Doctors say 'first fix our state hospitals'

The Department of Health must get its hospitals running properly before taking on its ambitious five-year plan to set up a R100-billion National Health Insurance (NHI) scheme, health professionals say.

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This was the view of doctors after weekend reports that the policy research document on an NHI plan, aiming to provide equitable health care for all South Africans based on an extra health insurance payroll tax, would be released within a month.

Poor people and low-income earners would be exempt in incorporating the private and public health care systems to provide universal services to rich and poor South Africans. And tax deductions for medical schemes contributions may be removed and redirected to the health insurance fund.

Under the scheme all South Africans would have to register with their closest primary health care "gatekeeper" - doctors who would refer serious cases to hospitals and specialists. The system would need more than R100-billion a year in funding.

Professor Denise White, chairwoman of the South African Medical Association, which represents public and private sector doctors, said the association had agreed in principle to the plan to provide universal access to health care.

"We are committed to engaging with stakeholders around NHI and we are committed to preserving that which is good and excellent in both of these systems. But one must be careful to not throw out the baby with the bath water in looking at it in only an ideological way. We have excellent doctors in both the public and private sectors," White said.

She said it was too early to comment on whether quality standards in private hospitals would be strained "but the private sector is by no means going to take on an NHI that is in a shocking state of disrepair".

"Public health has been chronically underfunded and there has been an absolute deterioration of the health care system - it requires a massive uplifting of that system before one could implement an NHI that could cope. There are plans to inject cash and revitalise hospitals, but there is no quick fix," White said.

Dr Sats Pillay, chairman of the Association of Surgeons in South Africa, which represents 500 surgeons, said the five-year plan was "a bit optimistic" although there was a need to change the system.

"We support the move to better provision of health care but it needs to be well thought out. It's a bit optimistic from the position starting off with 80 percent of doctors in the private sector looking after 20 percent of patients.

"We need to get state hospitals functioning properly and then parallel to that discuss the NHI at the same time, but one can't survive without the other. We need to get all the state hospitals fully functional," Pillay said.

Surgicom chairperson Dr Jan Mook said the government had made a "huge commitment" because it had taken Britain 22 years to establish the National Health System. He said doctors were "up in arms" over the proposed changes.

"The state health sector is in a lot of trouble and before you can think about this you need to rectify the health sector. Everybody is up in arms about it. We are all waiting to see what's going to happen," Mook said. "They are talking about getting all the government hospitals up to standard, but that is going to take some time and cost a lot of money if they have dissatisfied doctors and a shortage of doctors."

Mook said countries with health insurance, like Canada, had five percent unemployment and 95 percent of its citizens were taxpayers. However South Africa had high employment and an income tax base of about 10 percent.

Former South African Medical Association chairman Dr Kgosi Letlape, who now heads the Tshepang Trust, said the NHI was "a good idea" but the government had not been bold enough in establishing the system sooner.

Letlape said the current health care system, which separated the rich in the private sector from a public heath sector that had become a euphemism for the poor, was a legacy of apartheid. He said seven percent of black people were on medical aid while 42 million people had to rely on the public health sector.

DA MP Mike Waters said quality management in public hospitals was problematic.

"They have employed people as CEOs of public hospitals without having the necessary skills and there are massive inefficiencies and a waste of taxpayers' money - and they have not held these CEOs accountable. There are no monitoring standards," said Waters. "If it had been enforced we would have seen an improvement in state hospitals utilising existing funds efficiently.

"Doctors and nurses are leaving in droves because they can't work in conditions which have become unbearable for them."

DA finance spokesperson Dion George said he had submitted questions to the Minister of Finance seeking clarity on the plan and its funding.

IFP leader Dr Mangosuthu Buthelezi said in his weekly newsletter that his party endorsed the NHI, but he expressed concern that funding would come from taxpayers and called for privatisation of state assets.