National health insurance

The department of Health’s decision to finally table proposals in Parliament for a social health insurance is one that is long overdue. South Africa cannot blindly adopt the national health insurance (NHI) systems of First World countries like Australia, Canada and Switzerland. We need to develop systems that are specifically suitable for Third World countries like South Africa. There are no Third World countries that have come up with suitable alternatives for this country to adopt, but that is no reason for the government and policy makers to drag their heels on this vital issue. We urgently need to develop a better and an affordable healthcare delivery system in the private sector for the huge number of employed black people in this country who do not have any form of health cover. Only 2 million black people, coloureds and Indians are on medical aid, out of a population of 43 million. This has been the case for the past 30-odd years, which speaks poorly of our progress. The huge gap left by the government’s delay in developing a proper health insurance for this country has opened the way for a number of unscrupulous operators to enter the healthcare market to make a buck at the expense of members and healthcare providers. Since 1984, we have had just 7 million people on medical aids. Some 24 years down the line, the number with cover is still 7 million. This stagnation in growth comes even though providers were forced to offer their services at one third of the going rate. The low fee to service providers, mainly from previously disadvantaged areas, has made it untenable for them to survive. A study for my thesis in 2006 revealed that 99% of our future medical graduates and 90% of postgraduates had indicated that they planned to emigrate. Some of the middle-income areas revealed that 50% of practitioners had closed their rooms after being in practice for 15 years and opted to work overseas as locums to survive. Most of the money of the medical contributions is going to the administrators. One administrator takes almost 80% in fees, leaving the member with only 20% of their contributions for medical services. Doctors on this scheme are paid R40. This particular medical aid has attracted the blue collar workers, working for the banks, from the black and coloured populations. The next best option pays about R90 per visit, which is half the going rate. Again, most of the clients are from the previously disadvantaged areas. The only way doctors can come out even is for them to see volumes of patients and sacrifice on good quality care. The other five million reside in the better-off areas of our country and have good medical aids that pay a better fee, which, too, is not considered enough by their practitioners. These patients pay up to R350 per visit. This discrepancy in service fees has to be stopped immediately to ensure that all South Africans receive the same high standard of healthcare. A risk equalisation fund for general practitioner (GP) and specialist consultations should be enforced to put an end to this ugly legacy of having two types of private healthcare in our country: one for the haves and another for have-nots. Why can’t we upgrade our state hospitals so that people would not have to pay enormous private hospital fees? The NHI could and should be run by GPs as is done elsewhere in the world. An NHI with better remuneration for doctors would stem the tide of emigration and stop money-grabbing, financially draining medical aids. In the not too distant future, we will have very few good family practitioners in this country if we do not wake up and do something about it. In one year, 2004-2005, the country lost about 10 000 GPs out of total of 20 000 to emigration. Doctors have, too, lost their direction and purpose. They should be actively lobbying government with ideas to implement an NHI without wasting any more time. They and the citizens of this country have been battered enough by the greedy medical aid industry. It is time the doctors got up to regain control of managing their patients’ health without any further interference from corporate business. Dr EV Rapiti MitchellsPlain