Doctors fiercely opposed to NHI – according to report

11 September 2023

Some of the strongest opposition yet against the government’s planned National Health Insurance is now coming from the medical sector itself.

A recently released report by the Solidarity Research Institute (SRI) indicates how deep-seated medical professionals’ distrust of NHI plans is. First, health care workers indicated that they now have far more knowledge about the NHI and, in light of that, their disapproval of the NHI has increased sharply.

Moreover, an overwhelming 99% of the respondents are also deeply concerned about the government’s ability to administer and manage the NHI. 

Respondents are deeply concerned about the consequences this has for practising their profession. Likewise, they dread the NHI’s consequences for patients and even for the country’s economy, should the government push ahead with these ill-considered plans.

The report is the product of a fourth comprehensive Solidarity study which measured healthcare workers’ understanding of and attitudes towards NHI. The 2023 study follows those undertaken in 2021, 2019 and 2018.

According to SNI manager Nicolien Welthagen, health care workers have indicated that their level of understanding and awareness of the NHI have indeed increased sharply. It rose from 54,4% in the first study in 2018 to 79,4% in the 2023 study.

“This means there was an increase of 25% of respondents who feel they now have more knowledge about it. What is important is how their perceptions about the NHI changed along with it.

“The majority of health care workers now have a more negative and sceptical outlook than five years ago. When it comes to negativity there was an increase of 21% over this period,” Welthagen said.

Participants in the study came from diverse medical professions and demographic groups. While more than half of them recognise the unaffordability of medical funds for the majority of citizens, they are, for various reasons, concerned about the impact of NHI as a substitute.

- 94% of the respondents believe the successful implementation of the NHI is unlikely.

- Only 3% believe the government has consulted properly with stakeholders about the NHI.

- Only 2,9% believe all citizens will have access to high-quality healthcare under the NHI.

The distrust in the NHI is such that 94% of respondents believe private health practitioners may decide to go and work abroad because of the NHI. 

Welthagen says the report indicates that 19% have already initiated the emigration process. 

“What is even more worrying is that 47% say they would initiate the emigration process as soon as NHI is adopted in South Africa. The concern about their independence, in particular, weighs heavily upon medical professionals. A total of 90,9% of them believe that they should be granted the autonomy to work in private practice,” she said.

There is clearly also concern about the NHI’s impact on South Africa’s economy as a whole, and there is particular concern about such a system’s exposure to corruption.

“Corruption is considered to be the main obstacle to the NHI’s feasibility. For this reason, health care workers are not only suspicious of the NHI; they are against it.

“The perception about the anticipated corruption is of course reinforced by the presence of corruption in every other state-controlled institution,” Welthagen said.

According to her, there is consensus among respondents that corruption will penetrate the NHI, and it would be a vehicle for government officials to enrich themselves. “Then we do not even mention the general feeling that it simply cannot work. Shortages of essential elements such as funding, skilled staff, sound infrastructure and expertise are prominent,” Welthagen said.

“As it is, the government does not even improve the current public health care system. We have one but it is neither overhauled nor improved.”

The concern about the NHI can clearly be seen in the large number of new registrations with Solidarity’s professional networks for the medical sector. Almost 60 doctors have joined Solidarity’s Doctors’ Network in recent months.

The deadline to submit comments to the National Council of Provinces for this council’s consideration of the draft NHI legislation is by the end of this week.  

Armed with this report, Solidarity will also give its input. Solidarity is completely opposed to the introduction of the NHI and the centralisation of the South African health system.

Read the full report here: https://cms.solidariteit.co.za/wp-content/uploads/2023/09/Proposed-National-Health-Insurance-NHI-1.pdf

Statement issued by Nicolien Welthagen, Manager: Solidarity Research Institute, 11 September 2023