Private doctors’ buy-in will be key to NHI success, says Sama

2012-03-29 00:00

BUY-IN by more than 18 000 doctors in private practice in South Africa, will be key to ensuring the success of the government’s proposed National Health Insurance scheme (NHI). So will paying them a fair wage.

This is the view of the acting chairperson of the SA Medical Association (Sama), Dr Mark Sonderup, who was commenting yesterday on the first phase of the 14-year roll out plan of the government’s ambitious scheme. Three pilot sites have been identified in KwaZulu-Natal.

There was no doubt that a new way of thinking was needed to address the serious health issues facing the country, Sonderup said.

“But there has to be some serious discussions about remuneration. If doctors are prepared to give up three hours of their working day to look after patients in the public sector, as proposed in the new draft policy, then the “sacrifice has to be worthwhile”.

Sonderup said the critical element of the scheme, about to be launched in three pilot sites in KZN, was that a “fair and equitable” package was offered to doctors prepared to participate in the NHI. Sonderup said it was imperative that a “sound engagement strategy with doctors and specialists” be an integral part of the initiative.

He believed that it would be South Africa’s general physicians who would carry the biggest load, followed by paediatricians and obstetricians.

“Doctors in South Africa — for the most part — are in favour of the NHI plan,” said Sonderup. “But there are certain issues that would need to be addressed. Will doctors’ services be on a voluntary basis, for example? These are the nuts and bolts that need to be included in discussions.”

Sonderup said what would constitute fair and equitable remuneration would need to be negotiated.

He said Sama would monitor the progress of the initial sites with keen interest. “We are hopeful that the national Department of Health has formulated the right policies. Now it is a case of waiting and seeing.”

Yesterday Health MEC Dr Sibongiseni Dhlomo briefed the legislature’s health committee on the next step in the multi-billion-rand NHI rollout and the work that will be undertaken in the KZN pilots. The sites are Umzinyathi (the district of Dundee) uMgungundlovu (Pietermaritzburg) and an additional site in Newcastle.

He told MPLs that “contrary to common belief”, the department would engage with the private sector “vigorously” on all aspects of the NHI.

“We need to explore models for service provider billing and payment of general practitioners, pharmaceutical companies, etc.”

In its reaction the Inkatha Freedom Party in KZN said it was “seriously concerned” about the government’s claim that the NHI would reduce costs and improve health outcomes. “We are worried about the centralising of purchasing, which we believe will not control costs and won’t necessarily eliminate out-of-pocket payments,” said Dr Usha Roopnarain, shadow MEC for health in KZN.

“While we welcome the NHI, the government’s heightened expectations could be a problem. That is why we are asking the MEC and the National Department of Health to accept the impacts and consequences that the piloting of the NHI might have in the participating districts before anything even begins. The last thing we need to do is to build up empty promises.”

Roopnarain said the IFP was also concerned that the implementation of a centralised purchasing structure would lead to corruption. “What is needed is transparent procurement procedures and financial accountability in terms of public spending.”

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