The Controversial NHI Bill That Could Worsen Doctors’ Shortage Crisis In South Africa

South Africa recently published its draft National Health Insurance (NHI) which has been estimated to cost ZAR 256 Bn.

The bill creating an NHI Fund opens the way for government’s ambitious plans to reform South Africa’s health system, a move which would be one of the biggest policy changes in the country’s health sector since 1994.

Despite the fact that health-care access for all is enshrined in South Africa’s constitution inequities remain, mostly due to distortions in resource allocation. Decades later, South Africa’s apartheid past still shapes health, service, and resource inequities.

According to surveys conducted, there is an unequal resource distribution between the poor and the rich where, 20 percent of the richest in the country utilize 18 percent of the resources in health, compared to the poorest 20 percent who only use 5 percent.

Less than 20 percent of the country’s population of 58 million can afford private healthcare, while a majority, largely the poor blacks seek services at state hospitals which are mostly understaffed, short of equipment and has long queues.

The South Africa government is taking strides to address the challenge of access and equity in the healthcare sector. The recently released NHI bill promises to bring the same health coverage to all those in the country regardless of their ability to pay for it., this is according to the Health Minister Dr Zweli Mkhize.

Since its release, the bill has stirred heated debates with questions of how it will be funded, who will benefit and which medical issues will be covered topping the discussions.

These worries and concerns have been raised since the government has not been clear in breaking down contents of the bill to the people including medical practitioners.

Some key controversial issues in the proposed bill are:

After the NHI is fully implemented, medical schemes will not be allowed to cover health services that are provided by NHI which means that the medical aids will only provide a complimentary cover; services that the NHI doesn’t cover.

Citizen will not be able to seek services from a specialist directly unless, a doctor or nurse at your NHI healthcare facility sees the need to refer you to one.

How the NHI will be funded:
⦁ A payroll tax (employer and employee),
⦁ General tax revenue, which will include transferring funds from provincial health budgets to the NHI Fund
⦁ A surcharge on personal income tax
⦁ Taxpayers’ medical scheme fees tax credit will be reallocated to the NHI Fund

It is not clear yet how much taxpayers will cough up and as for the payroll tax, not much was also highlighted to expound what citizens will part with.

For a long time, doctors and dentists working privately have been deciding the amounts of money they charge. Despite government’s attempts to set fees, its efforts have not bore fruits. However, in the NHI Bill, the practitioners will only be able to charge the rates prescribed NHI.

Following the release of the bill, a significant number of doctors have said they consider emigrating in case the NHI is implemented. Research by the trade union group Solidarity has shown medical professionals have not been receptive of the idea and have cited lack of information.

The survey found that 83.2 percent of healthcare workers believed that private health professionals will leave the country if the NHI is implemented.

43 percent of health care workers would consider leaving South Africa if the government continues to implement the NHI scheme.

Business tech reports that health professionals are already emigrating.

The current doctor to patient population ratio is under 1 to 1000, a figure which is below the world average. Reports indicate that South Africa’s private sector has even fewer doctors per 100 000 people than most countries in the world.

Most South African doctors emigrate to developed countries and most of them go to Canada, New Zealand, Australia, the US and the UK. The push factors motivating their migration often is dissatisfaction with remuneration packages and poor working conditions.

The South African doctors also remain prime candidates for employment in a number of developed countries across the world owed to the high quality and standard of medical education they receive in their training.

Owed to the fact that doctors of the Southern African country are often in demand, any small displeasing move could trigger their mass immigration.

Implementing the NHI could be a risky venture if the medical practitioners are not involved in the talks as the country could end up losing doctors which the country direly needs.

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