HEALTHMANPRIVATEPRACTICEREVIEW:August2018

August2018Asummaryofbreakingnewsandgeneralinformationregarding

healthcareinthepublicandprivatesector,publishedinthemedia.

1.FoodforThought2.NewsonGovernment3.SpecialNews4.FinancialNews5.PharmaceuticalNews6.GeneralNews7.NewsonMedicalSchemes&Circulars8.SpecialNotices

FoodforThought

RockystartforNationalHealthInsuranceTenderProgrammeThefirsttendersfortheNationalHealthInsuranceScheme(NHI)havebeenissued,butonlythreemedicalschemeadministratorspitchedforthecompulsoryinformationsession.AccordingtotheSundaynewspaperRapport,expertsarecriticalofthetenderspecificationsforfivepriorityprogrammesannouncedbyHealthMinisterAaronMotsoalediwhenhepublishedtheNHIBillforpubliccomment.

Inonetender,thegovernmentwantsaprivatecompanytocontractoncologyradiationservicesformorethan9,000prioritybacklogpatientsatfourstatehospitalsinKZNandGauteng.Inanother,thesuccessfulcompanywilltakeoverthegovernment’sschoolhealthprogrammeforwhichthegovernmenthasidentifiedchildreninneedofmedicalservicessuchasoptometryanddentistry.HealtheconomistAlexvandenHeeversaystheaimof theNHIistodotheprocurement,butthegovernmentisnowcontractingprocuremententitiestosub-contractservices.“Whycan’tthegovernmentsimplyimplementand

managetheprogrammes?WhydowethenhavetocreateaNHI?”

ReadtheSummariesofNationalHealthInsuranceBill,MedicalSchemeAmendmentBill,HealthMarketInquiryfindingsand

recommendationsintheattacheddocument.

Internationalexpertshighlight‘significantweakness’inSATobaccoBillInalast-minutesubmissionontheSATobaccoBill,internationalacademicsarguethattheBilldoesnotsufficientlydifferentiatebetweennicotineproductsofwidelydifferingrisktohealth.A'signif icantweakness'isthatit

alsodoesnotembracethedef initionof ‘tobaccocontrol’usedbytheWorldHealthOrganization(WHO),including‘harmreduction’.

Thesubmission,titledCommentsontheDraftControlofTobaccoandElectronicDeliverySystemsBill2018,isbyProfessorsDavidBAbramsandRaymondSNiaura(NYUCollegeofGlobalPublicHealth,NewYorkUniversity);CliveDBates,directorofCounterfactual,aconsultingandadvocacypractice;

andDavidTSweanor,adjunctprofessoroflawandchairoftheadvisoryboardoftheCentreforHealthLaw,PolicyandEthicsattheUniversityofOttawa.

AgriSA,theFoodandAlliedWorkersUnionandtheSouthAfricanSpazaandTuckshopAssociationsaythenewtobaccobillwould‘devastateSA’sagricultureandtownshipbusinesses'.HealthMinisterAaronMotsoaledireleasedtheControlofTobaccoProductsandElectronicDeliverySystemsBillforpubliccommenton9May,2018.Thethree-monthperiodforsubmissionsclosedon9August.

NewsonGovernment

Morethan20000Gautengpatientsharmedatstatehospitalssince2016

GautengHealthMECGwenRamokgopahasconfirmedthatmorethan20000patientshavebeenharmedduetonegligenceinthespaceoftwo-and-a-halfyearsatstatehospitalsinGauteng.

Therehavebeen20417oftheseincidentsintheprovincefrom2016todate.ChrisHaniBaragwanathHospitalisthemostdangeroushospitalforpatientsinGauteng,with4320recordedincidents.

Casesweremostlyrelatedto'allegationsofnegligence,incompetenceofstaffmembers,humanerror,secondmentofpatientsandsystemfailure'.

Incidentsrecordedatotheracademichospitalsincluded:SteveBikoHospital(1789),GeorgeMukhariHospital(1574)andCharlotteMaxekeJohannesburgHospital(1262).

HeidelbergHospitalhadthelowestnumberofincidentsat42.

Ramokgopasaidthatactiontakenaftersuchincidentsinvolveddiscipliningstaff,referraltothepolice,andreferralstotheHealthProfessionsCouncilandtheSANursingCouncil.

Howmanydoctorsandnurseswilllosetheirlicensesover#LifeEsidimeni?

