US vs South Africa: whose health care is better?

The US and SA have health care systems that have structural similarities but when it comes to equity and the components of value-based care, the devil is in the detail.

I was recently seen by a private physician who is affiliated with the International Society of Travel Medicine (ISTM) based on the recommendation of my Passport Health nurse in NY. A few months ago, during my travel visit in preparation for this journey, I had an extensive review of all the countries to which I planned to travel and what the requirements and recommendations were in terms of safety, vaccines and medications. In discussing the vaccines, she advised me that it would be fine to get some of these vaccines and meds in South Africa as it would be at a fraction of the cost. She scribbled the name of a physician who was part of ISTM and off I went.

In a number of my conversations with South Africans, the topic of the inequities of health care often arose. The conversations were all with well off white South Africans and almost always involved comments on the inequity of the private versus public systems. My doctor, who I’ll refer to as Dr. W., also echoed those views. The public health care system is free but at a different cost. He and others shared that people with means have insurance, utilize the private system and receive high quality care. Those at the mercy of the public system suffer the side effects of an underfunded and understaffed system of care. This was not very surprising as it’s a pervasive global problem, including in the US.

Even though I’ve always known the cost of care is cheaper abroad than in the US, the scale of the price differences was quite surprising. It’s the one unanimously agreed upon global criticism of our system. The below table compares pricing for the components of my travel visit in South Africa (ZAR converted to USD) with that of a typical travel clinic in the US.

As I was on the table getting my vaccine injection, Dr. W told me about an American patient he saw last week in his office. He is a 55 year old male who is uninsured and traveling with his wife. Not surprisingly, he realized that as a retiree it’s cheaper to travel than to live in the US. Given his age, Dr. W. recommended a prostate specific antigen (PSA) test, commonly done as a screening for prostate cancer. He turned out to have prostate cancer and needed a radical prostatectomy, a surgical procedure to remove his prostate and surrounding tissue. The cost for the procedure in the US was $100,000. The cost in South Africa – 70,000 ZAR. That amounts to $5,691, almost eighteen times lower than the US price.

In general, we know we pay more but don’t understand why because we’re fed all sorts of false rationales. The system under the surface is so complex that it’s easy to throw out anecdotes on the reasons and people just believe it. I’m still hopeful that one day, price transparency, coupled with a deeper understanding of the actual drivers of cost, will result in transformational change in the US health care system without compromising quality.