Doctors dumping South Africa

Many South African doctors and other health practitioners have said they would not be willing to work under the government’s National Health Insurance (NHI) scheme and are considering emigrating.

President Cyril Ramaphosa signed the NHI Bill into law in May this year. The scheme aims to achieve universal coverage for health services. 

It provides a framework for universal care through a state-run fund and will ban the private sector from financing treatment covered under the plan. 

While the government has promised that the signing of the NHI into law will result in universal healthcare free at the point of delivery, this ambition is far from reality, and the legislation has come under severe scrutiny.

Many have argued that the NHI will make healthcare worse in South Africa, both for providers and users.

Earlier this year, the managing director of the Board of Healthcare Funders (BHF), Dr Katlego Mothudi, said the government’s NHI plan would worsen healthcare provision in South Africa.

This is partly because the NHI Bill limits private healthcare funding, weakening the national system. 

The NHI Act restricts the private healthcare sector to providing services that the NHI does not cover.

“BHF does not support the NHI Bill in its current form due to the unconstitutionality of several of its provisions, its proposed restriction of medical schemes, and the concomitant loss of economic value that will inevitably follow,” he said.

“The private health funding sector in South Africa should not be sacrificed in favour of NHI.”

He argued that the private healthcare sector is a valuable source of jobs, scarce skills, infrastructure, financial investment, and quality healthcare. 

“The value it adds to the economy and its support to the public health sector cannot be underestimated. The Bill reduces the role of the private sector, and we want those sections removed,” he said. 

The NHI Bill weakens the private healthcare system. Mothudi explained that weakening any aspect of the private healthcare sector will weaken the national health system rather than strengthen it.

After the NHI Bill’s signing, Tax Consulting SA said it sparked a wave of concern among various South Africans, especially among medical professionals, medically high-risk individuals, and cautious taxpayers. 

“This healthcare reform initiative promises to provide universal healthcare coverage to all citizens, but its implementation has raised many unanswered questions,” it said. 

“This may be the final straw that leads South Africans to emigrate.”

The organisation said medical professionals asked them to assist with their potential emigration because they do not want to work for the government.

“Families with medically at-risk members fearing for their loved one’s future in South Africa. Numerous taxpayers are uncertain about the tax burden for funding these healthcare provisions and the potential burden on the economy,” it said.

A day before President Ramaphosa signed the NHI Bill into law, the South African Health Professionals Collaboration (SAHPC) – representing over 25,000 healthcare professionals – released a statement slamming the decision.

The organisation expressed its “profound disappointment and concern” with the decision to sign the Bill into law.

“SAHPC members, representing a diverse array of healthcare specialities, have consistently advocated for policies that prioritise the well-being of patients and ensure the sustainability of the country’s healthcare system,” it said. 

“Their disappointment stems not only from the disregard for their expertise but also from the potential consequences the unworkable bill may inflict on the healthcare landscape.”

SAHPC spokesperson Dr Simon Strachan said the organisation’s members have made submissions at every stage of the legislative process, dating back to the release of the green paper in 2011. 

“It is disheartening to see our efforts to contribute to a more robust, workable and patient-centric healthcare system being ignored,” he said. 

“Where we are now is unprecedented, and we believe that the NHI, in its current form, will reverse, rather than progress, equitable, quality healthcare in South Africa.” 

“As healthcare practitioners, our primary concern is the wellbeing of our patients. As experts in our field, we believe the President has an obligation to ensure that the NHI improves rather than limits overall healthcare for every citizen. He has failed to do this.”