While the proposed National Health Insurance (NHI) could make use of existing private healthcare human resources, the necessary tax increases to fund it could drive more healthcare professionals from the country, the Professional Provident Society (PPS) has said. Economic and other factors, such as the Durban unrest, have already caused a surge of emigrations of professionals since July last year. In addition, foreign students graduates who study critical skills in South Africa (such as nurses and GPs) will no longer have an easy route to permanent residency.
The PPS, which counts about 30 000 healthcare professionals among its membership, pointed out the vulnerability of South Africa’s tax base – which has shrunk to only 6.9 million taxpayers, down from 7.6 million the year from the year before.
While it raised a number of concerns about the NHI, the group stated that it was broadly supportive of establishing universal healthcare in the country, and this goal could still be accomplished by using a dual public-private system. The PPS further noted that the government could benefit from the exceptional administrative capabilities and existing patient management systems.
However, NHI is dependent on strong, competitively remunerated human resources, with PPS pointing out that “South Africa has experienced a mass exodus of nurses in the 90s; we cannot risk that again. Both the government and private sector need to find a solution for South Africa and it cannot ‘import solutions’.”
“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.”
The PPS said in a 2019 report that the highest risk to effective universal health cover in South Africa is losing highly skilled professionals to emigration. Healthcare professionals have a great deal of geographic freedom, and it is becoming easier to work in their trades the world over. COVID with its restrictions may have slowed emigrations by skilled professionals, but since July 2021, experts have seen a surge backed up by 18 months of pent-up demand.
The PPS noted that research has shown “that the decision to emigrate is a complex one that is driven by various personal and societal pull and push factors.” The NHI could be yet another push factor adding to the list of healthcare professionals’ sore points. “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.”
Among general professionals, PPS’s research has indicated that many are considering emigration. A majority of respondents surveyed (73%) cited NHI as a potential reason for emigration, with 15% unsure and only 12% not considering leaving at all.
In addition to losses from emigration, the Department of Home Affairs has ended a 2014 waiver which allowed a quicker path to a residency permit for foreign students who acquire critical skills in South African higher learning institutions. Going forward, foreign students will no longer be able to apply for permanent residency visas without complying with the usual requirements such as providing proof of five years’ work experience. This is seen as detrimental to South Africa’s ability to attract and retain skilled professionals. This may further impact NHI implementation as the necessary skilled human resources are squeezed further as fewer foreign students may choose to study and then work in South Africa.
Source: BusinessTech
