Tuesday, 19 May 2009

Doctors struggling with debt: 10% more emigrating from South Africa

{pp}Newly qualified doctors will take 12 years to pay off tuition fees at current interest rates and some rural doctors not charging all patients.

South Africa, already plagued with a medical brain drain, is starting to see doctors battle with cash flow as indebted consumers abandon medical aids, ‘buy-down’ to cheaper plans or battle to pay bills when medical cover runs out.

Luis da Silva, managing director of Healthbridge, an information technology company which ensures fast payment of medical bills said that new research they had just completed shows that 10% of doctors that no longer use their services have emigrated since October. Healthbridge serves just over half of all medical practitioners in South Africa. “We came across really disturbing data that, as an example, showed that some doctors can’t even afford to replace old computer equipment because they have difficulties with cash flow.”

This comes at a time when public sector doctors have staged a number of strikes. Now doctors in the private sector are pointing out that cash flow is dropping. Doctors have pointed out that their long study periods, including community service see them with study loans that on average can take 12 years to pay back. Da Silva said: “There is dissatisfaction about their earnings among many doctors and even private sector doctors are feeling as they battle with high workloads and increasing bad debt.” Da Silva said Healthbridge’s support teams were coming across cases of “some rural doctors who are seeing increasing number of patients who can’t pay. They live in small communities and will never turn a patient away. They count on the fact that when the financial crisis eases those people will continue patronising them and start paying.” He said other medical practices were finding that patients are taking longer to pay or failing to pay any portions not covered by medical aid. He said that around five percent of doctors Healthbridge had surveyed have left the medical profession for other careers. Around a third of registered South African doctors already practice overseas.

International medical information journal, Eldis reported this year that, “With respect to doctors, migration from Africa to the United States is particularly important. The majority of African doctors migrating to the US came from three countries – Nigeria, South Africa and Ghana: 79% of these doctors were trained at only 10 medical schools.” The loss of these doctors puts strains not only on health care but on universities. Shireen Hassiem of the National Student Financial Aid Scheme, a government body that gives loans to students says: “If a person becomes a general practitioner and has fees of R222 000 for their tuition-only at around two percent above prime it would mean that if they earn R300 000 per annum they would pay off their studies in 111 instalments over nearly 12 years.” These costs don’t include textbooks or accommodation. If the doctor specialises – and South Africa has only 3 000 specialists at present serving a population of 42-million - they have to study for another two years after doing a year of community service and pay an additional R53 000 or more in further tuition costs. On average banks charge prime plus one to three percent more for a student loan.

Possibly because of a perception that doctors are high earners universities are swamped with applications to study medicine. Shirona Patel, communications manager at the University of the Witwatersrand says: “Wits Medical School gets around 5 000 applicants a year. Over the past three years we have increased the number of students we accept from 120 to 260 this year. There was a 100% increase in the number of A’s for maths and science from 2008; we think it is because of the new outcomes based education system. We will only know the quality of those A’s once they write their exam at the end of the year.” Patel said medical students with “good maths and science results are likely to get a bursary and if they continue to do well they won’t pay, their studies will be treated as a scholarship. These are normally given to second years onwards as many first years drop out.”  Wits School of Public Health reports a recent survey indicating that 51% of African countries have no public health training, “there is one programme in 16 countries and more than one in 10 countries (of the 54 in Africa). It is not surprising that there is great demand from African students for public health training at South African institutions.” But long years of study and high tuition costs no longer get the rewards of the past.

Da Silva said traditionally bad debt in medical practices starts in the second half of the year as funds expire for some medical aid members, “but doctors and patients are experiencing significantly more financial stress this year.” He said Healthbridge recently introduced Pocit Collections which makes it easier for patients to pay doctors. “Doctors can now send an invoice to their patients by SMS using Pocit Collections. The patient can immediately see what they owe the doctor for the consultation. Most then pay us immediately by registering on the Pocit payment website and paying by internet or they come into the practice to pay. “This has been remarkably successful. Doctors using it say they get paid within 24 hours or less of a patient getting a sms.” It seems that the longer a patient waits before getting a bill, the more likely he or she is to throw it into a drawer and ignore it.

In 2008 Healthbridge processed R15billion worth of medical claims and helped ensure R500million worth of efficiency savings.

Contact information:
Luis da Silva
Managing director
Tel: 011 581 1214
This email address is being protected from spambots. You need JavaScript enabled to view it.

Issued by:
Charlene Smith Communications Pty Ltd
call 011 646 7637 or 021 762 2656

Contact: Leila Beltramo
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
Tel: 021 762 2656

Published in Health and Medicine