HEALTHMANPRIVATEPRACTICEREVIEW:SEPTEMBER2019
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FoodforThoughtNewsonGovernmentSpecialNewsFinancialNews
NewsonMedicalSchemesGeneralNewsSpecialNotices
FoodforThought
OPINION:
NHIDream:Whenpolemictriumphsoverpolicy
ByAslamDasooaconvenoroftheProgressiveHealthForumandamemberoftheStalwartsand
VeteransoftheANCinCityPress,1September
2019.
“TherearetwoWhitePapersonhealthcarethat
aregermane.Thefirstone,introducedbythe
NelsonMandelaadministration,produceda
sensibleplantofulfiltheobligationofsection27
oftheConstitution.ThesecondistheWhite
Paper,spawned10yearslaterinthetoxic
cauldronofthePolokwaneconference,evoking
anewplanthatisatriumphofpolemicover
policy.Onewastheproductofstruggle,of
empiricalresearchandtheorganicparticipation
ofthepeopleinitsformulation.
“TheWhitePaperemanatingfromthe
Polokwaneresolutioniseverythingthatthe
formerisnot.Itistheresultofapoliticalsleightof
hand,withaflimsypamphletofquestionable
provenance,lackingcredibleresearch,thorough
analysisandproperconsultation,rammed
throughbyJacobZuma’striumphalist
Polokwanebrigade.
“Torescue,rehabilitateandreinforcethepublic
healthserviceisthetrulynobleenterpriseanda
greatactofsolidaritywithourpeople.Instead,
theyareofferedthethingrueloftheNHI.The
governmentspinisrepletewitheuphemisms
abouttheNHIwhileprivatesectorparties
engageinalarmisthand-wringing,sincereonly
intheirdespairatthefinancialdamagetotheir
brands.
"Boththesenarrativesarephoneyandworthless.
“PublichealthserviceswillstruggletogainaccreditationundertheNHIunlessstandardsareappreciablylowered.Toexpectthemtocompetewithanagileandwell-capitalisedprivatesectorthatisinuredtothesocialinvestiturenecessaryforhealthcareisa
mug’sgame.
"ThePresidentandtheMinisterofHealthare
eminentlysensiblepoliticiansandleaders.Ifthey
tookarisk-adjustedviewofhealthcare,they
wouldunderstandthenecessityofdirecting
immediateandmassiveinvestmentintothe
publichealthservice,turningitintothe
healthcareproviderandemployerofchoiceand
atrulyworld-classnationalasset.
Simultaneously,theyshouldabjurepopulist
exhortationsandimplementcarefulregulatory
reformoftheprivatehealthmarket,akintowhat
wasabandonedadecadeago,tointegrateitinto
asystemofuniversalaccesstoallnecessary
care,freeatthepointofcareforthewhole
population.
“Rescuingthepublichealthservicequalifiesasbeinginthenationalsecurityinterest,the
NHIdoesnot."
AllowautonomousbodytomakeNHI
decisions
AndrewBriggs
InCityPress(8September2019)VuyoMkizewrote:“ThegovernmenthopestoseetheNHIimplementedinfullby2026.However,giventhattheavailablehealthcarebudgetislimited,two
questionsapply:
•Howwillgovernment,aswellastheprivatesector,determinewhatiscoveredundertheirbenefits
packages;and,
•Whatinformsthechoiceofanewdrug,deviceorintervention?”
CommentingontheintroductionoftheNHI,ProfessorAndrewBriggs-aworldexpertonhealthtechnologyassessment(HTA)attheUniversityofGlasgow,Scotland-saidthat“processandgovernanceissueswillneedtobeclarifiedandfollowedinfull”beforethegovernmentcoulddecide
onauniversallybeneficialandequitablebasketofhealthcareservices.
Toreadmore,clickthebuttonbelow
NewsonGovernment
NHIhassomanyholes,it’sboundtosink,expertswarnOnFriday,13September,theNationalDepartmentofHealth(DoH)releasedaletteraskingfor
nominationsforthesteeringcommitteeofthenationalbenefitscommittee.Thenominationshaveto
bemadeby17September.
“TherushtoappointaninterimsteeringcommitteecomesastheHelenSuzmanFoundation
requestedmoretimefromtheNHIhealthparliamentaryportfoliocommitteetosendcommentsabout
NHI,”reportedTimesSelect(16September2019).ThedeadlineforsubmissionsisOctober11.
TheHelenSuzmanFoundationbelieves“theNHIBillisfartooimportantandcomplextobe
adequatelyengagedwithinthisshortcommentperiod”.
Accordingtoexpertsitwasdifficultforpeopletomake“informed”commentsbecausethesuggestedlawdoesnotsaywhattypeofhealthcareservicesthefundwillbuyandwhatitwill
cost.
However,seniorgovernmentofficialandheadoftheNHIoffice,DrNicholasCrisp,saidanactoflaw
couldnotbetoodetailedbecauseitsaimwastocreatean“enablingenvironment”forfurther
regulations.
“Itwillcostasmuchaswecanafford.Paywhatyoucan,togetwhatyoucanget,”saidCrisp.
BUSAtoengagewithstateonNHI
BusinessUnitySA(BUSA)istosetupaformal
mechanismforengagingwiththehealth
departmentonitsplansforuniversalhealth
coverage,reportedBusinessDay(5September
2019).AfterameetingbetweenBUSAand
HealthMinisterZweliMkhizeitwasagreedto
establishafive-memberteamfromeachsideto
engageontheproposednewsystem.
StavrosNicolaou,AspenPharmacare’s
executiveforstrategictrade,saidBUSA
plannedtoaskParliamentforasix-week
extensiononthepubliccommentperiod
fortheNHIBill.
