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Does South Africa Have Universal Healthcare?

Does South Africa Have Universal Healthcare
Who is Eligible For Care – South Africa’s constitution guarantees that everyone has access to healthcare services. This includes expats, refugees, and asylum seekers. Therefore, just by living in South Africa, expats are able to receive public healthcare.

Do foreigners pay for hospitals in South Africa?

According to the South African Constitution (Section 27) – The South African Constitution states that everyone is entitled to basic healthcare whether they are a South African Citizen or not. This means that Foreign nationals have the right to free basic health care and only pay when they need more than primary healthcare. In an emergency, everyone is entitled to free healthcare, whether a South African citizen or not.

Can universal health coverage be achieved in South Africa?

Keynote Address by Minister of Health, Dr Joe Phaahla, MP, on the occasion of the Policy Dialogue on Universal Health Coverage in South Africa during the Event of Universal Coverage Day – Themed : “Build the World We Want: A Healthy Future For All” Programme Director, Deputy Minister of Health, Dr Sibongiseni Dhlomo, MP, Director-General, National Department of Health, Dr Sandile Buthelezi, Chairperson of Portfolio Committee of Health, Dr Kenneth Jacobs, Members of Portfolio Committee present, WHO Country Representative, Dr Owen Kaluwa, MECs of Health present, Heads of Provincial Health Departments present, International Development Partners present, Esteemed Speakers and Panelists, Distinguished guests Ladies and gentlemen Good morning.

I am pleased to welcome you all to the first Universal Health Coverage Day event post the onset of the COVID-19 pandemic and more so, to have the opportunity to engage in person with you all on a critical aspect of our health system – attainment of universal health coverage, known to us as UHC. Approximately half the world’s population lacks access to such essential health services.

South Africa, like many countries globally, is striving to achieve UHC in fulfillment of the United Nations’ Sustainable Development Goal (SDG) target 3.8. In July 2019, our President, His Excellency Cyril Ramaphosa, launched the ‘Presidential Health Summit Compact’ aimed at strengthening our health system toward an integrated and unified system.

augmenting and better distributing human resources for health;improving supply chain management to improve access to essential medicines, equipment and supplies;executing the health infrastructure plan;engaging the private sector;involving the community;improving the health system in terms of quality, safety and quantity;increasing efficiency in financial management;developing national health information systems to guide policies, strategies and investment, andstrengthening governance and leadership to ensure accountability.

These pillars also closely approximate the key targets contained in the political Declaration on UHC that was agreed to by Heads of States at the United Nation’s High-Level Meeting (UN-HLM) on UHC during the UN General Assembly (UNGA) in September 2019.

  • These commitments were made a mere few months before the onset of COVID-19, the impact of which is still unfolding our population and health system.
  • In South Africa, in the immediate term, the need to pivot services to address the burden of COVID-19 has had negative impacts on non-COVID-19 patients and health services.

Of the entire service package, routine services for non-communicable diseases (NCDs) were greatly impacted. Follow-up visits for patients with NCDs were postponed and healthcare workers (HCWs) were re-deployed to COVID-19 services. Delays in diagnosis, monitoring and treatment of NCDs, particularly at primary health care (PHC) level has potentially severe implications for people living with NCDs.

In terms of Maternal and Child Health programs, pregnant women attended clinics later in their pregnancies during 2021 than in the previous year. However, while there was no significant change in numbers of antenatal visits, births increased in the same period, showing that some women did not access antenatal care as expected.

In addition, maternal and neonatal mortality, which are key health system indicators, have shown increases during the pandemic. HIV and TB services, which are the most robust vertical programs due to the intensive investment and resource allocation to address the burden of disease, also suffered.

  • Many people did not access these services for a range of reasons including public health measures, such as lockdown, and fear of exposure.
  • Data comparing 2020 to 2019 service utilisation shows consistently low numbers for the 2020 period.
  • On average, HIV testing declined by 22.3% in 2020 compared to 2019, with the largest decline seen from April to July 2020.

Even when lockdown eased, numbers did not reach the levels of the previous years. However, HIV services for those already living with HIV were maintained. TB notifications in South Africa declined by more than 50% and the weekly average of confirmed TB cases decreased by 33%.

  1. This decline in testing has significant implications for treatment initiation, linkage to care and reducing transmission of TB and HIV.
  2. On the other hand, trauma and injuries decreased by 14.6% in 2020 as compared to 2019, with predictable increases as lockdown levels eased and alcohol bans were lifted.

Despite these challenges, service innovations arose to address the burgeoning need for services. Service delivery for COVID-19 was augmented by drive-through and mobile testing units and vaccination sites, providing possible avenues for future services such as remote TB testing facilities.

