining a medical degree, let alone specialisation, and then be up to your ears in study debt while trying to build a practice and put food on the table. It’s just not going to happen.

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“And it’s not only doctors,” said Van Wyk. “It’s clinical associates, nurses, you name it. They’re all going to leave before it’s too late.”

Van Wyk also speculated that medical students may likely graduate, complete their community service and then make a run for it to another market where it would be possible to carve out a future financially and professionally.

Doctors will leave South Africa

The South African Medical Association (Sama) cautioned government more than a year ago that it estimated that a third or more of doctors presently practising in South Africa, will leave.

Sama reaffirmed this last month when the organisation objected to the universal healthcare bill’s passing in parliament.

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Already, the National Health Service in the UK, which has a staff shortage, is actively recruiting new staff – and South African medical qualifications, as well as the work ethic of our professionals, is valued there. In addition, medical professionals have been put on a critical skills shortage list by the UK government, meaning they can get residence visas fast-tracked.

Sources close to various medical associations said that as South African doctors exit, an influx of healthcare practitioners from other African countries can be expected.

Van Wyk added that more Cuban doctors will also likely be imported to compensate for the exodus of local doctors.

“The big question is, are we going to see a lowering of the general quality of healthcare in the country?”

Van Wyk said an additional concern that the national healthcare system would be digitised, and appointments loaded for doctors by the state. These patients will be linked to an online file, detailing their medical history as best captured by a previous consulting party.

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Van Wyk said doctors will be unable to manage their own time, as government might pack in as many consults in a day as possible.

“This will impact the quality of care and result in long queues in waiting rooms,” said Van Wyk.

Discovery CEO Dr Ryan Noach said there need to be a “multiparty funding model underpinned by a robust NHI”.

Written by Reitumetse Makwea, Hein Kaiser and Marizka Coetzer

– news@citizen.co.za