Our health in brief — part one: Workers’ compensation and the Road Accident Fund

First published in GroundUp.

When analysing South Africa’s health expenditure, often ignored is the Compensation Fund, which covers workers’ occupational diseases, injuries and death, and the Road Accident Fund, which covers anyone injured in a vehicle collision.

The literature on the extent of these health services is remarkably thin. There is a lack of systematic collection of information about them, either in terms of people served or expenditure on them. But between them, they paid out over R6-billion in the 2019/20 financial year (if you add on our rough estimate of workplace expenditure on healthcare it comes to R7-billion), nearly 3% of total state health expenditure.

To be clear: expenditure on occupational safety and measures to minimise the incidence of occupational disease are part of the cost of doing business. It should not be counted as part of aggregate health expenditure. But, even when best practice is applied, there will be accidents and occupational disease, and the cost of treating these at the workplace and through fund payments is part of health expenditure. Moreover, some workplaces offer health services that go beyond the treatment of accidents and occupational diseases.

Workplace expenditures: R0.9-billion

Compensation Fund: R2.7-billion

Road Accident Fund: R3.4-billion

Total: R7.0-billion

Creamer Engineering News reports that according to the National Institute of Occupational Health, about 11% to 18% of private-sector employers, excluding mines, provide workplace-based health services. Larger employers are more likely to provide these services.

The mining industry has the most intensive workplace healthcare. It aims to screen all of its 450,000 workers for HIV, TB, hypertension and diabetes. 210,000 of these workers have been tested for HIV. Of the 13,101 employees that tested positive, 98% are on antiretrovirals, provided via the mines’ health care facilities.

The technical version of this article includes much more data and also outlines the legal framework governing the fund as well as workplace health provision. What you will notice is that there are serious gaps in the statistics. For example data on workdays lost to occupational injury is spotty. We have good data on workdays lost for 2010 and 2016, but the data for all other years from 2011 until now is implausible and so we’ve left it out. Nearly 700,000 workdays were lost in 2016 due to workplace injury or illness (double that of 2010) and there were over 300 fatalities (compared to 185 in 2010).

Compensation for workers and vehicle collision victims is an important and substantial part of health expenditure. In future, more complete data is needed to analyse this expenditure properly. DM