  • The Central Chronic Medicines Dispensing and Distribution (CCMDD) model which was already in place prior to COVID-19 saw massive scale up to ensure patients had access to medication.
  • Local innovations in testing allowed for the development of locally produced COVID-19 tests, decreasing our reliance on the overseas market.

Additionally, the usage of technology for self-screening and health education has shown promise in South Africa, although infrastructure challenges do remain a barrier to access. Telehealth and telemedicine, facilitated through a change in regulations issued by the Health Professions Council of South Africa, allowed for remote consultation and monitoring of patients, thereby improving access to care.

It is time now to move our attention towards building a resilient health system that delivers UHC. In tracking countries’ progress, the WHO has developed an indicator which is an index reported on a unitless scale of 0 to 100. This index is computed from 14 tracer indicators of health service coverage.

The long-term objective for this indicator is a value of 100. South Africa’s UHC index has almost doubled in the past 20 years, from a score of 36 in 2000 to a score of 67 in 2019. Considering individual elements it should be noted that service coverage for Maternal and Child Health has remained relatively stable.

However, with the prioritisation of communicable diseases due to the HIV/TB epidemics, NCD services have suffered, despite the growing burden due to this disease group. This epidemiological transition, where the pattern of mortality and disease in a population is transformed from high mortality among infants and children to one of degenerative and human-made diseases (such as those attributed to smoking) affecting principally the elderly, alongside the severe inequities present in our country, necessitate drastic reform.

According to the World Bank, South Africa is one of the most unequal countries in the world, with “race” playing a key role in a society where 10% of the population owns more than 80% of the wealth. In South Africa, just over 1% of the population spend over 10% of their household budget on healthcare, and 0.1% spend over 25% of their household budget.

Our two-tiered healthcare system consists of a public state-funded sector that serves the majority of the population (approximately 80 to 85%), and a private sector serving around 15 to 20% of the population. The private sector is mostly funded through individual voluntary contributions to medical aid schemes or health insurance.

This way of funding the healthcare system leads to inequality. In addition, compared to countries with similar economies to ours, South Africa spends more on health (8,9% of GDP in 2021/21); however, health outcomes are not proportional to the amount spent.

It is clear that UHC is the answer for resilient health systems that ensure quality and equitable access to health care. Countries like Brazil, Canada, Finland, Norway, Sweden, Thailand, Turkey and the United Kingdom have successfully implemented UHC systems. This has significantly improved access to health services and health outcomes.

Countries with UHC responded better and quicker to emergencies as seen during COVID-19 pandemic. The National Health Insurance NHI is South Africa’s chosen route to achieve UHC. The NHI is a health financing system that is designed to pool funds to provide access to quality, affordable personal health services for all South Africans based on their health needs irrespective of their socioeconomic status.

Universal access: All South Africans will have access to quality health care when and where they need it without suffering financial catastrophe.Comprehensive services: The NHI will cover a comprehensive set of health benefits that cover a continuum of care.Financial risk protection: South Africans will not suffer financial hardship in accessing health care services. The NHI seeks to eliminate user fees, co-payments and direct out of pocket payments.Mandatory prepayment: The NHI will be financed through mandatory prepayment as opposed to current voluntary prepayment and out of pocket payments.Single fund: All sources of funding will be integrated into the NHI Fund. The multiple public sector funding streams, namely equitable share allocations, conditional grants and locally generated revenues will be integrated into the Fund. The single fund will provide cross subsidization of the rich and poor, young and old, healthy and sick.Strategic purchaser: As a strategic purchaser, the NHI will proactively identify population needs and efficiently and effectively purchase health goods and services. The advantages of strategic purchasing are enhancement of equity in the distribution of resources, increase efficiency, managed expenditure growth and promotion of quality in health service delivery. The NHI will also serve to enhance transparency and accountability of providers and purchasers to the population.Single-payer: The NHI Fund is the entity that pays for all health care costs on behalf of the population. The term “single-payer” describes the funding mechanism and not the type of provider.

Canada is an example of a country with a single payer system. The Canadian health system is universal and considers national health insurance and healthcare to be a fundamental human right for all their citizens. The health care system is publicly funded through national, provincial, and territorial taxation.

  • The provinces and territories have primary responsibility for financing, regulating, and administering universal health coverage for their residents.
  • South Africa seeks a unified single payer system where the NHI Fund is responsible for financing and the provinces (together with private providers) will be responsible for provision of health services.

This is to address the current fragmentation in health care in the various provinces to ensure a standardized set of benefit packages for all South Africans.· the UHC 2030 campaign states (and I quote), “The essence of UHC is universal access to a strong and resilient people-centred health system with primary care as its foundation.

