Too few doctors to implement National Health Insurance proposals

‘Current vacancy levels do not take into account the fact that we have too few doctors' posts to implement the National Health Insurance plan, which is part of the ANC election manifesto,' said Anderson.

‘When will the Department of Health realise that decent salaries and working conditions for doctors, specialists and nurses are the central cog in both the private and public health sectors?' he asked.

Profmed is a restricted medical scheme open to professionals with a minimum of a four-year degree and membership of the scheme is claimed to be growing steadily due to what the scheme says are its ‘rich benefits', while the principal officer and trustees have managed to keep premiums within industry averages. The scheme has an A+ credit rating from international rating agency Global Credit Ratings.

A high proportion of Profmed members are medical practitioners. The medical scheme therefore has a ‘foot in both camps' and aims to be sympathetic to member-medical practitioners who have dual needs; they wish to be members of a cost-effective medical scheme, and as service providers they wish to be paid at rates that reflect the value of their professional services.

‘Without a well-equipped public sector, where student doctors and specialists are mentored and properly trained, neither the public nor private health sectors can function,' he said. ‘There is no quick fix to this problem. '

He said that eight South African universities had been training in the region of 1200 doctors a year, marginally up from 900 a year in 1970, when the population of South Africa was 22 million. The population of South Africa is now 48.5 million. He said that figures released by the Democratic Alliance last year stated that vacancy rates for doctors ranged from 35% in the Free State, to 63% in Limpopo.

Ill-considered changes drive the talented and skilled away

‘In addition, thousands of South African-trained doctors and other medical personnel such as nurses and radiographers have emigrated. While there are many reasons for emigration, ill-considered changes or proposed changes to the regulatory health environment have not helped.

‘Despite the good intentions of the Department of Health, proposed changes such as the issue of ‘certificates of need', the suggestion of capping private sector doctors' tariffs for PMB benefits and the uncertainty of how National Health Insurance will play out have created an environment of professional uncertainty. It has not been easy for doctors to evaluate the consequences of proposed changes, which is vital when making long-term decisions for themselves and their families,' he said.

Anderson warned that the crisis in the medical profession might lead to a situation similar to that in Zimbabwe, where only the very rich could afford medical care.

Zimbabwe's health system one of the first casualties

‘Medical schemes in Zimbabwe were one of the first casualties as the country experience hyper inflation and emigrating medical personnel. Now, the only medical schemes that offer meaningful services are foreign-based. And of course foreign-based insurance is risk-rated, so that the old and sick pay far more than the young and health, there is no built-in cross subsidization.

Anderson pointed out that even before the ‘dollarisation' of the Zimbabwean economy, medical practitioners in Zimbabwe demanded payment in US dollars or British pounds. Medical tariffs were and remain unaffordable to middle-class Zimbabweans. Public-sector services have to all intents broken down completely.

In his budget speech in March this year, Minister of Finance Tendai Biti said that 68% of doctor posts in the public sector were vacant. This figure is very close to the 63% vacancy level in Limpopo.

An informal survey of medical tariffs in Zimbabwe conducted by Profmed noted that general practitioners in Zimbabwe charged between £20 and £50 (R260 to R650) and specialists charged between £70 and £150 (R910 and R1950) per consultation. (Exchange rates calculated at R13 to one pound).

‘South African tourists or expatriate workers in Zimbabwe are routinely flown home for medical treatment,' he said.

Other challenges faced by the southern African region include a serious shortage of functioning essential medical equipment, and a high burden of preventable diseases such as malaria, HIV and Aids, tuberculosis and cholera. The potential damage of virulent viral epidemics uses such as swine flu, SARS and avian flu are incalculable.
‘We must do everything we can to make sure that this scenario does not repeat itself in South Africa,' said Anderson.

‘There is global shortage of medical personnel. All governments should ensure that they create the right working conditions for medical staff, with safe working conditions and a range of career paths. Salaries should also be paid on-time, and reflect the years of study necessary to practice medicine, the long hours and the responsibility of the work,' he said.