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Survey paints bleak picture of practitioner pessimism

As South African health professionals have become more knowledgeable about the National Health Insurance scheme they have become increasingly negative about it, reports MedicalBrief. Almost 21% have taken steps towards emigration, while more than 41% intend to do so, according to the findings of a survey by Solidarity trade union’s research institute.

In what Solidarity claims is a representative national survey of private and public sector health workers — following on an a July 2018 survey of its members — serious concerns were expressed by 95% of respondents over the state’s ability to manage the NHI and make timeous payments to practitioners (90.1%). Less than 3% were optimistic about the NHI.

Just over a quarter of those surveyed were GPs, while a fifth were specialists. Over 80% of the respondents were working in private practices or at private hospitals, while less than 10% were working in state hospitals. 

Most (83.3%) were seriously concerned about the state being able to determine and enforce tariffs, place of work, nature of diagnostic tests and type of medication and treatment. Many respondents (66.5%) also were seriously concerned that they were likely to be paid lower tariffs per patient. 

The majority of respondents (87.4%) were seriously concerned about the shortages of healthcare service providers. In its commentary, Solidarity points out that former Health Minister Dr Aaron Motsoaledi has stated that the NHI would require at least three times more doctors than there are currently in South Africa. At present, only about 1 200 medical students complete their studies every year, and there is a shortage of approximately 83 000 professional healthcare workers. 

While many (70.1%) respondents agree that medical aid funds are too expensive and not affordable for most people in South Africa, 88.7% are strongly of the opinion that the implementation of the NHI could result in private healthcare professionals deciding to leave the country. 84.6% are of the opinion that the NHI cannot be implemented successfully, and 84.5% are convinced that the NHI has the potential to destabilise the healthcare system in South Africa.

Furthermore, 77.6% disagree that the NHI can improve service delivery and healthcare in SA. Almost three quarters (74%) also do not believe that all South Africans will enjoy access to affordable and quality healthcare under the NHI. The majority (76.1%) are not convinced that the government has consulted adequately with interested parties to receive contributions from all with regard to design and planning. 

Almost 70% (69.2%) of the respondents feel the proposed subsidy-based system is not fair. According to this system, those with an income will contribute to the NHI in proportion to their income, subsidising those who do not have an income and cannot contribute.

Most of the respondents (60.5%) disagree that healthcare workers are sufficiently prepared, resilient and creative to adapt to the new circumstances brought about by the NHI. 

Replying to the question if respondents already are taking steps to emigrate, 20.8% indicated that they had already put the process in motion to emigrate. A further 41.6% said they would take steps to emigrate when the NHI was implemented. Therefore, there is a possibility that South Africa could lose 62.4% of its healthcare workers. Only about 15% were sure that they would not take steps to emigrate when the NHI was implemented. 

Almost 90% (88.1%) of the respondents indicated that medical staff should be able to work for themselves in private practice and that they should be able to choose for whom and where to work.

Respondents were allowed to choose more than one option. An average of 34.4% indicated that healthcare workers should work for a hospital, the state or independent employers. Only 23.6% indicated that they should work for a medical fund.

Solidarity notes that “from the comments made by the respondents it is clear, however, that it should be their own choice for whom or where they want to work, that they want no political interference in this choice and that they definitely do not want to be forced or prescribed to. They feel it is their right to make a choice.”

Almost all the respondents (93.8% – exactly the same percentage as in 2018) were of the opinion that there was a healthcare crisis in South Africa at present. Some 82.5% of the respondents blamed state healthcare for the crisis, while 11.9% were of the opinion that the private sector was the cause . More than two thirds (66.4%) believed the weak economic conditions were the cause of the crisis, while 55% said poor work ethics and practices of healthcare workers were contributing factors.

Almost half (49.7%) indicated that South Africa’s heavy burden of disease and health risks in society were contributing to the problems. 29.7% said that medical aid funds were contributing to the healthcare crisis, and 11.9% blamed the private healthcare sector.

Most of the respondents (88,7%) were convinced that the implementation of the NHI would result in healthcare workers leaving the country or their occupations. Only a quarter of the respondents indicated that they would be prepared to work with the government in developing a sustainable NHI.

In comments, many respondents described bad management and administration in the public healthcare sector. They mentioned poor appointments based on BEE principles, poor sense of responsibility, bad spending of the budget and bad planning of numerous aspects of healthcare, including bad management and implementation of policies and incorrect objectives in training. 

Numerous examples of corruption were described. They referred to theft, misappropriation of funds, looting, striking and no sense of responsibility and accountability.

It appears that the respondents in the main are not geared to accommodate the NHI objectives. Almost one third of the respondents (28.2%) indicated that they did have the knowledge and skills in regard to preventive healthcare and 28.4% indicated that they did have knowledge and skills in regard to community healthcare to accommodate the NHI, but only 20.9% indicated that they had the administrative knowledge and skills and 10.8% that they had the infrastructure. Very few (7.5%) believed they would have time available to accommodate the NHI, and only 7.2% believed they would have sufficient administrative staff. Only 6.5% felt that they could accept possible reduced tariffs.

Most respondents were unsure about how prepared they currently were to accommodate the NHI objectives, because no clear facts had been made available on the effect the NHI would have on practices, clinics and hospitals.

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