Tuesday, September 20, 2005

Private healthcare still hurts

Recently, I underwent knee surgery and found the whole experience decidedly sombre. I know it is a truism to say hospitals are clinical and sterile, but they are. They are dens of suffering and the environment contains too much public discussion about bodily fluids for my liking.

Then, again, I am one of the lucky ones. My operation went well, the treatment was superb and the hospital room was comfortable, with couch, en suite bathroom and 24-hour satellite television to dull the pain. This is the benefit of private healthcare, whether in the UK or South Africa.

But most people in the world do not get this treatment. About 60% of spending on healthcare in South Africa is in the private sector, with less than 20% of the population benefiting from it. The State spends R33-billion on healthcare for 38-million people; the private sector spends some R43-billion on 7-million.

The South African healthcare system is an ‘either or’ arrangement. Either you have medical aid and go privately, or you use public facilities. The system in the UK is more of a hybrid. If I had braved the waiting list the same consultant who performed my surgery would have done it free, albeit in two years’ time. The long waiting list meant I had little choice but to max-out my credit cards to see the same consultant privately. Strangely, this concoction of a system means that doctors, who are technically independent contractors paid at a reasonable rate by the State, work in the public service and the private system at the same time. This seems better than in South Africa, where doctors migrate to the private sector the day after graduation. Only 23% of specialists work in the public sphere in South Africa.

But the UK system is also hardly ideal. The best scenario would be to get all doctors committed to the NHS, bringing waiting lists down. When the public system works it is fantastic. As a South African used to private care, it has been a real eye-opener to use a ‘without charge’ public system on other occasions. The free NHS maternity care and GP services we have received so far have been first-rate.

But the challenge of shorter waiting lists is fostering a general slide towards more private care in the UK. In South Africa, the slide has long since turned to a freefall. Four years ago, there were 161 private hospitals in South Africa; now there are 200, which means ten new private hospitals a year. Who is winning? Private healthcare fat cats, that’s who. Profits in the private healthcare business are astronomical. Medical aid premiums have consistently outstripped inflation and the services they cover decrease each year. It is all good and well if you have medical aid or are wealthy. But no one is asking the bigger questions: when will the private healthcare avalanche end and at what cost? The desire for private healthcare in South Africa has become the norm, with everyone aspiring to a job that provides it, rather than thinking about how to improve public healthcare. Attempts to curb private care and bring doctors back to the public system seem abandoned. What happens when the premiums become even higher, the medical-insurance companies even more powerful or when the State system collapses? We will probably need a lot more than satellite television to dull the pain.

Copyright Brandon Hamber, August 2005. "Look South" Column published on Polity on 2 September 2005.