Health System in South Africa

Description:

Health systems in South Africa

Introduction

South Africa has one of the healthiest climates in the world inductive to playing sports and enjoying an active, outdoor lifestyle, plenty of fresh fruit and vegetables however its people aren’t as healthy as might be imagined.

South Africa’s major public health concerns are HIV/AIDS, smoking-related diseases and tuberculosis, all of which affect the non-white population more than the white; apart from these, the country is relatively free of major health problems given Africa’s reputation as a continent riven by diseases and other health hazards.

Immunisations aren’t currently required or even recommended for those visiting South Africa’s major cities and coastal resort areas (although some doctors recommend you to check that your polio and tetanus jabs are up-to-date), unless you’ve come from an area where yellow fever is endemic (for example, Kenya, Tanzania and the northern half of South America), in which case you need to carry documentary proof that you’ve been vaccinated. This situation, however, could change and you’re recommended to consult your doctor at least six weeks before travelling to the country to check the current situation.

For those travelling off the beaten track in South Africa for any length of time, some doctors recommend shots against typhoid and a Havrix injection against hepatitis A. Vaccinations against hepatitis B are needed only by those who will be working in healthcare, while a cholera vaccination is both unpleasant and generally ineffective.

Public Healthcare: South Africa's health system

South Africa's health system

Healthcare in South Africa reflects a mixture of the First and Third Worlds: some public healthcare facilities in rural areas are very basic indeed, while some private facilities (and medical research) are cutting-edge, placing South Africa firmly at the forefront of medical advances.

Generally, public facilities tend to be underfunded, bureaucratic, inefficient and hopelessly over-subscribed, whereas many private facilities are excellent – as good as any found in Australasia, Europe and the US.

To find a general practitioner (GP) – i.e. a family doctor – in your area, contact the Health Professions Council of South Africa Tel. 012-338 9300 or 6680, www.hpcsa.co.za, with which all medical practitioners must be registered.

Public hospitals and clinics in South Africa are usually reasonably well equipped and staffed (although not always) but are often very overcrowded with patients and you need to wait for a long time to be seen (by staff who are usually overworked and sometimes indifferent); and you must often pay for treatment.

Although the state contributes around 40 per cent of all healthcare expenditure, the public health system has to serve just over 80 per cent of the population. Public health uses around 11 per cent of the government’s budget, which is allocated to the nine provinces. The amount of funds they receive and the efficiency of their use varies considerably, and poorer provinces, such as the Eastern Cape, offer a much lower standard of healthcare than richer provinces like Gauteng and the Western Cape.

The South African public sector health system has now 3,500 clinics in the public sector, offering free healthcare to children under six and to pregnant and breastfeeding women.

To alleviate a long-standing shortage of doctors, 450 foreign doctors have been employed, many of them from Cuba. Unfortunately, the country still suffers from a medical ‘brain drain’, with countries like the UK and Canada keen to recruit South African doctors who have a good reputation.

If you’re treated at a state hospital in South Africa and are a non-resident, you must pay and South Africa has no reciprocal health agreements with other countries; even citizens and residents often have to pay, the amount depending on your salary and how many dependants you have (hospitals have rating scales to calculate the amount to charge you). Charges are often low (by Western standards), however for example, pensioners pay only around R13 (£1.13) for a consultation, medicine and in some cases tests. The maximum charge for top income earners is R55 (£4.78) for a consultation, although you must pay extra for medicine and tests. Top-earning patients pay R484.90 (£42.15) per day for hospital stays, excluding medicine and theatre costs. Specialist treatment is available at state hospitals, but waiting lists can be very long and it’s recommended to opt for private treatment if you can afford it.

The public system health care is still inadequate, and all visitors, temporary residents and permanent residents in South Africa are strongly recommended to have comprehensive medical insurance to pay for private healthcare.

Private hospitals and clinics are a much better choice for those who can afford them, and the costs are rather lower than in many western countries, particularly the US. Around 18 per cent of South Africa’s population are members of medical schemes that give them access to private healthcare, and the number of private hospitals is growing quickly: in 1997 there were 161, by 2004 there were 200.

