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HEALTHMANPRIVATEPRACTICEREVIEW:JUNE2019
InthisNewsletter:Asummaryofnewshighlightsinthehealthcaresector
January-June2019
FoodforThoughtNewsonGovernmentSpecialNews
NewsonMedicalSchemesSpecialNotices
AsummaryofFinancial,PharmaceuticalandGeneralhighlights(January-June)inthehealthcare
sectorwillbepublishedintheJulyeditionofSAPPFHealthView.
FoodforThought
Afundingmodelthatwillnotfixpoordelivery
ManiedeKlerk(SUMBusinessSchool)BusinessDay,4June2019
“Nationalhealthinsurance(NHI)isoneofthe
mostmisunderstoodtermsinhealthcareinSA,”
wroteDeKlerk.
“NHIisnotastrategyorahealthstructure.Itisactuallyonlyafundingsysteminwhichmoneyforhealthcareiscentrallymanaged-
nottheprocessorqualityofcare."
“TheNHIasafundingsystemcanonlyworkif
therearepredefinedhealthcarebenefitscovered
underthissystem.
“Canuniversalhealthcoverage,fundedbyanNHImechanism,improvehealthforSouth
Africans?Yes,butonlyifwedotherightthingsright.”
ALSOREAD,NHI:Whatdoescosthavetodowithit?
ThePast:DrAaronMotsoaledi
PresCyrilRamaphosa TheFuture:DrZweliMkhize
AssessingtheMotsoalediYears
MarcusLow,DailyMaverick,30May2019
Afteradecade(May2009–May2019)Health
MinisterAaronMotsoaledi’seracametoanend
whenPresidentCyrilRamaphosaappointedDr
ZweliMkhizeasMinisterofHealthinhisnew
cabinet.
“TheMotsoalediyearscanbroadlybejudgedon
twofronts,”wroteMarcusLowinDailyMaverick(30May):TheresponsetotheHIVepidemicand
thefunctioningofthepublichealthcaresystem
anditsrelatedinstitutions.
“Itishardtoargueagainstthedeeplydepressing
picturepaintedbythereportsoftheofficeof
HealthStandardsCompliance.
"ItisalsohardtolookattragediessuchasLifeEsidimeniinGauteng,theoncologycrisisinKwaZulu-Natal,andthepersistentproblemswithemergencymedicalservicesinmultipleprovinceswithoutconcludingthatthesearesymptomsofdeep-seateddysfunctioninprovincialhealthdepartments,”wroteLow.
“AfterthePharmaGatescandalof2014,
Motsoaledimadeheadlinesbydescribingthe
pharmaceuticalindustryplottoderaillawreform
effortsinSAas'genocide',butheneverusedhis
powerstoissueacompulsorylicenceon
overpricedmedicine,nordidheexpendmuch
politicalcapitalonreformofSA’soutdatedpatent
laws.
Similarly,whileMotsoalediwasanoutspoken
criticoftheprivatehealthcaresectorinSA,the
draftreportoftheCompetitionCommission’s
HealthMarketInquiryleaveslittledoubtthathe
failedtousethelevershehadathisdisposalto
regulatetheprivatesector.
“Oneversionofthepast10yearswouldsee
MotsoalediasavictimofthepoliticsofState
Capture.Asecondversionwouldholdhimand
thoseclosetohimattheNationalDepartment
responsibleformuchofthesystemicfailuresin
thehealthcaresystem.
“NationalHealthInsurance(NHI)hasbeenon
thecardsforages,butwhenadraftbillwas
publishedin2018itwashalf-bakedandlacked
clarityinvariouskeyareas,suchastheroleof
provinces.
"StateCaptureorunrulyprovincescannotbe
blamedforthesepolicyandleadershipfailings.
Somethingelsehasclearlygonewrong.”
Anewdawn?ZweliMkhize
Mail&Guardian,
3June2019
GiventhenewlyappointedMinisterofHealth,Dr
ZweleMkhize'sexperienceworkingwith
business,andhisreputationforbeinga
pragmatistratherthananideologist,hopesare
highintheprivatehealthcareindustrythatthe
daysofaMinisterofHealthopenlyhostiletothe
sectorareover.Mkhize,63,isamedicaldoctor
withexperienceinpublichealthandfinance.
