Updated GP and Specialist Numbers for SA - MM3 Admin
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Trade, Competition & Applied Economics HEALTH REFORM NOTE 7 OCTOBER 2010 Updated GP and Specialist Numbers for SA 1 Introduction quoted sources that state that there 2 The Use of HPCSA Data are 36,9123 doctors practising in This note builds on National South Africa, we find evidence of The September 2010 ANC NHI Health Insurance (NHI) Note 4 only 27,432 doctors practising in proposal (p. 35) uses figures from that was published in November total (17,802 general practition- the Health Professions Council 2009.1 In that note the difficul- ers (GPs) and 9,630 specialists). of South Africa (HPCSA) to indi- ties in obtaining accurate data on cate the total number of doctors. human resources in health (HRH) Furthermore, when the distribu- This data source shows a steady in South Africa (SA) were pointed tion of these doctors between increase in medical practitioners out. At that stage an effort was the public and private sectors (GPs and specialists) over the past made to collect data from various is examined, our research indi- decade – data shown in Figure 1. sources and to collate the data in cates an almost equal distribu- order to arrive at a fair picture of tion of GPs between the two However, as previously explained the number of doctors and nurses sectors: 2,861 people per GP in in NHI Note 4, the HPCSA fig- in South Africa. Care was also tak- the public sector and 2,723 peo- ures overstate the number of doc- en to emphasise the problems and ple per GP in the private sector. tors (GPs and specialists) actively gaps in the officially available data. We find that contrary to popular working in SA. We know that the perceptions about the spread of HPCSA figures (as given in Figure The recent release of the resources, the majority (61.9%) 1) include doctors who are regis- ANC’s latest NHI proposal2 in of GPs work in the public sector. tered in SA, but practise abroad or September 2010, prompted us to While more specialists (56.2%) that have moved on to other occu- update our initial HRH figures with work in the private sector, the pations (such as those in manage- the latest available data. This note population ratios are also not as ment or other administrative jobs), shows that contrary to officially skewed as commonly believed. but are still maintaining their regis- This research note forms part of a series of notes dealing with issues of health reform in South Africa. In the interest of constructively contributing to the NHI debate, the Hospital Association of South Africa (HASA) has commissioned this series of research notes which can be accessed on the Econex website: www.econex.co.za. 1. Available on our website: www.econex.co.za 2. ANC National General Council 2010, Additional Discussion Documents. Released September 2010. Available at: http://www.anc.org.za/docs/discus/2010/aditionalo.pdf (p.14) 3. See Figure 1. 1
Trade, Competition & Applied Economics HEALTH REFORM NOTE 7 - OCTOBER 2010 Figure 1: Growth in medical practitioners (GPs and specialists), 2002-2010 doctors in SA. This note serves to 38 000 correct the misleading notion that 36 912 there are almost 37,000 doctors in 35 707 36 000 SA and aims to provide a more ac- 34 687 34 324 curate and up to date assessment. 34 000 33 220 32 198 32 000 31 214 3 Updated HRH Figures for 30 578 South Africa 29 903 30 000 Following from the above discus- 28 000 sion, Econex updated the work 2002 2003 2004 2005 2006 2007 2008 2009 2010 done in NHI Note 4 in order to see how the situation might have Source : HPCSA figures from ANC NHI proposal (September 2010) & Health Systems Trust changed since 2009, as well as to provide the latest HRH figures. This trations with the HPCSA. The HPC- non-payment, including more should inform the ongoing debate SA does not distinguish between than 6,300 emergency care around the details and implemen- doctors actively working in SA as practitioners and 1,942 medi- tation of a NHI system in South clinicians and those who are not cal practitioners and dentists.” Africa. Table 1 provides the latest practising here or are not practis- This was confirmed in a media estimates for GPs and specialists ing as doctors, and therefore these statement4 by the HPCSA ear- actively working in South Africa. numbers are inappropriate indi- lier this year, saying that, “Last cators and over-estimate the true year the HPCSA was forced to 3.1 Data sources and scenarios number of doctors working in SA. suspend some 12,800 practition- ers who did not comply with In accordance with our original Evidence of this comes from the their requirements...” (To date, methodology, we used the latest HPCSA themselves. In the SA Health