Community-based services, health promotion and disease prevention are key components as well as immunization, which constitutes a strong platform for primary care upon which UHC needs to be built.” Therefore, there needs to be a distinction between the NHI Fund as a financing mechanism and health service strengthening reforms that are currently underway to enhance the ability of the NHI Fund to achieve UHC.

These include but are not confined to: Primary Health Care Re-engineering, expanding the service provider base to contract with public and private providers, establishing accreditation, infrastructure, and quality improvement mechanisms as well as private sector reforms in line with recommendations from the Health Market Inquiry.

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Reinforcing the political leadership shown in the commitments highlighted previously that show that South Africa is serious about achieving UHC. We, as the National Department of Health, similarly call on and wish to engage with, all stakeholders at all levels of the health sector as well as our counterparts in other sectors, to ensure that Section 27 of our Constitution is realized. We also re-affirm commitments towards addressing the upstream social determinants of health, to protect our populations from ill-health and promote healthy lives for all.We acknowledge the vast inequity that permeates every aspect of our society and commit to making the NHI, as the vehicle of UHC, a reality so as to ensure that every person in South Africa is able to access care that is not dependent on their ability to pay.We have seen the ability of our health system to be adaptive and responsive to the changing needs of our population and health system and we will continue to work with relevant stakeholders to maintain a high level of regulation and governance without compromising on responsiveness to need.We will continue to support institutions such as the Office of Health Standards Compliance, as well as health facilities, to reach and maintain the desired levels of quality of care that will increase public trust and utilisation of the health system.We will use the lessons afforded to us during COVID-19 as well as pre-COVID-19 initiatives such as the establishment of the National Public Health Institute of South Africa to strengthen our health system and ensure resilience during public health emergencies.

Lastly, through this dialogue we are opening a necessary conversation amongst South Africans, and all health stakeholders about the necessity of health reforms and the need to implement the NHI to expand the accessibility of the health care system to all. And, I look forward to the outcome of this forum and the varying ideas we have to achieve the Universal Health Coverage. I thank you

Why do South Africans find it difficult to access healthcare?

Abstract: – Access to health care is a particular concern given the centrality of poor access in perpetuating poverty and inequality. South Africa’s apartheid history leaves large racial disparities in access despite post-apartheid health policy to increase the number of health facilities, even in remote rural areas.

  1. However, even when health services are provided free of charge, monetary and time costs of travel to a local clinic may pose a significant barrier for vulnerable segments of the population, leading to overall poorer health.
  2. Using new data from the first nationally representative panel survey in South Africa together with administrative geographic data from the Department of Health, we investigate the role of distance to the nearest facility on patterns of health care utilization.

We find that many apartheid legacies remain in place. Ninety percent of South Africans live within 7km of the nearest public clinic, and two-thirds live less than 2km away. However, 15% of Black African adults live more than 5km from the nearest facility, in contrast to only 7% of coloureds and 4% of whites.

  • There is a clear income gradient in proximity to public clinics.
  • Also, we find distance decay in the uptake of important health services such as having a skilled birth attendant, an immunization record and a growth chart for children.
  • The poorest tend to reside furthest from the nearest clinic and an inability to bear travel costs constrains them to lower quality health care facilities.

Within this general picture, men and women have different patterns of health care utilization, with the reduction in utilization of health care associated with distance being larger for men than it is for women. Much has been done to redress disparities in South Africa since the end of apartheid but progress is still needed to achieve equity in health care access.

What type of healthcare system is South Africa?

In South Africa, private and public health systems exist in parallel. The public system serves the vast majority of the population. Authority and service delivery are divided between the national Department of Health, provincial health departments, and municipal health departments.

Is health Care in South Africa free?

HEALTH & HEALTH SYSTEM – South Africa’s constitution guarantees every citizen access to health services through the public and private health sectors.8 The country is divided into nine provinces and each has a Department of Health that participates in health delivery, along with local Departments of health responsible for health promotion and preventative services.

Low quality public health care is available to all citizens for free with no formal health insurance plans.5 This public health system is divided into three tiers of health services. Primary care facilities are meant to be the first point of contact for patients and provide an initial assessment of the patient.

There are over two thousand primary care clinics and are mostly staffed with nurses providing community health services. District hospitals are the second tier and this is where patients can be tested and have minor procedures performed. Tertiary hospitals are bigger in terms of infrastructure and have advanced technologies for major surgeries.

  1. Specialists are required at these hospitals because patients with serious conditions are treated there.9 Most of the South African public health system is funded by a National Revenue Fund, which collects payments made to local, provincial, and federal governments.
  2. There is a decentralized distribution of funds from federal to local municipalities, giving local public health agencies independence over allocation of funds.5 To ameliorate the lack of quality and access to care, the government plans to establish the National Health Insurance in 2026.

