Healthcare is not a normal market and university forms are not harmless

A friend of mine recently had one of those proud family moments. Their eldest was admitted to a respected South African university. High fives all round. Perhaps even a celebratory bottle of champagne. All that remained was to complete some apparently harmless but compulsory administrative paperwork.

But is it harmless?

Among the registration requirements was a compulsory medical certificate to be completed by a doctor. So far, that may sound mildly inconvenient but probably sensible. Until you read the actual wording.

The doctor was asked to certify that the student was “in good health and not suffering from any physical or mental defect, disease or disability” that would prevent them from being trained or later practice in the profession.

That is not a simple administrative requirement. It sets off alarm bells on multiple levels. Even before we get to the mental health, disability and ethical concerns, my health systems reaction is going to be very blunt – this is naïve, poorly thought through and alarmingly close to institutional overreach masquerading as administration.

And it points to a much bigger problem in South Africa, a widespread failure – at both individual and institutional level – to understand that healthcare is not a normal market, and that behaving as if it is has serious consequences.

In most areas of life, if demand increases, the system adjusts.

If more people want phones, groceries or the latest fashion accessory, suppliers increase stock. Consumers compare prices, make choices and the market more or less responds.

Healthcare does not work like that. And one of the reasons is this is that in healthcare, demand is often not created by illness at all but by a myriad of factors often not controlled by the patient.

A form like this does not arise because thousands of students are suddenly unwell and in urgent need of clinical evaluation. It arises because an institution wants reassurance, legal cover, administrative comfort or risk transfer – and decides the healthcare system must provide it. Leaving the healthcare system to absorb the cost.

And that cost is not theoretical. South Africa’s public universities collectively admit roughly 200 000 first-year students each year.

Even if this requirement is limited to one institution or one faculty, the cumulative effect could be substantial. Parents will all start trying to secure GP appointments within narrow deadlines.

Clinics will be clogged with walk-in consultations driven not by illness but by paperwork. Doctors will spend time filling in forms instead of caring for sick people.

Students without private cover will be pushed into public primary care queues that are already overstretched.

And that is just to sign off on the physical health side.

The mental health side is where this becomes genuinely absurd. Because what exactly is a doctor being asked to certify here?

That a young person has no current mental health condition?

That they carry no future risk?

That they will cope with the pressures of study?

That they will one day practise “in a fitting manner”?

No serious clinician can responsibly guarantee that from a once-off encounter.

That is not medicine. That is fortune-telling with a practice number, that carries a very real professional and medico-legal risk.

Any risk-averse GP confronted with such wording would be tempted to refer the student for a psychological or psychiatric opinion, simply to protect themselves.

Which means the parent or the medical aid now has to absorb yet another cost. And in a country already facing a severe shortage of mental health professionals, it is hard to imagine a more irrational use of scarce capacity.

South Africa does not have an oversupply of psychiatrists, psychologists or other mental health professionals sitting idle, waiting to reassure institutions that applicants are psychologically acceptable. We already have long waiting times, a massive mental health treatment gap (estimated at 70%-90 %), overstretched services and too little capacity at primary care level to provide care for people with a clear and urgent clinical need.

Yet, here we are, diverting time and expertise into pre-emptive bureaucratic screening of young adults who have not presented because they are ill, but because they need a stamp on a prescribed form.

This is exactly why healthcare does not behave like a normal market. In a normal market, unnecessary demand is merely inefficient. In healthcare, unnecessary demand crowds out real need.

Every avoidable consultation takes time away from somebody who is sick. Every non-essential form consumes scarce professional capacity.

Every artificial deadline creates a surge that distorts access for everyone else. That is how systems are overloaded and eventually, fail.

If thousands of families are all trying to access the same limited pool of appointments before the same deadline, the market does not magically become efficient. It becomes congested.

That is how healthcare works. You are not buying groceries. You are joining a queue for a scarce and finite resource.

And if South Africa is going to normalise this kind of bureaucratic demand in the name of safety, professionalism or institutional risk management, then we need to ask a much harder question: How much of our health system are we willing to waste on proving that healthy people are healthy – while sick people wait? Because that is not a side issue. That is exactly how systems begin to fail in full view of everyone – while still being called “just and administrative procedure”.

• Dr Wolvaardt is the MD of the Foundation for Professional Development, a private higher education institution driving social change through education, research and strengthening of health systems