however, this reduction in the data from the government’s pub- Review (2008: 358) there is refer- data has not been observed.) lic sector Personnel and Salary ence to an announcement by the Administration System (PERSAL) Registrar of the HPCSA at the Consequently, it is not appropriate as a starting point for both GPs time that “11,500 healthcare to use these inaccurate figures, as (11,309) and specialists (4,442) in practitioners would be erased for an estimate of the total number of the public sector in 2010. Medical About ECONEX ECONEX is an economics consultancy that offers in-depth economic analysis covering competition economics, international trade, strategic analysis and regulatory work. The company was co-founded by Dr. Nicola Theron and Prof. Rachel Jafta during 2005. Both these economists have a wealth of consulting experience in the fields of competition and trade economics. They also teach courses in competition economics and international trade at Stellenbosch University. Director, Cobus Venter, who joined the company during 2008, is also a Senior Economist at the Bureau for Economic Research (BER) in Stellenbosch. For more information on our services, as well as the economists and academic associates working at and with Econex, visit our website at www.econex.co.za. 4. HPCSA Media Statement, 11 March 2010. Available at: http://www.hpcsa.co.za/downloads/press_releases/current/hpcsa_annual_fees_now_due.pdf 2
Trade, Competition & Applied Economics HEALTH REFORM NOTE 7 - OCTOBER 2010 scheme industry estimates (6,949 bers – especially when it comes to figures were used as is, while GPs and 5,695 specialists) were the population ratios in section 4. the private sector estimates were used for the updated totals in the decreased with 5% and 10% for private sector, based on doctors When analysing Table 1, one GPs and specialists respectively. visited by members and subse- should keep in mind that it is not quently reimbursed by schemes. only the underlying split between 3. For the third scenario the the private and public sectors that adjustments to the PERSAL and In order to avoid double count- is important, but rather the abso- medical scheme industry esti- ing, one has to exclude from lute number of doctors in the coun- mates were split between the the public sector part-time try. That is ultimately what we are two sectors, i.e. a 2.5% decrease and sessional doctors that trying to determine. The need for for GPs were made in the pub- are working primarily in the doctors over the next decade or lic and the private sectors, while private sector, but one also has to two should therefore be assessed we subtracted 5% from the spe- exclude doctors in the private sec- based on the total number actively cialist figures in both sectors. tor who primarily work in the pub- working in SA (as will be shown in lic sector. Since there is no indi- the following Health Reform Note). From the figures above one can cation in either dataset who these see that the different scenarios doctors may be, or exactly how Three human resource sce- do not yield significantly dif- many there are, it is a very difficult narios are created to address ferent numbers. Whilst some adjustment to make. If one were the issue of double count- industry experts believe the in- to make the adjustment in both ing (i.e. where doctors work in cidence of public sector doctors sectors, one would certainly un- both public and private sectors): working part-time in the private derestimate the number of doctors. sector is more prevalent than the 1. In the first scenario the other way around, we are cau- Medical scheme industry esti- respective 5% and 10% de- tious not to underestimate private mates assume that there are 5% creases for GPs and specialists sector resourcing. We therefore of private GPs and 10% of private were made in the public sector elected to use the third scenario to specialists in their databases who alone. Thus, the PERSAL figures determine the most likely number are working in the public sector given above were adjusted ac- of doctors in SA, as opposed to the as well as the private sector (and cordingly, while the private sec- second scenario. Accordingly, the are therefore already included in tor estimates were left unadjusted. best estimates are a total of 17,802 the PERSAL data). However, we GPs and 9,630 specialists in the do not make the adjustment in the 2. The second scenar- country, or 27,432 doctors in total. private sector only as this meth- io assumed the same adjust- odology may result in underes- ments, but for the private sector This total is in line with a recent timating the private sector num- only – implying that the PERSAL statement by the South African More Information ECONEX regularly publishes Research Notes on various relevant issues in South African competition, trade and applied economics. For access to previous editions of Research Notes, or other research reports and published articles, go to: www.econex.co.za If you want to add your name to our mailing list, please send an e-mail to iris@econex.co.za 3
