Dr E.V. Rapiti of Cape Town welcomes Judge Arthur Millar’s ruling against the government’s certificate of need (CON) requirement for doctors and private hospitals.
The court found the CON unconstitutional, as it restricted practitioners’ rights and discouraged investment in new hospitals. Dr Rapiti, a former advocate of National Health Insurance (NHI), criticizes the NHI’s current implementation as an ineffective means of achieving healthcare equity. He reflects on past challenges, such as difficulties in staffing state hospitals and the impracticality of the CON to compel doctors to work for the state. He notes that doctors often emigrate due to poor working conditions and bureaucratic interference.
Dr Rapiti also disputes claims that the private sector serves only 20% of the population, highlighting that many patients in lower-income areas pay out-of-pocket for services. He argues that private sector efficiencies make GP visits more cost-effective than state-run services and that corruption could undermine the CON system. Dr Rapiti points to failed CON attempts in Canada and suggests that a dual healthcare system, combining public and private sectors, would better serve a democratic society. He calls for moreengagement between the government and stakeholders to find practical solutions, criticizing the government’s track record in managing other sectors and expressing scepticism about its ability to effectively run the healthcare system.