It intends to ensure access to all citizens and residents of South Africa to quality health services provided by both the public and private sector, regardless of socioeconomic status. It would be a social health insurance in that it enforces contributions from employers and employees to partially fund the system.

South Africans would have federal government-sponsored plans to choose from that will pay directly for health services from all providers. The aim of the program is to encourage the wealthiest to pay into the public system and incentivize them to use public health services.5,12 The private health sector in South Africa accounts for the largest share of health expenditures through out-of-pocket-payments and medical schemes.

There are around 200 private hospitals throughout the country which can only be accessed with private insurance or self-pay. Only 18% of the local population regularly use private providers and despite being much smaller than the public sector, it accounts for about half of expenditures.

About 79% of doctors work privately, leaving only 21% of doctors for the public sector.13 The distribution of healthcare resources is inequitable because it disproportionately favors private health care. There are over 120 medical schemes that historically excluded black South Africans until 1970 and still mostly cater to wealthier demographics.9,10 Medical schemes vary by occupation and the capacity of people to afford them.

The schemes requires members to pay copayments and for services not included in the benefits package.10 Only 16% of the population has a medical scheme because the cost is still a barrier to a majority of South Africans.10,11 About 73% of white individuals are members of a medical scheme, 52% of Asian individuals and only 10% of black Africans, indicating a clear racial disparity in private coverage.12 South Africa is faced with challenges that have been detrimental to the health system.

The country has the largest HIV/AIDS epidemic in the world. South Africa has 0.7% of the world’s population, yet accounts for 17% of the global burden of HIV infections.11 This continued epidemic has forced the health system to focus on lowering prevalence and incidence of HIV/AIDS. Approximately 6.5% of health expenditures is used on services for HIV/AIDS and on average, the US spends $1.5 billion dollar for HIV/AIDS programs.5 South Africa also faces workforce shortages in the health system.

Medical schools have an annual output of medical graduates ranging between 1200 and 1300, which is inadequate for the population size. The government had tried to improve this issue by recruiting doctors from Cuba in a government-to-government agreement.

Can I get free surgery in South Africa?

Everyone is entitled to free primary health care services at government facilities. This means that clinics are free to all; All women are entitled to free abortion at government facilities.

Do South Africans pay for healthcare?

Costs of the Healthcare System – South African public healthcare is funded by the government by taxation, as well as through point-of-care spending from patients. Public healthcare in South Africa is subsidized by up to 40%. The system uses the Uniform Patient Fee Schedule or UPFS to regulate patient billings and physician payments.

Patient charges are based on income and family size and the UPFS uses three categories of patients to determine the cost of different visits and procedures. Full paying patients are either being treated by a private physician, are externally funded, or are non-citizens. This would apply to expats, who are eligible to use public facilities but must pay the highest billing category.

Partially subsidized patients are eligible to have the cost of their care partially covered on the basis of their income. Finally, fully subsidized patients are those who are referred to a hospital by the Primary Healthcare Services. This mostly applies to people who have a lower income.

Do I need health insurance in South Africa?

No. Travel insurance for South Africa is not mandatory, but it’s highly recommended that you get travel health insurance for South Africa. Because your trip to South Africa may include adrenaline-inducing sports or a safari, purchasing health insurance will ensure that you’re covered in case you become injured or sick.

How much does it cost to see a doctor in South Africa?

The cost of being sick in South Africa Finding affordable healthcare in South Africa is possible, but it comes with challenges. Patients often wait for hours to be assisted, and fatigued doctors sometimes miss underlying conditions. For many, however, the cost of a private practitioner can be prohibitive.

  • Private vs public healthcare
  • Vaughn Harrison, a partner at Hogan Lovells law firm says, “Private healthcare is generally regarded as being good, while public healthcare is regarded as being in decline, even though the majority of citizens rely on this service.”
  • This, he says, is despite the high percentage of funding that’s allocated to the sector.

On average, South Africans can expect to pay R514 for a private GP visit. The pricing below is based on information obtained from one practice in each area.

Area Price per consultation
Foreshore R750
CBD R600
De Waterkant R600
Vredehoek R510
Parow R565
Goodwood R550
Bishop Lavis R300
Mitchells Plain R350
Milnerton R500
Kraaifontein R480
Durbanville R568
Guguletu R400
Average R514

How can medical schemes assist with these costs? Medical schemes provide a blanket of protection during routine- and emergency health events. Depending on the kind of cover chosen, medical expenses covered include, for example, doctor’s visits, nursing, surgery, dental work, optometry, medicine and hospital accommodation when needed, says Council of Medical Schemes (CMS).

