Whilst the government struggles to provide quality health care in South Africa, the free market has stepped in.
Over the past 10-15 years, private health care initiatives have emerged and flourished to meet the needs of an underserved portion of the population. Prevented from belonging to low-cost benefit schemes by senseless legislation, citizens are choosing to pay out of pocket for emergency and other ad hoc medical needs for themselves and their families. In addition, many employers have become creative in finding ways to cover worker’s medical costs to ensure a healthy workforce.
For both companies and their employees, it is more cost effective to use private, efficient medical providers and avoid wasted hours in queues at public clinics and hospitals. This is an economic decision that benefits all parties.
With some personal experience and rudimentary research, it is easy to discover some of the many private health providers that have emerged over the past 10 years. Given their related business interests, pharmaceutical outlets such as Dischem, Clicks, and privately owned pharmacies have begun providing on-site primary health care.
Qualified nurses provide mother/baby advice, administer prescribed injections, check blood pressure, measure blood sugar levels, and advise further treatment. A recent innovation has seen the introduction of on-line off-site medical advice provided by qualified doctors in the presence of said nurses. And announced only last week, Dischem has now equipped a mobile clinic for use in Gauteng - most especially for school visits.
Having observed the success of these enterprises, the Checkers/Shoprite group have upscaled their Medirite outlets and launched a similar service at equally affordable rates with cutting edge Telehealth for non-emergency care.
Private day hospitals in underserved areas, walk in doctor, and dentist practises (no appointment required and a fixed-fee consultation) have burgeoned, catering to a broad range of patients with and without medical aid cover as well as providing a critical service for tourists and out of town visitors.
Another remarkable example of a private initiative is that of Unjani clinics. Originally a single converted and equipped shipping container provided by a large company as part of their Corporate Social Investment (CSI), the model has grown to include over two hundred points of service scattered throughout the country.
These mini clinics are run by qualified nurses and provide a range of services in the heart of mostly poor and poorly catered for areas. They provide communities with access to primary health care close to their place of residence, reducing the need for pricey transport costs. Many of these clinics also have at least one vehicle for use to convey blood samples and medication. Several additional corporates have since joined with Unjani clinics as sponsors, co-funders, and suppliers. They are run as not for profit organisations and charge affordable fees for their services. The success of these clinics is evidence of the dire need for quality primary health care and the glaring inadequacies of an inefficient and often uncaring public healthcare provider.
Further, the advances in internet connectivity provide a growing base of information, enabling people to self-medicate for common ailments via ‘over the counter’ medications, vitamins, and health supplements. There is also an ever-increasing body of knowledge educating people on how to prevent many lifestyle illnesses.
All these developments in the private sector signify that many citizens are seeking and finding alternative, affordable ways in which to address their health needs; the market has recognised and met the demand. It is fallacious to think that private health care is only about the large clinic groups and expensive medical aid insurance.
Cynics may claim that private health care providers only care about profits at the expense of the poor, but as illustrated for many corporates these are add-on services which make good business sense given their core business model. In the case of Unjani clinics, these are largely funded by CSI budgets. The altruistic objectives of business and charitable organisations should not be dismissed.
It is difficult to calculate the numbers of people who are one way or the other funding their own healthcare requirements, but rough estimates indicate it could be anywhere between 1 and 3 million (Unjani clinics alone estimate over 850,000 visits per annum). The outdated statistic quoted by commentators is that 16% of the population are covered by medical schemes, and therefore 84% are dependent on the state - these numbers are clearly no longer valid. Many more citizens have become self-sufficient, thereby reducing the burden on the public health service.
These developments should be welcomed, encouraged, and supported. The private sector should be free to train nurses, doctors and other medical personnel. Qualified doctors awaiting positions for their internships should be assigned to the private sector for their final year of in-house training. Legislation preventing low-cost benefit options should be removed.
What the state needs to recognise is that their role should be to provide for the poor, the disabled, and the unemployed. They cannot push the private sector genie back in the bottle. They should focus on creating constructive partnerships with the private sector and start building from the bottom instead of destroying from the top.
