Doctors perform liver iPad-aided liver surgery in Germany. The procedure is expected to improve the quality of transferring pre-operational resection plans into actual surgery. (Photo: REUTERS/Fabian Bimmer)
Doctors perform liver iPad-aided liver surgery in Germany. The procedure is expected to improve the quality of transferring pre-operational resection plans into actual surgery. (Photo: REUTERS/Fabian Bimmer)

I'm not very good at being ill. I can't say it's something that happens very often and so I don't have much experience of it. But practice makes perfect.

When I do it, I do it in style. Not for me any of your trifling colds, stomach upsets or pulled ligaments. Oh no. My ailments are of A&E quality. I don't mess around.

And so it is that I, a woman whose only experience of a UK emergency room has been to have my chin sewn up after skidding off my motorbike or to be a sympathetic presence to some other poor soul, have found myself in a South African hospital not once but twice in the mere seven months we've been here.

Because we're lucky enough to have private health insurance, we can access the services of one of South Africa's network of private hospitals and primary care providers, the two biggest of which are Netcare and Medi-Clinic.

Once you get yourself through those sanitised doors and have registered and the prodding and poking is complete, it will, of course, be time to pay. Unless you happen to require an operation, that is, and then, depending on your policy type, you'll need to get on that phone to the insurance company.

Simply availing myself of hospital facilities, including use of the operating theatre for half an hour, a bed for a few hours and a bit of food when it was all over, came to the grand total of R7,800 (£480). All of which had to be paid upfront, before they'd admit me.

Public versus private healthcare

Next came the rather dour anaesthetist who charged R,1,700, followed by the poor old consultant surgeon, who only requested the comparatively measly fee of R990.

And mine was only a relatively minor operation. You certainly wouldn't want anything big to happen over here if you didn't have your insurance all present and correct. It would bankrupt you.

And it's with that thought in mind that, every time I've lived abroad, I've learned to truly appreciate just how lucky we Brits are to have our free-at-the-point-of-delivery, no-matter-who-you-are-or-what-your-income-bracket-is NHS.

Because the quality of the healthcare that you can expect in South Africa is based purely on your ability to pay and plummets from high-quality first world to overstretched third world provision in the blink of an eye.

While the country invested a huge 8.3% of GDP (compared with World Health Organisation recommendations of 5%) or R248.6 billion on health in 2011, some 48.5% of this money was spent within the private sector.

This, despite the fact that private provides services to only 16.2% of the population, the equivalent of just over eight million people, most of whom have medical insurance in the form of Medical Aid, a fund into which they pay monthly.

A further 49.2% of GDP, some R122.4 billion, on the other hand, was spent within the government-funded public health sector, which caters to the needs of 84% of the population - about 44 million people.

This means that, although the government spends about 11% of its total budget on healthcare each year, facilities tend to be very overcrowded and staff extremely overworked.

For instance, because a massive 73% of GPs work in the private sector, there is a huge and long-standing shortage of doctors.

To alleviate the situation, the government has made it compulsory for newly qualified practitioners to undertake a year of community service and has also made it easier for foreign doctors to practise. But the issue is still acute.

Plans for change

Moreover, because the amount of funds allocated to South Africa's nine provinces and the efficiency with which they are administered vary widely, healthcare standards tend to be lower in poorer areas such as the rural Eastern Cape than in richer ones such as the Western Cape.

Nonetheless, as a foreign national, whether treated at a state or private hospital, you will be required to pay as South Africa has no reciprocal agreements with other countries.

Citizens/residents using public services, however, are charged based on their salary and how many dependents they have, with hospitals using a rating system to calculate the amount owed in a bid to make care affordable. The state contributes about 40% of total public healthcare expenditure.

Nonetheless, there are plans for change. The government is in the process of introducing its NHS-equivalent scheme called National Health Insurance (NHI).

This is intended to ensure that all South Africans have access to affordable, quality healthcare, regardless of their employment status and ability to pay directly into the NHI Fund that will underpin it.

The NHI is likely to be financed by general taxation and some sort of health insurance contribution, which includes the diversion of current Medical Aid funds.

New hospitals and nursing colleges are already being upgraded and rebuilt to pave the way, but one of the biggest long-term challenges undoubtedly continues to be a lack of trained personnel.

While already subject to delays, the scheme is, nevertheless, due to be rolled out over the next decade or so, becoming fully operational by 2026.

And good luck to them, I say. It just seems a tad ironic that, even as South Africa attempts to move towards a more socially responsible model a la NHS, in Britain we seem to be dismantling our much-loved system and privatising it by the backdoor a la South Africa.

Now that does make me sick.

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Cath Everett is a resting journalist who has written about business, technology and HR issues for over 20 years. She recently moved from the UK to South Africa with her husband