Dr Ian Opperman
CHAIRPERSON: TARIFFS COMMITTEE
According to the Times LIVE media (http://www.timeslive.co.za/thetimes/2016/06/08/NHI) “NHI (National Health Insurance) ‘needs a dose of reality’”. In the Times article, dated 08 June 2016, it is mentioned that South Africa could face a mass exodus of doctors if the NHI is implemented in its present format, and how this will be funded has also not been made clear. The article explains that Doctors’ organisations and NGOs were responding to the Health Department’s White Paper on the NHI intending to bridge the gap between private and public healthcare. Reportedly, more than 100 submissions were received by the May 31 deadline and the department is still responding to those submitted just before the deadline. The NHI is to be a single state-run medical aid fund that would buy all healthcare services, according to the White Paper released in December, as stated in the Times article.
According to the NHI proposal, medical aid scheme cover would be restricted to the treatment of rare diseases and high-cost medicines – which would make medical aid cover prohibitively expensive and destroy private healthcare, say analysis in the Times article. The Times article states that many responses have warned that implementation of the plan will force doctors out of South Africa. Cited in the Times article, the SA Private Practitioners Forum said: “Despite the massive number of vacancies, the government is unable to retain medical staff, which is an indicator that poor work circumstances are leading to the loss of healthcare personnel”, adding that if the government sets healthcare prices, which the White Paper says it intends to do, doctors will go bankrupt. The Helen Suzman Foundation (cited in the Times article) warned that a restriction on medical aids could devastate the private sector.
The Independent Municipal and Trade Union says all patients will be affected by the NHI because they will be forced to go to doctors the government pays for; “If you like your doctor you can only keep him if he is accredited and contracted by the NHI. This Aspect of the NHI is unconstitutional” (cited in the Times article). “The White Paper suggests that doctors be assigned to locations of the state’s choice so that there is a fair distribution of health professionals in under-services areas”, says the Times article. AfriBusiness, an NGO, mentions that “Forcing doctors to relocate to areas of greatest need will infringe on their freedom of trade and it will simply make medical practitioners leave the country”, and the Private Practitioners Forum said that “this country does not have sufficient doctors for the plan to be feasible” (cited in the Times article).
Jason Urbach (The Star, 4 February 2016, http://www.iol.co.za/the-star/sa-cant-afford-a-scheme-like-the-nhi…) similarly states that individuals will be paying three times for compulsory health care cover through a mandatory surcharge on taxable income, a payroll tax, and VAT, on top of which for many would be their voluntary contribution to a medical scheme. The White Paper reportedly foresees tax increases to pay for it says the Times article. However, Urbach reiterates that “South Africa simply cannot afford a system of national health care”. Urbach adds that those who are cash-strapped will have no option but to cease their voluntary payments to medical schemes and rely fully on that supplied by the government. Urbach concludes his article by stating “The government does not have to provide “free health care for all”. Instead, it should focus its resources on those who truly cannot afford health care, and leave the rest of the population to decide for themselves how to spend their money”.
Although the NHI could potentially have positive outcomes for those who cannot afford health care, Psychologists in Private Practice will likely be negatively affected by the implementation of the NHI, more specifically, if their clients belong to a medical aid scheme and if their clients are middle to upper class. I believe that the statement made by Urbach in his concluding statement of his article is a compelling point:
“The government does not have to provide “free health care for all”. Instead, it should focus its resources on those who truly cannot afford health care, and leave the rest of the population to decide for themselves how to spend their money”.