Month: June 2023

A depressing reflection of the State of South Africa was the complaint of Richard Friedland, CEO of private health provider, Netcare, about a coming nursing crisis. An aging cohort of nurses, many more of whom will be retiring, is not being replaced for want of government action – ‘…..about which it was warned well in advance and chose to ignore it …” Netcare, he reported “…had been accredited to train more than 3,000 a year; it now trains barely a 10th of that…”

Clearly there is a demand for more nurses and a very large potential supply of aspirant nurses, given the current employment benefits and prospects. Why the government stands in the way of Netcare helping to close the gap between supply and demand of nurses is perhaps not as obvious as it should be?

Let us attempt to round up the usual suspects. The first suspect must be the arguments against private medicine that are made in principle. The case for equal treatment for all, paid for by the taxpayer, is one that ideologues employed in the Department of Health, hold fervently. Helping the nursing and other services a private hospital provides may provide may threaten this vision.

Though even the ideologues appear to concede the case for top up medical benefits paid for by the more prosperous. Perhaps they realistically understand that the better off in their key economic roles are much more likely to take themselves and their contribution to the revenues of government away from SA, for want of a world class and affordable medical service. A benefit we assuredly receive from the private hospitals and independent physicians that they are willing to pay for through a pay as you go system.

For an economy so obviously lacking in human capital, and not only for the capital embodied in the cohort of nurses, who are especially attractive immigrants, the consequences of an uncompetitive medical offering for highly mobile skilled South Africans are truly disastrous for income growth and taxes collected in SA. Upon which any National Health Service must ultimately

depend. Equal and hopelessly inferior is not an attractive prospect even for those who ignore the current realities of our government provided medical services.

It may still be asked why can’t the government, via its own large suite of public hospitals and large budgets, are failing to train more nurses and doctors for that matter? The answer is in the existing budget constraints. Budgets that provide well for those already in government service, provide employment benefits that keep up with and often exceed inflation of living costs, but leave very little over to employ new entrants to government service, of whom there are potentially legions. The private sector does not compete at all well with the public sector in the competition for workers of all skills- taking into account the private medical and pension benefits that the public sector employees draw upon.

But more important in the resistance to private medicine may be the force already prominent in explaining the actions and allocations of budget, commonly taken by state operated agencies in SA. Public hospitals and their procurement practice –definitely not excepted. The taxpayer has been held to ransom by the opportunists who intermediate between the State as payer and the service and goods providers. They have been extracting wealth from the taxpayers on a mind-numbing scale as Zondo our media and the US government has revealed.

The envisaged National Health Service will be a single payer for all the health services provided by the state. The intended budget will be an enormous one and the opportunities to navigate the gaps between the government as payer and the service and goods providers will be many and valuable. That that you can’t do (big) business with the SA government without a bribe or kickback must be regarded as alas, unproven. The evidence, the reality of SA, vitiates the case for a universal health system. But the private interest in such arrangements is a powerful one. That providers of private medicine in SA will have to resist to survive. They must make their case to the voting public- as Netcare has done.