Private healthcare groups have warned that the planned implementation of the National Health Insurance (NHI) scheme could lead to a wave of doctors and other skilled professionals leaving the country due to the additional working and earning restrictions placed on them.
The NHI Bill is currently undergoing a public consultation process, with a number of healthcare, civil society and political groups presenting on why the new system should or should not be introduced.
In a presentation to parliament this week, medical scheme Discovery said the scheme in its current form will likely lead to the outward migration of health practitioners from the country through a combination of alternative careers, emigration and retirement.
Somewhat ironically, this would reduce the access to healthcare for all South Africans – the core focus of the NHI and universal health coverage.
Discovery said that disinvesting from the private sector and a loss of skills will also lead to training platforms being compromised, with a long-term impact on healthcare in the country.
In a separate presentation, medical scheme Bonitas said that a lack of certainty around the role of the private healthcare sector under the NHI is also likely to lead to skills losses.
“While it is accepted that the details of comprehensive health care services that will be covered by the fund cannot be included in the NHI Act, it is important that the right for universal healthcare is managed in a responsible manner for the current medical schemes industry, and South Africans are made aware of the services that would be covered.”
This will also assist key industry players to have a better understanding of what healthcare services they will have to cover as part of the non-duplicative cover environment envisaged under NHI and will assist the industry transition process while ensuring member stability and industry sustainability, it said.
“Failure to manage and provide a clearer position on these matters will aggravate the risk of skills losses. Greater clarity can also be used to guide more constructively focused public discourse on private sector health delivery in the NHI environment as compared to its current more emotive nature.”
In August 2021, trade union Solidarity published a report showing that a significant number of healthcare workers plan to leave the country due to concerns around the new system.
The survey drew a response from 1,410 healthcare workers in three separate studies conducted in 2018, 2019 and 2021.
Across the studies, the overarching response from healthcare professionals is one of uncertainty and mistrust around the NHI, with general sentiment towards the system being overwhelmingly negative.
“Almost all the respondents have serious concerns regarding the state’s ability to manage and administer the NHI,” Solidarity said. “The total administration and management of funds and decision-making will be in the hands of the state.
“Most are seriously concerned about the fact that the state can determine and enforce tariffs, place of work, type of diagnostic tests and type of medication and treatment.”
Solidarity said that respondents’ opinions are likely shaped by the observed mismanagement and maladministration at institutions such as Eskom, the SAA and the SABC. The NHI will be significantly larger and more complex, must serve a population of more than 55 million people, and will have to manage and execute many contracts, it said.
Read: Big ‘NHI tax’ expected for South Africa: Discovery