  1. According to the council, South Africans can choose from among approximately 760 medical schemes.
  2. As of 2021, approximately 14% of the South African population belonged to a scheme.
  3. South African medical schemes are especially unique, in that they cover Prescribed Minimum Benefit (PMB) conditions,” says the CMS.
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“These are a set of defined benefits to ensure that all medical scheme members and beneficiaries have access to certain minimum health services, regardless of the benefit option they have chosen.” PMBs include:

  • Any emergency medical condition
  • A limited set of 271 medical conditions (defined in the Diagnosis Treatment Pairs); and
  • 26 Chronic conditions (defined in the Chronic Disease List)

Medical schemes are expensive and imperfect According to the CMS, the average gross contribution towards medical aid per beneficiary per month is R2,053.48, and client complaints are frequent. The following are the main issues raised, according to the CMS.

  • Application of co-payments and insufficiency of benefits
  • Non-payment and short payment of claims (PMB- and non-PMB related)
  • Exclusion of certain treatments from funding
  • Imposition of general and condition-specific waiting periods
  • Termination of membership due to non-disclosure of material information
  1. “While some medical plans misapply the Act and Regulations by incorrectly limiting funding for PMB conditions, most members are not aware of their benefit offerings and financing limitations,” says the CMS.
  2. Additionally, it appears there is little to no understanding of the rules that govern their medical scheme.
  3. South African healthcare compared to BRICS

A 2016 study conducted by Harrison indicated that South Africa held up very well in comparison to its peers in the BRICS (Brazil, Russia, India, China, and South Africa) collection of emerging economies. At that time, South Africa was outperforming its counterparts in terms of healthcare, and in adherence to the healthcare parameters.

If anything, more citizens were spending money on medical schemes than in other BRICS countries. What does the future hold? The National Health Insurance (NHI), potentially. “The government has announced its intention to provide health care to all. This will be a big task, and one that needs careful management, as it will be costly.

Also, no estimates regarding the costs of introducing the NHI have been furnished to date,” says Harrison. “The NDoH must tread carefully when introducing the NHI, so as not to disrupt the private healthcare sector and the various professionals engaged therein, such as doctors, dentists, and nurses,” he says.

Once implemented, the NHI will extend decent medical cover to all South Africans. It will diminish the long queues and spread the healthcare burden across all sectors, ensuring all citizens have access to the assistance they need. To improve the country’s health, South African taxpayers can expect their funds to be allocated towards the NHI.

“While it is frequently stated that the only certainties in life are death and taxes, it can also be said that the costs of extending medical care to all, and attempts to make this affordable, will continue to tax South Africans,” says Harrison. He explains that issues of medical costs and coverage is a vexing one for all societies.

What is the biggest health problem in South Africa?

TUBERCULOSIS – In South Africa, tuberculosis is a significant public health concern. Every year, approximately 450,000 people contract the disease, with 270,000 also infected with HIV. TB is the leading cause of death in South Africa, It kills approximately 89,000 people per year, or 10 people every hour.

How many people in South Africa Cannot afford healthcare?

Statistics recently published by the Institute of Race Relations (IRR) show that millions of South Africans aren’t covered by a medical aid or basic healthcare provider. According to the report, out of South Africa’s population of over 54 million people, only 17.4% are covered by a South African medical scheme.

  1. This means that only 9.5 million South Africans have access to private medical care while more than 44 million don’t.
  2. Private quality healthcare roughly refers to easy access to general practitioners (GPs), dentists and medication.
  3. Having access to adequate medical cover can drastically improve the quality of life and life expectancy of a person.

The leading barrier to private healthcare in South Africa continues to be the price. The millions of South Africans living without medical cover put increasing pressure on the public health system. Data provided by government-owned website,, reveals shocking statistics about South Africa’s private healthcare sector.

The website explains that South Africa has over 4 200 public health facilities, with an estimate of 13 718 people visiting each clinic. This is extremely high, as the World Health Organization’s (WHO) guidelines indicate that public health facilities should not exceed 10 000 people per clinic. Medical insurance is an affordable alternative to the many South Africans who cannot afford medical aid cover.

Medical insurance comes at a much lower cost, providing members access to quality healthcare cover. It’s important to note that medical aid differs from health insurance and should not be substituted for the latter. Medical insurance offers stated benefits and a formulary that may or may not cover Prescribed Minimum Benefits (PMB).

What is the problem with healthcare in South Africa?

What has the pandemic exposed about South Africa’s healthcare system? – Firstly, South Africa’s biggest problem is that the health needs of its people exceeds capacity. Secondly, the vast majority of people actually don’t know their health status which delays access to care. Thirdly, the way the system is funded perpetuates inequality.

Who qualifies for free health care in South Africa?

