The government should consider regulating where private sector doctors and specialists work, in order to distribute their services more evenly across the country, the Board of Healthcare Funders (BHF) says.
"The disproportionate distribution of health-care professionals is a concern. Better planning and regulations are required to enforce efficient allocation of human resources … It is therefore imperative that the certificate of need be revisited," said the BHF, a key player for medical schemes in the country, in a report released on Friday.
It is a controversial suggestion unlikely to sit well with doctors, who previously persuaded the Constitutional Court to set aside regulations requiring them to obtain a certificate of need, or ministerial approval, prior to practising.
While the National Health Act contains provisions that enable the minister to regulate this arena, he has not done so since the Constitutional Court case.
However, the issue is very much still alive, as the Competition Commission’s health market inquiry recently recommended in its draft report that the health department develop a new framework for licensing all health-care facilities, based on a national plan that considers public and private sector capacity and the needs of the population to be served.
While its emphasis is on private hospitals, it said licensing could be extended beyond acute facilities over time.
The BHF’s head of research, Charlton Munrove, said other approaches to licensing should also be considered. "The best way to do it would be to try to create incentives to get [healthcare] professionals where they are needed, or let them see public sector patients too. It needs to be a collaborative approach or you end up in court." he said.
The BHF released research on Friday showing that almost half (22,802) the health-care professionals working in private practice in 2017 were in Gauteng, which is home to about a quarter of SA’s population. Its analysis was based on the Practice Code Numbering System (PCNS) database it manages on behalf of the Council for Medical Schemes. Health-care professionals working in the private sector need a PCNS number in order for their patients to claim from their medical schemes.
The analysis found a 52% increase in active health-care professionals registered on the PCNS over a 17-year period, rising from about 36,000 in 2000 to 54,800 in 2017. Over this period, the average age of health professionals registered with the PCNS increased, suggesting older professionals are migrating from the state sector to the private sector, said the BHF.
The number of medical scheme members rose from 7-million beneficiaries in 2000 to 8.9-million beneficiaries in 2017, a growth rate of just 27%.
It suggests an oversupply of private sector health-care professionals, creating an incentive to overservice patients, said Munrove.
However, Alex van den Heever, from the Wits School of Governance, said the PCNS data overstate the number of private health-care professionals as it includes people who are registered but not billing and did not exclude people who are employed by the state but also do a limited amount of private sector work.
"The absence of any evaluation of the public sector data provides a distorted picture. There were 14,454 GPs in the public sector in 2016, up 7.4% from 2006 [and] there was a 49.2% increase in professional nurses. The more limited increase in specialists has been largely due to the strategic prioritisation of district health services over provincial and tertiary hospitals and [is] not due to any activity of the private sector," he said.