AccordingtoMarkHeywood,socialjusticeactivistandformerdirectorofthepublicinterest
laworganisationSection27,thenewlyappointedMinisterofHealthhas“exactlywhat(former
HealthMinister)AaronMotsoaledididn’t”:
"thepoliticalauthoritywithintheANCto'crackthewhiponhealthMECs,tophonepremiersandsay,sortyourmessout'."
AlthoughMotsoaledigrewSA’sHIVtreatment
strategytothelargestprogrammeintheworld,
morethanhalfofprovincialhealthdepartments
wereplacedundereithernationalorprovincial
administrationduringhisdecadeofreign
between2009and2019.
Untilnow,theANChashadanimplicit
“gentleman’sagreement”betweenitsofficialsin
Pretoriaandthoseintheprovincestokeepthe
peace,accordingtopolitical,analystRalphMathekga.”Intoday’sfactionalism,thesoftpowerofpolitical
authorityexpertsascribedtoMkhize,maybethe
onlywaytoensurethecountry’spoliciesmove
frompapertoreality,”hesaid.
HeywoodsaidonewouldhopethatMkhizeuses
hisauthority,because-withafewexceptions-
thenewlyannouncedhealthMECsare"a
mediocre,unknownanddubiousbunchofwhom
somehavealreadybeenimplicatedin
corruption".
Mkhize’spast–especiallyhistenureasthe
country’slongest-runninghealthMECfrom1994
to2004inKZN-reflectsacalculatedabilityto
toethepartylinepubliclyforpoliticalsurvival
whileoperatinginoftenunseenwaystogetwhat
hewants.
"Mkhize’sparticularbrandofstayingpoweris
onethatwillserveRamaphosawellinahighly
factionalenvironmentwhereisolationisakintoa
politicaldeathknell,arguesMathekga."
It’sofficial–WearethesickestnationontheplanetAccordingtothelatestIndigoWellnessIndex,SouthAfricansaretheworld’sunhealthiestnation,with
thecriticallyillstatusofthepublichealthsystembeingfingeredasthemainreasonforthepoorstate
ofcitizens’mentalandphysicalhealth,reportedTheCitizen(18April).
FamilymedicineprofessoratStellenboschUniversity,BobMash,saidabout80%ofSouthAfrica’s
populationdependedonthepublicsector’sprimarycareservices.Butaccesstothisprimarycarein
thepublicsectorwasoftenlimitedbythesheernumberofpatients.
NewsonGovernment
NHLSandHPCSAprobedbySpecialInvestigatingUnit
NationalHealthLaboratoryService:InMarchPresCyrilRamaphosaauthorisedthe
state'sSpecialInvestigatingUnit(SIU)toprobe
theNHLSfor“multipleallegationsof
maladministration,improperorunlawfulconduct
andintentionalornegligentlossofpublic
money”.
Theinvestigationwillcovermorethanadozen
tenders,rangingfromtheprovisionofcomputers
toleasingvehicles.
TheNHLSclosedthe2016/2017
financialyearwithaR1.9-bndeficit
becausetheauditor-generaldoubtedit
wouldbeabletorecoverdebtsowedby
provincialhealthdepartments.
TheNHLSfiredsuspendedCEOJoyce
MogaleandCIOSikhumbuzoZulu,
following“procurementirregularities”
worthR200-m.
HealthProfessionsCouncilofSA:InMayitwasannouncedthatPresCyril
Ramaphosahasreferredaprobeintothe
HPCSAtotheSIU.
TheSIUwillinvestigateanyallegedunlawfulor
improperconductbyemployeesoftheHPCSA
thathasharmedtheinterestsofthepublicsince
September2016.
6-yearmedicinewaitinglistthreatenslives
“Thereare16000medicinesonthewaitinglist
tobeapprovedforuseinSA,inabacklogmore
than6yearslong-forcingpatientstoimportthe
drugstheyneedfromoverseasatgreatpersonal
cost,”reportedSaturdayStar,(25May2019).
Morethan8000oftheseareapplicationsfor
newregistrationsofmedicine,whichisavailable
andinuseforpatientsoverseas,butnotlocally.
Halfofthesedrugshavebeensittingonthe
waitinglistformorethanfiveyears.