The National Health Insurance (NHI) is a health financing system that is designed to pool funds to provide access to quality affordable personal health services for all South Africans based on their health needs, irrespective of their socio-economic status.

  • NHI is intended to ensure that the use of health services does not result in financial hardship for individuals and their families.
  • NHI seeks to realise universal health coverage for all South Africans.
  • This means that every South African will have a right to access comprehensive healthcare services free of charge at the point of use at accredited health facilities such as clinics, hospitals and private health practitioners.

This will be done using an NHI card. The services will be delivered closest to where people live or work. NHI is being implemented in phases over a 14-year period that started in 2012. It will be established through the creation of a single fund that will buy services on behalf of the entire population, The funding for NHI will be trhough a combination of various mandatory pre-payment sources, primarily based on general taxes.

Do you pay at state hospitals South Africa?

Emergency treatment in South Africa – Most hospitals in South Africa have emergency treatment wards that you can visit without an appointment if you have any injury or health complaint that needs urgent treatment. For example, this includes breaking a bone or suffering acute or severe pain in any part of your body.

  1. Anyone in South Africa can access emergency healthcare in state hospitals, including tourists.
  2. However, if you don’t have medical insurance then you may be charged up to 60% of the total costs.
  3. You can opt for emergency treatment in private hospitals if you have sufficient health insurance or are willing to pay for services out of pocket.

The nationwide number for an ambulance in an emergency in South Africa is 10177. You can also call 112 from any mobile phone to get put through to emergency services. Some of the main private health insurance providers in South Africa (such as Netcare and ER24) have their own medical emergency numbers.

Are hospitals in South Africa free?

Healthcare costs in South Africa – Public healthcare in South Africa is subsidized up to 40% of total costs; charges are based on your income and number of children. Visits to the doctor can cost around R55. However, waiting lists can be long, especially when it comes to seeing a specialist.

  • Hospital stays can cost up to €50 a night if you are in the top income bracket.
  • Funding for public healthcare in South Africa currently comes from government spending through taxation and point-of-care spending from those using services.
  • There are plans to implement a National Health Insurance (NHI) scheme to provide more free services for all and improve the quality of public healthcare.

However, estimates for funding this range from R165bn to R450bn, South Africa’s total healthcare spending in 2014 was 8.8% of GDP, which amounts to R16,957 per capita.

Can a doctor refuse to treat a patient in South Africa?

THE WHEN AND HOW OF TERMINATING A DOCTOR-PATIENT RELATIONSHIP – Posted 12 July 2022 Unity Ramaifo Health care practitioners often find themselves in situations where they wish to cease their treatment of non-cooperative or non-paying patients. As unpleasant as these situations may be, unfortunately the solution is not as easy as merely turning these patients away and shutting the doors on them.

There is much more to consider before a practitioner can terminate the doctor-patient relationship. Section 27 of the Constitution of the Republic of South Africa 1996, affords everyone a right to health care services and guarantees that no one may be refused the right to emergency health care services.

Once a medical practitioner accepts a patient for treatment, both an ethical and a legal duty of care arise. It is for this reason that practitioners must take the necessary precautions when terminating the doctor-patient relationship, to ensure that they have discharged their duty of care in such a manner that the patient has continuity of care and will not be regarded as abandoned.

  • Failure to discharge these obligations properly could lead to a complaint to the Health Professions Council of South Africa (HPCSA) or even a civil claim against the practitioner.
  • A practitioner needs to have sufficient reason to terminate the doctor-patient relationship.
  • According to the HPCSA’s Guidelines for Good Practice in the Health Care Profession, booklet 1 of 2016 (the Guidelines), a practitioner must always act in the best interest of the patient, even if such interests contradict their own.

The guidelines are there to protect patients from prejudice arising from a practitioner’s personal beliefs and to protect patients from possible discrimination. Before a practitioner terminates a doctor-patient relationship, they must evaluate the individual circumstances of that patient and make use of ethical reasoning to ensure that the termination is just and fair.

  • They should consider all possible alternatives and measures which might remedy the situation and enable them to continue to care for the patient.
  • Some situations will be easier to assess than others, where it will be clear that there is no solution but to terminate the doctor-patient relationship.
  • Once it is established that no possible alternative or remedy exists, and most importantly, that a continuation of treatment will prejudice the level of care given to the patient, a practitioner may terminate the doctor-patient relationship.

