South African doctors and other professionals send warning to government: We can always leave

 ·9 Feb 2022

Skilled South African professionals are concerned about the impact of the proposed National Health Insurance (NHI) and what it will mean for tax increases, says the Professional Provident Society (PPS).

The NHI Bill is currently undergoing a public consultation process, with a number of healthcare, civil society and political groups presenting on why the new system should or should not be introduced.

In its presentation to parliament this week, PPS said that its members are concerned that the NHI will impact their taxes, and that increasingly higher taxes will encourage globally mobile professionals to move to other geographies. PPS represents a membership of some 150,000 professionals in South Africa, including around 30,000 medical professionals.

It noted that South Africa’s current tax base is very fragile, with just 10% of taxpayers are assessed taxpayers. In addition, just under 40% of total taxes come from individuals, and a significant portion are professionals.

Citizens have the freedom to spend their post-tax income how they want to, it said.

“Emigration is always a realistic option for the qualified. Each healthcare worker not only represents a skilled worker, but many are also self-employed and pay taxes as individuals, as well as in their business capacity.

“In our survey, 73% felt that emigration would be the outcome if NHI is not implemented responsibly.”

Dual healthcare system 

While PPS raised several concerns about the NHI, the group said that it was broadly supportive of introducing universal healthcare in South Africa, and that this could still be done by adopting a dual public-private system.

It noted that the private sector has exceptional administrative capabilities while existing patient management systems exist and can be leveraged by the state.

“The successful implementation of NHI relies on strong Human Resources capabilities, which includes competitive remuneration. South Africa has experienced a mass exodus of nurses in the 90s we cannot risk that again.”

It added that the government and private sector are now tasked with finding a solution for South Africa and that it cannot ‘import solutions’.

“Between us, we know what works and we know our unique South African condition. Let us implement what is affordable for the country – the solution must be economically sound. Professionals are a big proportion of healthcare delivery and the tax base. Their voices need to be considered.

“We urgently need to see the funding model, the implementation of the Health Market Inquiry (HMI) and details of how the system will work.”

Emigration biggest risk 

In a 2019 presentation on the NHI, PPS said that the highest risk to effective universal health cover in South Africa is the loss of highly skilled professionals, through emigration, for better prospects elsewhere.

“PPS believes that this risk is not appreciated enough by the government as a likely consequence of the proposed legislation. Healthcare professionals are not restricted geographically; it is becoming increasingly easier for them to apply their trade almost anywhere in the world.

“Research has proven that the decision to emigrate is a complex one that is driven by various personal and societal pull and push factors.”

The responses to PPS member research have shown NHI to potentially be a push factor that may add to the list of pain points experienced by healthcare professionals.

Historically, some of the top individual reasons cited by doctors for leaving South Africa were financial reasons, working conditions, and the South African income tax system. Socioeconomic and political issues also play a material role in the emigration decision.

“Healthcare worker migration from South Africa in the past has been driven by policy decisions and socio-economic and political considerations.

“In 2001, the number of nurse emigrants was roughly 20% of the total number working within the public sector in South Africa. That, together with being ranked as having the eighth-highest global number of emigrating physicians in the year 2000, created a dire situation for the sustainability of healthcare in South Africa at the time.”

PPS’s research among general professionals indicates that emigration is a consideration for many.

Results from the PPS NHI survey highlighted that an overwhelming majority of respondents (73%) cited NHI as a potential reason for emigration, with 15% unsure and only 12% noting that they would not consider leaving at all.

The reasons given for considering emigration was that professionals would seek better working conditions, and they fear loss of income.

South African professionals benchmark themselves against their global peers, meaning that when considering work opportunities, they do not limit themselves to their local environment.

Read: Investec tells staff in South Africa to get vaccinated – or pay for their own tests

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