Two of the largest private healthcare providers are Netcare (www.netcare.co.za ), with around 43 hospitals and 18 day clinics throughout South Africa, and Medi-clinic (www.mediclinic.co.za ), which has around 35 hospitals.

Your insurance should include cover for private ‘rapid response’ emergency services, the private equivalent of ambulances. The state ambulance system is severely stretched, partly because of South Africa’s high rate of road accidents. The largest private rapid response company is Netcare 911, which has the biggest fleet of response vehicles (cars, ambulances, helicopters and fixed wing aircraft) and paramedics in the country. For more information go to the Netcare website (www.netcare911.co.za ).

Health Insurance: Private health insurance in South Africa.

If you’re visiting or living or working in South Africa, it’s extremely risky not to have health insurance for your family. If you’re uninsured or under-insured, you could be faced with some high medical bills.

When deciding on the type and extent of health insurance, make sure that it covers all your family’s present and future health requirements in South Africa before you receive a large bill. A health insurance policy should cover you for all essential health care, whatever the reason, including accidents (e.g. sports accidents) and injuries, whether they occur in your home, at your place of work or while travelling. Don’t take anything for granted, but check in advance. When travelling in South Africa, you should carry proof of your health insurance with you at all times.

When buying private health insurance, you should consider South African as well as international companies. When comparing policies, carefully check the extent of cover and exactly what’s included and excluded from a policy (often indicated only in the very small print), in addition to premiums and excess charges.

The most important questions to ask yourself are: does the policy provide the cover required and is it good value.The best value is usually a policy covering only specialist and hospital treatment.

If you aren’t covered by South African social security and need comprehensive private health insurance to obtain a residence permit, you must ensure that your health policy will be accepted by the authorities.

South African Companies

Private policies vary considerably in price, depending on their scope and the percentage coverage, but generally cost from R1,000 (£85) to R2,000 (£175) per month for a family of four, although costs are higher for comprehensive cover and the elderly.

The largest medical insurer in South Africa is Discovery Health (www.discoveryworld.co.za ), with over 1.5 million members – at least twice as many as any of its competitors.

Smaller healthcare providers include Multimed (www.multimed.co.za ) and Selfmed (www.selfmed.co.za ).

Shop around and compare policies, which vary considerably: some have particularly murky small print that entitles the insurer to avoid paying almost any claim.

As in many countries, South African insurance companies are loath to pay claims (one of the reasons they don’t insist on a medical examination is so that they can refuse to pay a claim because you omitted to tell them you’d had a heavy cold three years previously!). So, when completing the questionnaire, be sure to list all previous illnesses, hospitalisation, current ailments and treatment. However, South African companies are usually no worse (or better) in this respect than those in other countries.

Foreign Companies

There are a number of foreign health insurance companies with agents or offices in South Africa or offering cover for people living in South Africa, including AXA PPP Healthcare (www.axappphealth care.com), BUPA International (www.bupa-intl.com ), the Exeter Friendly Society (www.exeterfriendly.co.uk ) and HealthCare International (www.healthcareinternational.com ). These companies offer special policies for expatriates, and most international health policies include repatriation or evacuation (although it may be optional), sometimes including shipment (by air) of the body of a person who dies abroad to his home country for burial. An international policy may also allow you to choose (within limits) the country in which you have non-urgent medical treatment.

A medical examination isn’t usually required for international health policies, although ‘pre-existing’ health problems are excluded for a period, e.g. two years. Claims are usually settled in major currencies and large claims are usually settled directly with the hospital or doctor by insurance companies. Always check whether an insurance company will settle large medical bills directly; if you’re required to pay bills and claim reimbursement from an insurance company, it can take several months before you receive your money (some companies are slow to pay).

The cost of international health insurance varies considerably with your age and the extent of cover. With most international policies, you must enrol before you reach a certain age (usually between 60 and 80) to be guaranteed continuous cover in your old age. Premiums can sometimes be paid monthly, quarterly or annually, although some companies insist on payment annually in advance.

If you already have private health insurance in country other than South Africa, you may be able to extend it to include South Africa rather than taking out a new policy.