Meanwhilepharmaceutical
manufacturershavevoluntarilywithdrawn
thousandsofapplicationstoregisternew
productswiththeSouthAfricanHealth
ProductsRegulatoryAuthority(SAHPRA)
inanefforttohelpclearthehuge
backlog.Somecompanieshaddecided
tocutbacktheirlistsinordertospeedup
theapprovalofmoreimportantproducts.
Localdrugmanufacturersarelobbying
theregulatortoprioritisetheirproducts,
arguingthatthiswouldboostinvestment
inthesectorandmakedomestic
companiesmoreattractivetopotential
internationalpartners,reportedBusiness
Day,(29May).
NationalHealthInsurance:Whatdoescosthavetodowithit?
GovernmenthasplannedforNHItobeinplaceby2026,butthecentralquestionofhowitwillbe
funded,remainsunanswered.TheideabehindNHIisthathealthcarewillbeaccessibletoallSouth
Africansatnearbyfacilitiesthatwillbestaffedbyprivatesectorcontractorsprovidingservicestothe
publicsector.–BusinessTimes(3March2019).
AccordingtotheNHIWhitePaper,spendingontheschemewilltotalR256-bnin2025/2026based
on2010prices,iftheeconomygrowsatanannualrateof3.5%.Thiswouldresultinapossible
fundingshortfallofR72-bnby2025.
AccordingtoAlexvandenHeever,professorattheWitsUniversitySchoolofGovernance,theNHIisnotimplementable.Hedescribesitasa“politicalvanityproject”,becauseSAisnotina
positiontofinanceit.
“TheconsequencesofthegovernmentadoptingitsproposedNHIpolicyareentirelypredictable.It
wouldreducethequantityandqualityofSouthAfricanhealthcareprovision;drivemorehealthcare
professionalsoutofthecountry;createabureaucracyincapableofefficientlyhandlingthehuge
volumeofclaims;imposeanunnecessaryandintolerableburdenonbothgovernmentand
taxpayers;andcausejoblosses,"wroteJasonUrbach,adirectoroftheFreeMarketFoundation(17February2019).
SpecialNews
READMORE
DoctorpharmacistcollaborationessentialtocutoutiatrogenesisrisksSouthAfricanpatientsareessentiallygettingarawdealwhenitcomestomedicationcounsellingand
assuredadherence.
“IntheUnitedStatestheyexperiencefrom25%toupto50%non-adherencetoprescribed
medication,while$100-bnisspentonavoidablehospitalisations.Wedon’thavedataonthisfor
SouthAfrica,butthereisnoreasontobelievewedon’thavethesameproblemhere.Wedo,ifnot
worse!”AspenPharmaexecutive,StavrosNicoloau,toldhisaudienceatAfricaHealthManagement
ConferenceinMidrand.
Non-compliance,hestressed,wasstillamajorissuelargelyduetopatientsnotunderstanding
instructions,forgetting,feelingbetter,orbeingputoffbythemedicationcostsorco-pays:“Manyhave
co-morbiditieswhichconfusethem,theybecomeindecisiveandputofftakingthemedication."
READMORE
NewsonMedicalAids
'Bigshift’tocheapercareAccordingtoMedicalaidbrokerAlexanderForbesthenumberofcorporateclientswhoreviewedtheirplansforthisyearhaddoubled.
Forthefirsttime,morepeoplehaddowngraded
thanupgraded,reportedSundayTimes
(5May2019).
Profmedprincipalofficer,CraigComrie,said2019wasthefirsttimetheschemeintroduced
low-costoptionsandabout3500ofits70000
membershadswitched.
AccordingtoDiscoveryHealthCEO,JonathanBroomberg:"membersjoiningDiscoveryHealthMedicalSchemetendtojoinatlowerplanlevels
thantheyhaveinthepast.”
Bonitasprincipalofficer,GerhardvanEmmenis,saidwhile94%ofmembershadnotchangedtheirplansthisyear,10949had
downgradedand7345hadupgraded.
Atleast47-mwithoutcoverAccordingtothelatestdatafromStatisticsSouth
Africa(StatsSA)morethan47-mSouthAfricans
donotbelongtoamedicalaid,withjust9.4-m*
peopleenjoyingthebenefit.
