A large majority of specialists and doctors believe the state facilities in their area do not provide acceptable services
South Africa has a committed workforce of medical practitioners who enjoy their work. However, the state of healthcare in the country and continuing attempts by the government and third-party role players to regulate them and interfere in the doctor-patient relationship are tarnishing their view on the future of the health sector. This makes it difficult for them to see positive developments to change their view of the future.
These were the main messages coming out of a comprehensive survey of the country's health practitioners conducted jointly by Medical Chronicle, a widely read medical publication, and independent health strategy advisory company Lifechoice. The objective of the first annual Provider Attitude Barometer survey was to gauge the views of general practitioners and specialists on key health matters, present these views to stakeholders and foster constructive dialogue to improve the delivery of care in South Africa.
More than 1200 unique responses were received from readers on a variety of topics that included practising medicine in South Africa, the government's focus on health, the focus of medical schemes and their contracted third parties, representative associations, remuneration, electronic medical records and some other general items.
The views expressed provided some thought-provoking insights.
With regard to practising medicine in South Africa, only 12.4% of respondents strongly agreed or agreed with the statement that South African health had a bright future. Respondents were only slightly more optimistic about the future of their chosen discipline.
Despite a negative view on the future of health, only 8% of respondents disagreed or strongly disagreed with the statement that they would always practise medicine in South Africa. There was no age bias in this view and the majority of respondents indicated that they found their work rewarding and psychologically stimulating and showed a willingness to work with the state sector to improve access to care.
Fixing the state
Questioned on the government's focus, the majority of respondents (56%) did not support the concept of National Health Insurance. Only 4% of respondents agreed with the view that the government should be focusing on the NHI instead of fixing the state sector and only 9% of respondents agreed that state facilities in their area provided an acceptable service.
The reason for the lack of support for the NHI is evident. Although Health Minister Aaron Motsoaledi has demonstrated a healthy appreciation for the need to fix the state sector as a prerequisite for the successful implementation of the NHI and adopted appropriate strategies to achieve this, the message from the profession is that the fruits of these strategies and initiatives are yet to be seen by them.
Medical schemes were also seen in a negative light by medical practitioners. They indicated that they were not convinced that medical schemes had members' interests at heart.
There were also strong views that managed care had been ineffectual in containing costs and schemes were ineffectual in managing their non-healthcare costs. These views are in line with the increased costs of belonging to a medical scheme and the increase in non-healthcare costs seen over the past 30 years, especially since the introduction of the Medical Schemes Act in 2000. Members of the medical profession also felt strongly that legislative requirements and red tape undermined their ability to focus on patient care.
The survey also tested providers' attitudes towards remuneration. Any human resource expert will tell us that input from staff about their remuneration should be interpreted with caution. After all, how many of us feel that we are paid enough?
Although most respondents expressed a view that they were not well remunerated, the views expressed by general practitioners about specialists' remuneration and vice versa arguably provided more meaningful insight into remuneration issues. Sixty-six percent of specialists indicated that they thought doctors were not well remunerated, but only 21% of doctors felt that specialists were not well remunerated.
This was not the only question that indicated the different views of doctors and specialists on certain matters. The most significant discrepancy was the question of whether access to specialist care had to be by referral only.
Key organisations
Seventy-nine percent of doctors believed that all specialist visits should be by referral, but 66% of specialists said referral should not be required for all specialist visits. Given that rising hospital costs in South Africa's private sector correlate directly to the increasing cost of specialist services and that specialists manage the majority of hospital admissions, medical schemes need to give consideration to ensuring that members only have appropriate access to specialist services.
Questioned about their views on the key organisations in the health sector, 59% of respondents reported that they belonged to the South African Medical Association. Only 24% of the respondents belonging to it were positive about its focus. The association is the single most important representative entity for doctors in South Africa and best positioned to lobby on their behalf and this finding would therefore suggest that a change of focus is required by the association or, alternatively, that its focus should be better communicated to its membership.
Most respondents also felt that doctors working in the state sector should have their own representative body.
The respondents also felt the Health Professions' Council of South Africa, a government body that regulates the profession and is funded by registration fees paid by doctors, did not have the right focus. Only 6% of respondents reported agreeing with the council's current focus. Respondents also felt that, given the council's focus, it should be funded by the government.
More than half (52%) of respondents indicated a view that generic medication was effective. Although this view is pleasing in light of the challenges our health system has, given its limited resources, the view of the other respondents will be of concern to those who are striving to make healthcare more affordable.
Although surveys of this nature should always be interpreted with caution, the views of the practitioners working in the field are important to understand and give insight into the changes needed and the focus required to improve the health of all South Africans.
Just as no company can afford to ignore the views of staff, we cannot afford to ignore the views expressed in the survey as we move towards improving the health system.
Dr Andrew Good is the managing director of Lifechoice, an independent health consultancy