Under the National Health Insurance (NHI) system, doctors will be given instructions regarding exactly which brand of medicine they may prescribe and when they may request tests.
The NHI Bill submitted to Parliament on Thursday makes provision for the drawing up of a list of medicines to be used and protocols related to when services may be offered. Doctors who do not comply may be kicked out of the NHI system and will not be able to renew their accreditation every five years to provide services.
In addition, the bill has the contentious provision that the NHI Fund itself will decide how much it will pay a service provider, and all doctors have to go along with this.
Johann Serfontein of the Healthman consultancy group, which advises the SA Private Practitioners’ Forum, says the provisions for treatment create a tremendous ethical problem for practitioners who are responsible for the effective treatment of their patients.
Although several medical aid funds also have preferred drug lists and protocols for treatment, the doctors are not bound to them. These are funding policies, but the member of the health insurance fund and his or her doctor can still decide which medication they want to take and which treatment is appropriate.
Serfontein says the Medical Schemes Act also specifically provides for cases where members may deviate from these lists and protocols at full cover if the preferred treatment method is not effective.
In fact, the bill binds the doctor to treat NHI patients in a specific way, whether or not they agree with it.
He says that, if a doctor does not agree with the prescribed referral route as determined by the NHI and has to follow the procedure for a complaint, valuable time can be wasted.
“There are certain specialists who require direct access.
“A retinal tear must be repaired by an ophthalmologist within 48 hours. Will such a patient be treated in time?”
Serfontein fears doctors will leave the profession and even the country if their working conditions deteriorate.
Although doctors will be able to make their own treatment decisions for patients who pay privately or have medical aid, fewer people will be able to afford it when they also have to contribute to the NHI.
This could leave doctors with no choice but to be an NHI-contracted doctor.
As far as permitted rates are concerned, Angelique Coetzee of the SA Medical Association says it is still too early to talk about the prescribed rates, and the association will provide input on this.
She also says it is important for clinical experts to be involved when the forms are drawn up to ensure quality care in the private and public sectors.
The Institute of Race Relations and the Free Market Foundation have already expressed their concern over the bill’s concentration of power in the hands of government.
The institute says that, under the NHI, the state will control every aspect of healthcare – which services are covered, how much providers are paid, what medications can be prescribed and whether blood tests are allowed, as well as the cost of everything from aspirin and antiretroviral drugs to stitches and CT scans.