NHI risks South African doctor exodus

The implementation of National Health Insurance (NHI), in its current form, may result in an exodus of doctors from South Africa. Many have already expressed their concerns with the legislation.

This is feedback from Cas Coovadia, the CEO of Business Unity South Africa (BUSA), who told 702 that the organisation is worried about implementing such a scheme. 

“We are doing quite a lot of work with the government in critical areas of the economy, and that is going reasonably well but not as fast as we would like,” Coovadia said. 

“On the NHI, however, we are worried. In fact, we are very worried that the private sector has been sidelined.” 

President Ramaphosa has signed the NHI Bill into law, making it an act of Parliament, in a signing ceremony this week. 

The NHI plans to achieve universal coverage for health services by transforming South Africa’s healthcare system. 

While business and civil society support this aim, they have said the current scheme will not achieve it as it cuts out private funding, is unconstitutional, and is unworkable. 

Coovadia explained that NHI, as a concept, could only work with collaboration between the public and private sectors. 

Instead, the government’s scheme excludes the private sector by banning it from funding any procedure already covered by the NHI. 

“Doctors are very concerned, and we might see an exodus of doctors out of the country,” he warned. 

Many organisations, including the South African Medical Association (SAMA), have warned that the NHI Bill will chase medical professionals out of South Africa.

SAMA said it is deeply concerned about the passage of the NHI through Parliament despite numerous objections by the organisation.

It said the NHI’s passage excluded suggestions by medical professionals, including doctors, which poses a risk of an exodus of these sought-after skills from the country.

Without healthcare professionals’ buy-in, the chance of success for the planned NHI is slim.

Solidarity’s medical professional networks echoed this sentiment, saying many of its members are considering emigrating due to the implementation of the NHI. 

Peirru Marx, network coordinator of Solidarity’s medical networks, said medical doctors who are members of the Solidarity Doctors’ Network vehemently oppose the NHI bill.

“Our research shows that medical professionals do not support the NHI. They do not want to be part of it,” Marx said.

“They know it is an election gimmick, and in reality, conditions will be much worse for South Africans under the NHI.”

He said healthcare practitioners witnessed how corruption, deterioration and mismanagement hamper the public healthcare system.

A study conducted among doctors by the Solidarity Research Institute (SNI) found that if the NHI was implemented, they would leave the country in large numbers.

• 94% of respondents believe private health practitioners may decide to work abroad because of NHI.
• 47% indicated that they would start the emigration process as soon as the NHI is accepted in South Africa.
• 19% said that they had already initiated the process to emigrate.
• 0% of medical practitioners are optimistic about the NHI.

Marx says although the NHI’s unworkability and unaffordability provide enough reason to abandon the NHI plans immediately, this is not the end of concerns.

“There has not been a significant increase in the number of doctors produced in the past ten years. Moreover, we now produce 58% fewer nursing students than in 2012,” he said.