HalfofthetopofficialsresponsiblefortheLifeEsidimenitragedystillhavenotbeenreportedtotheirprofessionalassociations,accordingtoinformationfromtheSouthAfricanNursingCouncil(SANC).HealthombudMalegapuruMakgobaandformerdeputychiefjusticeDikgangMoseneke—whopresidedoverthearbitration—recommendedthatthetopnursesanddoctorsembroiledinthedeadlyscandalbebroughtbeforeeitherSANCortheHPCSA.TheGautengDoHonlyreportedBarneySelebano,theformerheadofthedepartmentandalsoamedicaldoctor,totheHPCSAinDecember2017—morethan10monthsafterMakgoba’sinitialrecommendation.Hehasyettositinfrontofapreliminarycommitteeofinquiry,whichinvestigatescasesofallegedmisconductandisstillabletopracticependingtheoutcomeofhiscase.

MeanwhiletheSouthAfricanSocietyofPsychiatrists(SASOP)hasundertakenacampaigntoencouragehealthprofessionalstoexposeabuse.SASOPhaspartneredwiththeruralhealthactionprojecttoassistinthetrainingofitsmembers,whoincludepsychiatrists,occupationaltherapists,nursesandpsychologists.

ClinicscloseandmedicinerunsoutintheNorthWest

MafikengProvincialHospitalisrunningonskeletonstaffandtwoclinicsintheNorthWestprovincehaveclosedtheirdoorsbecauseofalackofsecurity,reportedMail&Guardianon10August.Moreover,afailuretopayserviceprovidershasleftmanyotherhealthfacilitieswithoutsecurityandinshortsupplyofdrugs.Somehealthworkersarerefusingtoworkintheabsenceofsecurityguardsaftercontractedsecuritycompaniesrecentlywithdrewtheirservices.TheNorthWestDoHadmitsthatsuppliershavestoppedtoprovideitwithmedicineandequipmentuntiltheyhavebeenpaid.

PrivateBillforterminallyill

COPEMPDeidreCarterandDignitySAhavelaunchedacampaigntohelpdoctorsrealisethetreatmentdirectivesoftheirterminallyillpatientswithoutfearofprosecution.TheNationalHealthAmendmentBill2018willsetoutthescopeofadvancedhealthcaredirectives,provideamechanismforresolvingdisputesrelatedtotheselegalinstruments,andclarifywhethertheymaybeoverriddenbyamedicalpractitionerorfamilymember.Thebillalsoseekstoclarifywhetherpeopleactingonthesedirectivesareimmunefromcriminalandcivilprosecution.

YoungdoctorsgetnohelpTheJuniorDoctors’AssociationofSA’s(JUDASA)TelegramchatgroupforyoungdoctorshopingtoapplyforplacementnextyearhasbeenfloodedbyhealthcareprofessionalswhofeartheymaybeunemployedbyJanuary,sinceregistrationsclosedon7August.However,theDoHclaimedtheproblemhasbeenrectified.

Statelawyers'rob'SA

AccordingtoareportinSundayTimes(12August)governmenthasdiscoveredoneofthebiggestscamsinSAhistoryinvolvingmedicalmalpracticelawsuits.

Governmentisinvestigatingcollusionbetweenpeoplesuinggovernmenthospitalsformalpracticeandstateattorneyswhoeithersettlecasesthathavenomeritordefendthecasessobadlythattheyinvariablylose.

JusticeMinisterMichaelMasuthaandHealthMinisterAaronMotsoalediconfirmedthatthescamsaresoentrenchedthatthestatehaslostbetweenR60-bnandR100-bnsince2013infraudulentmalpracticeclaims.

"Kingpins'inthescamareunderstoodtohavebeenidentifiedbygovernment.Thereportalsosuggeststhatgovernmentpreviouslylackedthe'politicalwill'todealwiththeproblem.

FinancialNews

CiplaSouthAfricagrowsfootprint

CiplaMedproSouthAfrica,whollyownedsubsidiaryofCiplaLimitedIndia,hasannouncedplanstoacquirea100%stakeinMirren(Pty)Limited.

MirrenisaSAover-the-counter(OTC)pharmaceuticalmanufactureranddistributor,whichhasbeeninoperationfor35years.ThetransactionissubjecttotheapprovalbytheCompetitionCommissionofSouthAfrica.