Trade, Competition & Applied Economics HEALTH REFORM NOTE 7 - OCTOBER 2010 Table 1: Updated estimates of active doctors, 2010 by Wadee and Kahn8 reported in the media, even though the au- Public Private Total thors acknowledge that there is a GPs “paucity of data regarding the true public-private distribution of - scenario 1 10,744 6,949 17,693 HRH and the public-private split is contested...” (2008: 143). Ac- - scenario 2 11,309 6,602 17,911 cording to their estimates, 27.4% - scenario 3 11,026 6,775 17,802 of GPs work in the public sector vs. 72.6% in the private sector, Specialists while 24.8% of specialists work in the public sector compared - scenario 1 3,998 5,695 9,693 to 75.2% in the private sector. - scenario 2 4,442 5,126 9,568 However, using the updated num- - scenario 3 4,220 5,410 9,630 bers from scenario 3 as calculated above in Table 1, the public / pri- Total doctors (scenario 3) 15,246 12,186 27,432 vate split looks substantially dif- ferent from Wadee and Kahn’s es- Source : Medical scheme industry estimates and PERSAL timates. Table 2 gives the revised Medical Association (SAMA) firms, “There is the need for a distribution which looks very sim- who estimates that with 14,000 central data source on special- ilar to the most recent estimates members they represent about ists (and all medical and dental from the CMSA. They find that half of SA’s doctors.5 Also the professionals) which is moni- 42.1% of GPs work in the private College of Medicines in South tored and updated annually.”7 sector and 57.9% in the public sec- Africa (CMSA) estimated that tor, and of specialists 55.6% work there were about 27,641 doc- in the private sector with 44.4% tors in SA at the end of 2009.6 4 Public / Private Sector Split working in the public sector.9 The fact that one has to consider As was pointed out in NHI Note various scenarios and use differ- 4, there is a common misconcep- 5 Population Ratios ent data sources in order to ob- tion about the relative distribution tain the best estimate, emphasises of doctors and specialists between Another important point is that the danger of using the HPCSA the public and private sectors. the distribution of GPs between figures as is. As the CMSA con- One often finds the figures given the public and private sectors 5. Kahn, T., 2010. “Plea for details of health insurance plan,” Business Day, 30 September. Available at: http://www.businessday.co.za/articles/Con- tent.aspx?id=122325 6. Strachan, B., 2009. “Meeting South Africa’s Needs: A Preliminary Report of an Investigation into Specialist Training and Development,” The Colleges of Medicine in South Africa. 7. See footnote 6. (p.34) 8. Wadee, H. & Kahn, F., 2008. “Human resources for health, “ Chapter 9 in the SA Health Review 2007. 9. See footnote 6. 4
Trade, Competition & Applied Economics HEALTH REFORM NOTE 7 - OCTOBER 2010 Table 2: Updated public / private split, 2010 This is a very important result, as the distribution of the popula- tion between GPs in the public Public Private and private sectors are then almost equal, and not as skewed as the GPs 61.9% 38.1% ANC proposal suggests. The reason Specialists 43.8% 56.2% why these estimates are so differ- ent is largely because of the use of Source : Econex calculations the HPCSA numbers, as explained previously. The mistake commonly users is also different from what are based on overstated and out-of- made is to use the total number of is commonly believed. McIn date HPCSA data from 2005. The medical practitioners registered tyre et. al. (2007)10 estimate that proposal also does not draw from with the HPCSA as a starting point 35.8% of the population were de- other reliable sources to inform the and then subtract all GPs and spe- pendent on the private sector for estimates. Accordingly, the indica- cialists on the PERSAL database to primary healthcare services in tion is that there are 588 people arrive at the number of doctors in 2005. We updated this percentage per GP in the private sector (based the private sector. By using incor- for 2010,11 and found that at least on 35.8% of the population seeing rect (and much larger) figures for 36.9% of the population currently private GPs in that year) and 4,193 the private sector specifically, one utilise private medical services for people per GP in the public sector. would arrive at a much lower es- their primary healthcare needs. However, our estimates show that timate for the population