Durban - South African doctors strongly oppose the National Health Insurance (NHI) Bill, saying they would not support the legislation in its current format as it would lead to “large-scale corruption” and that almost 40% of doctors would emigrate if a universal health-care system was implemented.
Economists and health experts have echoed the doctors’ concerns.
The SA Medical Association (Sama), which represents 17 000 doctors across the country, said the organisation could not support the bill, as it was tantamount to creating a “monopoly” in the health-care sector.
The bill is a financing system that pools funds and aims to provide universal access to quality health care for all South African and non-South African citizens, regardless of their financial ability to pay or socio- economic status.
Sama said: “The establishment of the NHI as a single, monopolistic purchaser for health care opens its structures up to large-scale corruption.”
The organisation said the changes the bill proposed could cause wide-scale harm to the delivery of health care if they were not managed properly, and that the bill had been introduced during a time where there was deep public mistrust of the government.
“Our public sector doctors are particularly scathing in their comments relating to cadre deployment at management levels, insufficiently qualified or even dedicated management and lack of accountability throughout the systems where they work. They do not attribute the problems experienced to lack of money, but to governance, management and accountability failures, mixed with purely corrupt practices and patronage,” Sama said.
Sama said it had conducted a survey among its members and found that members from the public and private health-care sector placed little faith in NHI moving from the planning and strategising stages to being implemented. In the survey, Sama found that 38% of respondents said they would consider emigrating if the NHI was fully implemented.
Only 39% of doctors said they would not leave, 17% were unsure and 6% would emigrate for other reasons, the report said.
Sama spokesperson Dr Mvuyisi Mzukwa said he doubted whether the government had a plan on how to deal with doctors emigrating. If there was one, then it had not been expressed publicly, he said. He also questioned the financial viability of the scheme as the South African economy was “shedding jobs” and these employees would have been some of the contributors to the NHI.
Economist Dawie Roodt said the NHI was expensive and there was not enough money to fund it. He said the government did not have the competency to see through its implementation, and this would cause widespread damage.
Michael Settas, independent strategic and technical health-care adviser, said doctors’ concerns about corruption were “very valid” as the proposed governance structure flouted every good governance measure.
“The problems with NHI are many. There are no checks and balances and no accountability, so you are virtually guaranteed that corruption and patronage will get worse, and especially considering the amount of money under the control of one entity.
“Unlike now, where funds go to provinces and district health, one centralised fund will determine all procurement and at what price, and the accreditation of hospitals,” Settas said.
He said the move was tantamount to nationalisation of the private sector, forcing doctors to work for the state.