Aspen’s‘strategyambiguity’inthespotlight

Inthepastfiveyears,AspenPharmacarehasbeenonanaggressivegrowthstrategy,whichhasputitontheglobalmapasaforcetobereckonedwith.However,RayhaanJoosub,deputyCEOofinvestmentcompanySentioCapitalManagement,wroteinBusinessTimes(12August)that,despiteitsexponentialgrowth,therewereafewredflagsaroundAspen.WithamarketcapitalisationofR131-bn,itoperatesinabout50countriesandsuppliesmorethan150countries.Itistheworld’sninth-largestproducerofgenerics.ThemainissueforJoosubwasthatAspenhasahighlevelofintangiblesonitsbalancesheet,anunclearacquisitionstrategyandalackoffocusonwhetheritsmainbusinessisstillgenericmedicationorwhetheritisshiftingintospecialistcategories.

SpecialNews

NHIshouldtakeheedofHMIrecommendations,saysSAPPF

WhileprivatedoctorsappeartobegenerallysupportiveoftheHealthMarketInquiry’srecommendations,concernsaremountingthatimplementationofthedraftNationalHealthInsurance(NHI)BillandtheMedicalSchemesAmendment(MSA)Billintheircurrentstatescouldbepotentiallydisastroustothecountry’swholehealthcaresystem.

SomeofthemainconcernspertaintotheperceptioncreatedinthetwoBillsthatNHIcouldbethepanaceaforfixingthebrokenpublicsector,thelackofclarityonthefundingandcostofanNHI,themassivereorganisationofexistingresourcesthatwillberequiredtofulfillthepromiseofaccesstoaffordablehealthcareservicesforallthroughthepoolingofstateandprivatemoneyintoasinglefund,contractingandpaymentarrangementswithprivateprovidersandmanymore.

SAPPFCEO,DrChrisArchersayswhiletheHMI’srecommendationsarebasedonadiagnosticapproachthatrequiredthecollectionandanalysisofrealdatatoreachconclusions,thisprocesswastotallylackinginthedraftingoftheNHIBill.

GovernmentshouldhavewaitedfortheHMIReportandconsideritsf indingsandrecommendationsinthedraf tingof boththeNHIandMSA

Bills,saysDrArcher.

Toreadmore,clickonthebuttonbelow

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PharmaceuticalNews

Racetofindmoneyforbreastcancerdrug

ProvincesarescramblingtofindresourcestofundRoche’sbreastcancerdrugTrastuzumabaftertheDoHapprovedapolicytoprovideitwithoutsecuringadditionalfunding.

ProvincesthatareprovidingTrastuzumabarehavingtoreprioritisetheirbudgets,ineffecttakingthemoneyfromotherprojects.

ThepolicywaslaunchedinAugust2017byHealthMinisterAaronMotsoalediandprovinceswereexpectedtostartprovidingTrastuzumabtostate-sectorpatientsinJanuary.However,theprogrammehasgotofftoaslowstart.

TrastuzumabhasbeenavailableintheprivatesectorunderthenameHerceptinsince2008,butwasonlyaddedtothestate’sessentialmedicineslistinJune2017because“itwassimplytooexpensive”.

EU’sdrugregulator’sstaffquitsaheadofBrexit

AthirdoftheemployeesattheEU’sdrugregulatorareexpectedtoquitastheregulatorleavesBritainbecauseofBrexit,promptingtheagencytotemporarilyscalebackoperationstofocusonessentialpublic-healthactivities.Employeeswhoaren’trelocatingtoAmsterdamwiththeEuropeanMedicinesAgency(EMA)havealreadystartedtoleave.

EuropeandrugswatchdogwarnsabouttaintedheartmedicationTheEuropeanMedicinesAgency(EMA)estimatestherecouldbeoneextracaseofcancerforevery5000patientstakingacommonbloodpressureandheartdrugmanufacturedinbulkbyaChinesecompanythathasbeenfoundtocontainanimpurity.ThealarmoverValsartanwasfirstraisedinJuly,promptingaglobalrecallofaffectedpills.TheagencybelievestheproblemprobablydatesbacktochangesinmanufacturingprocessesatZhejiangHuahaiPharmaceuticalin2012.