The following are possible situations, where termination of the doctor-patient relationship could be justifiable:

Aggressive or violent patients: Practitioners also enjoy the constitutional right to security and a safe environment. If a patient is abusive, either verbally, physically or sexually, the practitioner can terminate the doctor-patient relationship for their own safety and wellbeing. Non-payment of fees: Practitioners cannot be expected to work free of charge. If a patient is unable to pay the practitioner’s professional fees, even when offered payment plans and/or discounts, the practitioner may refer the patient to a colleague who charges less, or to a state facility, for further treatment, unless the patient requires emergency treatment. Improper relationships: The HPCSA Guidelines advise practitioners against improper relationships with their patients. Examples of an improper relationship, as per the Guidelines, include a sexual or quasi-sexual relationship, or an exploitative financial relationship. If a practitioner and patient’s relationship develops into a sexual or romantic relationship, or when the doctor-patient relationship is being misconceived or misinterpreted by either the doctor or the patient, the practitioner may terminate the doctor-patient relationship. The improper relationship must either cause strain on the doctor-patient relationship resulting in breakdown of the relationship, or alternatively, must affect the decision-making capacity of the practitioner to render effective treatment. Non-compliant patients: A practitioner is at risk of a complaint regarding defective treatment when a patient is non-compliant. Practitioners must therefore document every incident of non-compliance and weigh the effects of such non-compliance against the potential detriment to the patient. Practitioners must always inform the patient of the risks associated with non-compliance and warn the patient that if the non-compliance continues, they will not be able to treat the patient further without placing themselves at risk. If the patient remains non-compliant, despite such warnings, the practitioner would then be justified in terminating treatment, should the risk of such non-compliance be material. Religious or embedded beliefs: Although the HPCSA Guidelines preclude a practitioner from refusing to treat a patient as a result of religious beliefs or differences, the practitioner’s constitutional right to their religious beliefs must also be upheld. If rendering treatment to a patient will result in a practitioner having to perform an act is that contrary to his or her beliefs, such as performing an abortion or participating in end of life treatment, the practitioner may object to providing such treatment personally. Practitioners must however be careful not to judge patients or object to providing treatment merely because of a difference in beliefs. The act of treatment itself must be contrary to the practitioner’s belief and such belief must be deeply rooted. The Guidelines indicate that in such a case, the practitioner must inform the patient of their objection and advise the patient of their right to see another health care practitioner.

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Once it has been established that there is sufficient reason to terminate the doctor-patient relationship and that no alternative or remedial action exists which might fix the situation, the hard task of terminating the relationship begins. To do this, the practitioner must ensure that they do not alienate or abandon the patient.

  • The termination must be documented in the patient file and the patient must understand that the relationship with that practitioner has been terminated.
  • Most importantly, the patient must receive continued treatment.
  • It is recommended that a practitioner, from the onset, document all incidents which led to the termination of the relationship in the patient file, including the remedial measures or efforts attempted to salvage the relationship.

The practitioner can then either write to the patient or arrange a meeting with them. The practitioner must explain to the patient, in a calm and respectful manner, that he or she cannot continue treating the patient and the circumstances that have led to the necessity for termination.

  1. The communication must be clear and comprehensible to avoid any misunderstanding by the patient which might lead them to expect continued treatment.
  2. This conversation or written correspondence must also be documented in the patient file.
  3. The practitioner must recommend other doctors which the patient may consult and must assist the patient, where possible, to secure further treatment.

This can be done by writing a report or referral letter to the patient’s next or recommended doctor. The practitioner can also provide the patient with a copy of their patient file so that the next treating practitioner will have access to the patient’s treatment history.

  1. From the above, it is clear that practitioners cannot just close their doors to existing patients.
  2. Each patient’s circumstances must be evaluated carefully and appropriate steps must be taken to terminate the doctor-patient relationship, where this is indicated.
  3. The circumstances of some patients may be unique and some will be more difficult to handle than others.

In case of doubt, a practitioner should always consult a senior colleague or seek legal advice.

Why is medical aid so expensive in South Africa?

For R397 per month, you get unlimited GP visits and unlimited medication. You also get basic radiology, pathology, dentistry. Medical aids – even hospital plans – are so expensive, only a minority of employed South Africans can afford them. They are so expensive, in part, because they must provide members with prescribed minimum benefits (PMBs) which covers 270 conditions and 25 chronic diseases. Does South Africa Have Universal Healthcare © rawpixel/ Related articles:

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It is cheaper, partly because it does not have to provide PMBs. However, for the price (they start at R397 per month), it provides a heck of a lot such as (but not limited to):

Unlimited GP visits Unlimited acute and chronic medication Over the counter medication Basic radiology Basic pathology Basic dentistry Limited optometry Set amount for specialists

Another benefit of medical insurance it that there are no late-joiner fees such as those charged by medical schemes. Refilwe Moloto asked Johan Josling (CEO at Episodic Health ) to explain the differences between medical aid and medical insurance. Health insurance offers an alternative to medical schemes.

