White doctors spoke out vociferously against the ‘Deeble plan’ for national health insurance. Black doctors, however, are upset that this plan is being diluted, reports Pat Sidley
JOHN Deeble’s virtues, or lack of them, are in the eye of the beholder. To many general practitioners in this country, the Australian health care expert’s original ideas for a South African health system would have wrested any vestige of control from their hands, and placed it in the hands of the state.
The GPs with that vision of Deeble were largely white. Many others, however, see him differently.
He was flown out this weekend — courtesy of SA Druggists — to address the annual conference of the largely black South African Medical and Dental Practitioners’ Association, which was hoping to see his original plan adopted in this country.
To these GPs, most of them working among disadvantaged communities, a system which imposed a payroll tax on the employed and self-employed, and paid doctors in a lump-sum per registered patient, seemed a useful and moral way through the health care mess in this country. Better still, it would mean a guaranteed, quality service at minimal cost to patients, while guaranteeing a reasonable income for doctors, paid for by a dedicated tax.
It would have meant, in its ideal form, the incorporation into a single health system of all black GPs in private practice — a group who have traditionally been excluded from the health establishment. This was expressed in a heckle by Dr Gees Abram, who said: “What we need is a minister of one health system, not a minister of private health care and a minister of public health care.”
Older GPs at the conference related their experiences of not being allowed to work at black hospitals like Baragwanath, and of being paid amounts so low it would make the average, overworked registrar of today seem
Deeble shared a platform with Health Minister Dr Nkosazana Dlamini-Zuma. While she was sympathetic to his original plan, the report she commissioned, and which he helped put together, is different in crucial respects from his plan.
The main point of difference is the entrenchment of the private and public sectors, with an accreditation plan to bring some doctors into contracted state service.
Accrediting private practitioners was one area of severe criticism from the GPs. If implemented in the way the plan proposes, it would require a large capital outlay and other costs for private doctors to be placed in a position where they can be contracted as accredited practitioners.
But a major area of contention the doctors expressed was around the availability of cheaper drugs through an essential drugs list (EDL). Many of these doctors have thriving relationships with pharmaceutical companies and dispense these drugs themselves. Dispensing by doctors has also fallen under the critical eye of the National Health Insurance plan.
It’s a battle the doctors are not likely to win, points out Deeble, who notes that South Africa’s drug prices are among the highest in the world.
For several of those present, Zuma and her team had come under the influence of the large private health care players in the system — and this had diluted what Deeble had had to offer.
Deeble himself believes much of what he originally suggested has a better chance of succeeding here than the more complex arrangements mooted by the plan he co-
A chord which struck deep resonance among the GPs came from the persistent heckling from East Rand doctor Gees Abram, who believed it incorrect to have a two-tier health system with both a public and private sector: it should all be one, he bellowed at the minister.
He, like many others in the gathering, works in his private surgery as well as giving time at nearby public health facilities. This week he said that at this time of the year, when medical aid ceilings have long since been reached, patients who prefer using private general practitioners are “dumped” into the public health system as their funds dry up.
In this criticism of the present NHI plan, he is joined by many other critics who believe that it’s likely that many patients who start out in private care will end up “dumped” on the state at some stage.
Zuma, who handled the heckling with some aplomb, had to face an important constituency which believes she should not have ditched Deeble’s plan, and which is hoping to put it back on to the agenda.