SA'sfirstbiosimilaroncologydrugauthorisedforuse

Cipla,incollaborationwithTevaPharmaceuticalIndustriesLtd,hasannouncedthelaunchofthecountry'sfirstbiosimilarfortheoncologyandhaematologymarkets.

FilgrastimTeva,manufacturedbyTevaanddistributedinSouthAfricabyCipla,pavesthewayformoreaffordabletreatmentstoaidinthefightagainstcancer,accordingtoPaulMiller,CEOofCiplaSA.

Abiosimilarishighlysimilartotheoriginalbiologicreferenceproductintermsofquality,safetyandefficacy.“Forevery1%dropinthepriceoftheselife-savingmedicines,thenumberofpatientsgainingaccesstothemincreaseby1%.

GeneralNews

HealthSciencedean’ssuicidespotlightsSAworkplacestressThesuicideofProfBonganiMayosi–acardiologist‚researcher‚anddeanofhealthsciencesattheUniversityofCapeTown(UCT)–hasbeenattributedtothepressurehehadtoendurefromabusiveprotestingstudentswhooccupiedhisofficefortwoweeksin2016.

ItagainspotlightedtheenormousstressunderwhichSouthAfricanmedicalacademicsandpractitionerswork,withtworecentstudiesshowinghighlevelsofburnout.

Mayosi’ssuicidehaspromptedtheSouthAfricanMedicalAssociation(SAMA)tosetupasupportstructuretoaddresstheunderlyingproblemsofaheavyworkloadandlonghoursthatleadtodoctorssufferingfromstressanddepression.

Britaintoopt-outorgandonationschemetosavelives

Britainplanstoincreasethenumberoforgandonorsbychangingtherulesofconsentandpresumingthatpeoplehaveagreedtotransplantsunlesstheyhavespecificallyoptedout.InWales,asystemofpresumedconsentisinoperationandScotlandhasasystemfordonationopt-out.Around6000peopleinBritainareonthetransplantwaitinglist.Morethan400diedwhilewaitingforatransplantlastyear.

NewsonMedicalAids

Medicalaidcustomersatisfactionslides

MedicalSchemeseemstobe‘aslushfund’forcurator

AccordingtothelatestindexbyConsulta,abusinessstrategyconsultingcompany,theaverageoftheSACustomerSatisfactionIndexformedicalschemesdroppedfrom74.2in2017to72.7in2018.

Bonitas’scoredeclinedfrom73.1to70.2andDiscoveryHealthalsoreportedadeclinefrom74.8to73.1overtheyear.Medihelpwastheonlyopenschemeinthisyear’sbenchmarktoseeanimprovedscore.

Overall,SouthAfricansareincreasinglyfrustratedbyrisingpremiumsandshrinkingbenefits,aswellasafeelingoflowervalueformoneyincomparisonwithotherfinancialserviceproducts.

The13dismissedtrusteesofamedicalaidschemeforunionisedmunicipalworkers,Samwumed,arecontestingthecuratorshiporderonthescheme,whilesomeofitsmembershavealsoraisedconcernsovertheprovisionalcurator’ssuspensionoffourofitssenioremployees.

ThisfollowsthecancellationofkeycontractsthatarebeinginvestigatedbytheCouncilforMedicalSchemes.

AllegationsarethatDuduzaKhosana,provisionalcuratorofCapeTown-headquarteredSamwumed,whichcoversmorethan80000lives,ispayingherselfR240000amonthandincurringexpensesofR200000amonth.

Circulars:CouncilforMedicalSchemesThefollowingCircularswerepublishedbytheCMSinAugust2018.

Visit www.medicalschemes.co.zaformoreinfo.

32of2018AnnualStatutoryReturnsdevelopmentforthe2018fiinancialyear

33of2018Guidanceonbenefitchangesandcontributionincreasesfor2019

34of2018ClarityregardingtheNetcare911ruling

35of2018PostponementoftheAdvancedBrokerTrainingProgrammeinPortElizabeth,to31August201836of2018Auditorapprovals

37of2018QuarterlyStatutoryReturnsSubmissionfor2018

SpecialNotices

PsychiatryPractice:LocumPositionAvailableALocumposit ionisavailableataPsychiatryPract iceintheStrand,near

CapeTown,fromOctober2018totheendofMarch2019.ContactPract iceAdministrat ionat:chris@ludwick.co.za

ToadvertiseinPrivatePracticeReviewcontactMarethaConradie:maretha@healthman.co.za.

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