It covers you against unforeseen medical expenses It’s governed by the Financial Sector Conduct Authority. Medical schemes are covered by the Council for Medical Schemes. Johan Josling, CEO – Episodic Health Health insurance solutions are much cheaper than medical aid, but there’s a good reason for it Waiting periods differ There are no late-joiner penalties with health insurance products Johan Josling, CEO – Episodic Health Our solutions start at R397 a month, covering you for basic primary care things such as unlimited GP visits, acute and chronic medication, over the counter medication, basic radiology and pathology, basic dentistry, limited optometry and a set amount for specialists all that for R397.

Johan Josling, CEO – Episodic Health You should see health insurance as complementary to medical aid, not a substitute. A lot of people run out of their savings portion of their medical aid early in the year. For R397 per month, you are covered for unlimited GP visits – it doesn’t matter how many times you go in a year Also, your acute and chronic meds – that cannot run out Johan Josling, CEO – Episodic Health Listen to the interview in the audio below.

How much does a hospital stay cost in South Africa?

Costs of private hospital stays – Private hospitals charge a premium for overnight stays, A bed in a general ward costs around R4,000 per night and escalates to R4,900 for a private ward. Emergency stays in the intensive care unit (ICU) cost approximately R16,800 per night.

How much do South Africans pay for medical aid?

Discovery Does South Africa Have Universal Healthcare Discovery continues to dominate South Africa’s medical aid scheme sector, with over 1.3 million members and 2.7 million beneficiaries.

Offers 25 plans Across 7 scheme categories. No overall limit for hospital cover on any Discovery Health Medical Scheme plan. You can go to any private hospital on most plans; Access to screening and prevention benefits that cover tests to detect early warning signs of serious illness; Above Threshold Benefit (ATB) that gives further day-to-day cover once the Annual Threshold has been reached; Day-to-day Extender Benefit (DEB) for essential healthcare services in its network once medical savings are used up; You get comprehensive benefits for maternity and early childhood that cover certain healthcare services before and after birth; On selected plans, the group pays your day-to-day medical expenses from the available funds allocated to your Medical Savings Account (MSA), and, Works in conjunction with the Vitality rewards programme, as well as the coming Discovery Bank.

Plans Primary member Contribution
KeyCare R1 003 – R 3 023
Smart R1 565 – R2 412
Core R2 403 – R3 022
Saver R3 220 – R4 060
Priority R4 121 – R4 795
Comprehensive R5 441 – R7 487
Executive R9 122

Is breast reduction free in South Africa?

You just have to go consult at that Hospital in order to know for sure what you qualify for but the Hospital use their Selective Clinical Criteria to see if the patient qualifies for a FREE BR. You need to have a low BMI, Referral Letter and Affidavit of Unemployment if you not working.]

Who qualifies for free health care in South Africa?

Who is Eligible For Care – South Africa’s constitution guarantees that everyone has access to healthcare services. This includes expats, refugees, and asylum seekers. Therefore, just by living in South Africa, expats are able to receive public healthcare.

Can a foreigner buy medical aid in South Africa?

Medical Aid for Foreigners Medical aid is a form of insurance that covers the cost of medical services. It is available for foreigners and their family living and working in South Africa but depends largely on the type of visa one has while in the country.

Do you pay for public hospitals in South Africa?

Emergency treatment in South Africa – Most hospitals in South Africa have emergency treatment wards that you can visit without an appointment if you have any injury or health complaint that needs urgent treatment. For example, this includes breaking a bone or suffering acute or severe pain in any part of your body.

  1. Anyone in South Africa can access emergency healthcare in state hospitals, including tourists.
  2. However, if you don’t have medical insurance then you may be charged up to 60% of the total costs.
  3. You can opt for emergency treatment in private hospitals if you have sufficient health insurance or are willing to pay for services out of pocket.

The nationwide number for an ambulance in an emergency in South Africa is 10177. You can also call 112 from any mobile phone to get put through to emergency services. Some of the main private health insurance providers in South Africa (such as Netcare and ER24) have their own medical emergency numbers.

Do you have to pay for hospital care in South Africa?

Healthcare costs in South Africa – Public healthcare in South Africa is subsidized up to 40% of total costs; charges are based on your income and number of children. Visits to the doctor can cost around R55. However, waiting lists can be long, especially when it comes to seeing a specialist.

Hospital stays can cost up to €50 a night if you are in the top income bracket. Funding for public healthcare in South Africa currently comes from government spending through taxation and point-of-care spending from those using services. There are plans to implement a National Health Insurance (NHI) scheme to provide more free services for all and improve the quality of public healthcare.

However, estimates for funding this range from R165bn to R450bn, South Africa’s total healthcare spending in 2014 was 8.8% of GDP, which amounts to R16,957 per capita.