Between2002and2018,thepercentageof
individualscoveredbyamedicalaidscheme
increasedmarginallyfrom15.9to16.4%.
Duringthisperiod,thenumberofindividualswho
werecoveredbyaschemeincreasedfrom7.3-m
to9.4-mpersons.
22.6%ofSouthAfricanhouseholdshadatleast
onememberwhobelongedtoamedicalaid
scheme.
*Accordingtothe2017CMSreport,theactual
figureis8,8-m.whichislowerthanStatsSA's
figureof9,4-m.
Employersgoprivatetofindprimaryhealthcare“SomeemployersarenotwaitingfortheelusiveNHIschemetoimprovethehealthoftheirworkers,
absenteeismlevelsandproductivity.NoraretheywaitingfortheHealthDepartmentandmedical
schemesregulator,theCouncilforMedicalSchemes,tohammeroutasetofbenefitsforalow-cost
medicalschemeoption,”wroteLauraduPreezinBusinessDay,(23April2019).
About400000-450000employeeshavebeensignedupforprimaryhealthcareplansthatgive
themaccesstoGPs,medicine,basicbloodtestsandX-raysintheprivatesectorsotheycanavoid
thetime-consumingandinefficientclinicsandstatehospitalsfortheseservices.
AlexanderForbesbacksoversightplan
InAprilFinancialservicescompanyAlexander
ForbesvoiceditssupportfortheTreasury’splan
tobringregulatoryoversightofmedicalschemes
underthesameumbrellaasinsuranceproducts,
asspeltoutinthedraftConductofFinancialInstitutionsBill.
Thebill,whichwasreleasedforpubliccomment
inDecember2018,aimstoregulatehowthe
financialservicesindustrytreatsitscustomers.
Itincludesaproposaltomovecoreregulatory
functionsfromtheCouncilforMedicalSchemes
(CMS)totheFinancialSectorConductAuthority
(FSCA),asuggestionthathasupsetthemedical
schemesregulator.
Discovery’snewruling‘putslivesatrisk’
InFebruarydoctorsexpressedconcernovera
newDiscoveryrulethatmembersofthesaver,
smart,keycare,coreandpriorityplanshaveto
usedayhospitalsorpayheftyco-paymentstogo
toanordinaryhospital.Theirmainconcernsare
thatpatientscannotbemonitoredovernightafter
proceduresindayhospitals,thereareno
intensivecareunits,andmanyarenotequipped
todobloodtransfusions.
Anti-fraudeffortpaysoffIn2018DiscoveryHealth’seffortstocurbfraud
resultedinasubstantialR555-mrecoveredon
behalfofschemesitadministers.Ofthe5443
casesthatwerereportedforpossible
irregularities,concernswereconfirmedonabout
75%ofinvestigations.
Circulars:CouncilforMedicalSchemes
ThefollowingCircularswerepublishedbytheCMSinMay/June2019.Visitwww.medicalschemes.co.zaformoreinfo.
39of2019Advancedtrainingforbrokers
40of2019QuarterlyStatutoryReturn
SpecialNotices
VacancyforGPinGrahamstownOpportunityforaqualified,post-communityserviceGeneralPractitionerinGrahamstown
FortEnglandPsychiatricHospitalinMakhanda(Grahamstown),EasternCape.
Ruralallowanceispayableandon-siteaccommodationisavailabletosuccessfulcandidates.
Forfurtherinformation,contacttheClinicalHead:A/ProfMNagdee([email protected]).
ChildorGeneralPsychiatristinCapeTownOpportunityforapsychiatristinawellestablishedchildandadolescentpracticeatVincentPallotti
HospitalinCapeTown.
Currentpatientsarepredominantlyadolescents,somechildrenandadults.
Practicetobetakenoverasof1September2019.
Formoreinformationcontact:[email protected]
ToadvertiseinPrivatePracticeReviewcontactMarethaConradie:[email protected].
HealthViewandPrivatePracticeReviewprovidenewsandopinionarticlesasaservicetoourmemberstoenhance
theirunderstandingofthehealthcareindustry.Theinformationcontainedinthesepublicationsispublishedwithout
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informationalpurposesandshouldnottobeconstruedasadviceorrecommendations.Individualsshouldtakeinto
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