Monday, January 08, 2007


We are what we repeatedly do.

Excellence, then,

is not an act, but a habit.

- Aristotle

"Ever tried. Ever failed. No matter. Try Again. Fail again. Fail better."

Samuel Beckett

Monday, January 01, 2007

An open letter to South African policy makers

The standard of medical care is now global: this means that the expertise, the skill, the consideration expected of a medical practitioner in South Africa is the same as would be expected of one in the USA, Australia, Canada and the UK. True, levels of litigation and liability differ but the expected levels of care do not.

South African doctors are good and are welcome in the countries abovementioned.

Professional fees in South Africa are not determined by market forces because the government believes, correctly, that market forces would price most consumers out of receiving necessary care. However, most medical expenditure does not go to heath care providers: a larger proportion is spent on administrative costs in the industry than on doctors’ fees.

Given the small proportion of people capable of being doctors, doctors in South Africa are paid considerably less than their counterparts elsewhere whereas business people are paid considerably more. This says a great deal about what South African society values and how little political capital doctors in South Africa have.

The NHRPL has one purpose, to drive down the cost of medical care: it seeks to broaden access rather than fairly remunerate health care providers. Access is a laudable goal as is fair remuneration. However, these two are mutually exclusive. So, trade-offs are necessary and expected and not objectionable. My point, made repeatedly, is that healthcare providers should not be expected to bear such societal costs disproportionately as they currently do. That is inequitable and unsustainable and drives emigration.

The HPCSA’s primary remit is to protect the public not serve the interests of health care providers. The only body charged with acting in the interests of health care providers is the SAMA.

As a doctor, I believe that doctors in South Africa get a raw deal and I know that that will not change for a number of reasons and that it arouses very little sympathy. I also know that it is short-sighted because good health is the base of the human capital pyramid. Good health is the base of all economic measures including Gross National Happiness.

To the law of unintended consequences!