How government plans to convince private doctors to work in the public sector under the NHI

The Department of Health is working on a number of plans to ensure that the required skills are in place for the successful implementation of the National Health Insurance (NHI).

In an interview with 702, health minister Dr Zweli Mkhize said that this will include training up new doctors, and incentivising doctors currently in the private sector.

“You actually just train the people and get the people with the necessary skills. The skills are not only locked in the private sector,” he said.

Critics of the NHI plan have previously highlighted the flight of medical skills as a major risk to the scheme, with some surveys showing that 43% of respondents in the medical field would consider leaving the country when the scheme is implemented.

Some have noted that an exodus is already underway.

Profmed medical aid chief executive officer, Craig Comrie said that health professionals are already emigrating, noting that among Profmed’s health professional members, the typical measure of 17% leaving the country each year rose to 30% in June and July.

When asked about how the government plans to incentivise doctors in the private sector to work under the NHI in the public sector, Mkhize said that the answer was to ‘pay them’.

Medical officers working in the public sector earn between R820,000 and R1.36 million a year, while those in the public sector can earn between R1.1 million and R1.8 million.

Consumers will still have choices

Speaking on the choices that South Africans will have under the new NHI, Mkhize said that patients will still be able to make a number of key healthcare decisions – including the ability to choose their own general practitioner (GP) who is based in their local area.

This GP will then be able to refer you to a specialist if the need arises, he said.

He added that South Africans will continue to be covered by their choice of medical aid – and its full offerings – until the NHI is fully established. Once it has been established, whatever the NHI is unable to cover will then be covered by medical aids, he said.

“Members will still be able to keep their own private schemes but they will act in a complementary role. Sometimes people think they can afford medical aid, but they are not aware that government is ‘putting subsidies’ in terms of medical tax rebates.

“Once government removes (these rebates) and uses them to help fund the NHI then it will become a bit more difficult for people to actually afford medical aid,” he said.

Limitation 

Dr Olive Shisana, social policy special advisor to president Cyril Ramaphosa, has previously indicated that this limitation of medical aids is a key issue under the formation of the NHI.

For NHI to be affordable, efficient and equitable, it needs a national resource pool that will be used to provide health services to all, said Shisana.

“This is an instrument to end the race, class, gender divisions that continue to plague South Africa. For example, 76% of medical scheme members are white, and only 10% are black Africans.”

She said that if medical schemes are allowed to offer the same services as NHI, most of the specialists, doctors, dentists, and allied health professionals will simply provide care to the mostly white people and leave black African people with under-resourced providers.

“This maldistribution of human resources is at the root of the health care crisis,” Shisana said.

Professor Alex van den Heever, chair, social security systems administration and management studies at Wits School of Governance, refuted Dr Shisana’s comments relating to the group makeup of medical schemes in the country.

Citing the most recent General Household Survey published by StatsSA, he pointed out that white South Africans make up only 34.4% of medical scheme members, with black Africans account for nearly half (48.6%).

Coloureds and Asians/Indians make up 9.1% and 7.8% respectively, he said.

Therefore, according to these statistics, 65.6% of medical scheme members are not white, he said.

Read: South Africa’s NHI pilot projects were not a failure: health minister