per GP. This means that there are 0.37 GPs there are at least 2,723 people per per 1,000 population in that group GP in the private sector and 2,861 Similar to the situation for GPs, (private sector) and 0.35 GPs per people per GP in the public sec- medical scheme members are not 1,000 population for the rest of tor (see Table 3 for a comparison). the only ones seeing private sec- the population who depend exclu- Table 3: Population per general practitioner sively on public sector services for primary healthcare needs in 2010, based on the latest figures in Table 1. Public Private In the recent ANC NHI proposal12 ANC NHI proposal (2005 data) 4,193 588 the distribution of healthcare re- Econex estimates (2010 data) 2,861 2,723 sources significantly differs from our calculations, but the former figures Source : ANC NHI proposal (September 2010) & Econex calculations 10. Mcintyre, D., Thiede, M., Nkosi, M., Mutyambizi, V., Castillo-Riquelme, M., Goudge, J., Gilson, L. & Erasmus, E., 2007. “A critical analysis of the cur- rent South African health system,” Health Economics Unit, University of Cape Town and Centre for Health Policy, University of the Witwatersrand. Available at: http://heu-uct.org.za/research/publications/reports-and-working-papers/ 11. See methodology in Health Reform Note 4 on our website: www.econex.co.za. 12. See footnote 2. (p.14) 5
Trade, Competition & Applied Economics HEALTH REFORM NOTE 7 - OCTOBER 2010 tor specialists. Private hospital Table 4: Population per specialist data indicate that about 15% of their patients seeing private spe- Public Private cialists are not medical scheme beneficiaries. Given that there are ANC NHI proposal (2005 data) 10,811 470 8,126,193 medical scheme benefi- ciaries at the moment,13 it implies Econex estimates (2010 data) 9,581 1,767 that 9,560,227 people (19.1% of the total population) are depend- Source : ANC NHI proposal (September 2010) & Econex calculations ent on private sector specialists, while the remaining 80.9% sees cialist,”14 but rather a 5.4 times against the fact that the private sec- only public sector specialists. Un- difference. tor is better resourced, it is shown der that scenario, there are 0.57 that proportionally more GPs and specialists per 1,000 population specialists are active in the public in the private sector and 0.1 spe- 6 Conclusion sector than often reported. It was cialists per 1,000 population in also shown that the population the public sector. This translates In light of the current (proposed) per GP ratios quoted in the ANC to the population per special- changes in the health sector in NHI proposal is incorrect, and ist estimates shown in Table 4. SA, it is imperative that the policy that this ratio is roughly the same debate is appropriately informed. for the private and public sectors. Although the public sector esti- Hence, this note provided a brief mates in Table 4 are close to each update on the HRH figures in SA. Our next note in this series will use other, the private sector ratio still It shows that the widely used HPC- the updated HRH figures provid- differs significantly between the SA data, which is also used in the ed here as a starting point to cal- two sources. In other words, there ANC NHI proposal, overstates the culate different scenarios related is not a “23 times difference in the number of doctors in this coun- to the future requirement/need for number of people served per spe- try. Whilst there is no argument doctors and nurses, respectively. ECONEX Services Econex has extensive experience in competition economics, international trade and regulatory analysis. Strategic analysis was recently added as practice area. We have an established reputation for providing expert economic advice for high profile mergers and complaints that appear before the competition authorities. Some of the more recent highlights include the complaint against British American Tobacco, the merger between MTN and iTalk, the complaint against Senwes and the acquisition of KayaFM by Primedia. Apart from competition work we have also been involved in trade matters which included analyses of the effects of tariffs, export taxes and anti-dumping tariffs. As a result of our work in competition analysis we also have invaluable experience in some of the sectors of the South African economy where regulation continues to play a role, e.g. the telecommunications, health and energy sectors. We use economic knowledge of these sectors to analyse specific problems for some of the larger telecommunications, health and energy companies. 13. Council for Medical Schemes, Quarterly Report for the period ended 31 March 2010. Available at: http://www.medicalschemes.com/Publications.aspx 14. See footnote 2. (p.13) 6
You can also read