NHIBillinlinewithconstitution
Actingchiefstatelawadviser,AyeshaJohaar,
toldParliamentthattheNHIBillwascertifiedas
beingconstitutionallysoundonJuly29.Onthe
issueoftheprovinces,shesaidtheNational
HealthActdeterminedtheroles,responsibilities
andfunctionsofthespheresofgovernmentwith
regardtohealth,andnottheconstitutionitself.
Thisisinterpretedtomeanprovincesmayenact
provinciallawstodealwithhealthservices
authorisedandcontemplatedbythenational
frameworkandtogiveeffecttonationalpolicy.
Anyamendmenttotheseprovisionsdoesnotin
andofitselfoffendtheconstitution.
TheDA’sshadowhealthminister,Siviwe
Gwarube,amemberofthecommittee,
saidshedidnotacceptJohaar’sposition
onthebill.
Doctorsattheirwitsend
Accordingtoresearch,publishedintheSA
MedicalJournal84%registrarsintheclinical
medicineschoolatWitsUniversityaresuffering
burnout.
Theresearcher,CathelijnZeijlemaker,saidshe
wasparticularlyworriedbythe“extremelyhigh”
feelingsofdepersonalisationsheuncovered
among170registrarswhocompletedanonline
questionnaire.Zeijlemakersaidburnout
negativelyinfluencestheattitudeofregistrarsto
theircareers,leadingtochangesofspeciality,
changesofcareeroremigration.
InvestigatedCompanyawardedlargetender
TheLimpopohealthdepartmenthasawardeda
lucrativethree-yeartendertoajointventure
includingButheleziEMS,aprivateemergency
medicalservicescompanywhichisunder
investigationbytheSpecialInvestigatingUnit,
theHawksandNationalTreasury,reported
Spotlight(27August2019).ButheleziEMS
(BEMS)anditsjointventurepartnerFIMAviation
havebeenunabletoprovideanaeromedical
serviceintermsofthenewtender-either
leavingpatientsstrandedorrequiring
thedepartmenttomakeuseofotherprivate
sectorprovidersinGauteng.
Statehospitalsandclinicsfailsafetyaudit
AccordingtoastatementissuedbytheJack
Bloom,DAspokespersonforhealthinGauteng,
notasinglestatehealthfacilityinGautenghas
beenassessedascomplyingwiththe
OccupationalHealthandSafetyAct(OHSA).The
informationwasrevealedbyprovince'sHealth
MEC,BandileMasuku,inareplytoquestionsin
legislature.
Themostnon-compliantfacilitieswere:Bheki
MlangeniHospital;FarEastRandHospital;
TembisaHospital;Kopanong;Mamelodi;George
Mukhari;Ekurhulenidistrictclinics;
Johannesburgdistrictclinics.
MeanwhileWITSvice-chancellor,Adam
Habib,haschallengedGauteng
PremierDavidMakhura’scallfortheDoH
tofinancetheprovince’sdebt-ridden
teachinghospitals,sayingcentralising
theirfundingwithoutfixingtheirdeep-
seatedadministrativeandgovernance
challengeswon’tgivepatientsabetter
deal.
GautengishometofourofSA’s10
centralhospitals,whicharelinkedto
medicalschools,andprovidehighly
specialisedcaretopatientswith
complicatedconditions.Theyinclude
CharlotteMaxeke,SteveBiko,
BaragwanathandGeorgeMukhari,which
servepatientslivinginGautengaswell
asthosereferredfromotherprovinces
andfromneighbouringstates.
InSeptemberGautengDoHwarned
employeesitwillrecoversomeofthe
billionsindamagesclaimsitisfacing
fromthoseresponsibleforthemedical
negligence.Inarecentstaffcircular,
departmenthead,ProfMkhululiLukhele,
saidthedepartment“cannotcontinue”to
allowasituationwherelegalclaimsstand
athalfofitsannualbudgetofR50.8-bn.
Recentfiguresshowitisfacingclaimsof
R29-bn.
Meanwhilenoneofthegovernmentplans
designedtoimprovestaffshortagesand
trainingatstatehospitalshavebeen
implementedasdoctorshortagespersist,
reportedTimesSelect(30August2019).
AccordingtothedeanattheNelson
MandelaMedicalSchool,profLungile
Pepeta,the2011HumanResourcesfor
HealthSAto“increasetheoutputof
doctorsthreetimes”hasneverbeen
implemented.
Whatawaste!
GautenghealthMEC,DrBandileMasuku,
revealedthatthedepartmenthasirregularly
extended12contractsworthmorethanR1-bna
year.Thecontractshavebeenextendedmonthly
forthepastthreeyearswithoutgoingoutto
tender.Ofthecontracts,R675-misforsecurityfor
tertiaryandregionalhospitalsandclinics.
Theothercontracts,worthnearlyR400-m,arefor
thesupplyofrenaldialysisequipment,collection
ofmedicalwasteandsupplyoftubsandsmall
lidstohospitals.
CMShitbyprobes,lackoffunding,staffshortages
TheCMSisworkingalongwiththeSIUontheinvestigationtoridtheindustryof“fraudand
corruption”,RegistrarDrSiphoKabane,toldParliament(Fin24,30August2019).TheCMS
hasappointedaninvestigationpanel,ledbyAdvocateTembekaNgcukaitobi,tolookintoallegations
ofracialprofilingbymedicalschemes.PublichearingswillbeconcludedinSeptemberandafinal
reportbythepanelisexpectedbyNovember2019.
TheCouncilisalsochallengedbyalackofresources.AlthoughtheCMShasrequestedanincrease
of9.6%onlevies,thehealthandfinanceministershaveagreedtoanincreaseof7.03%.Kabane
commentedthatthebiggestsourceoftheCMSbudgetisbeingstrangled.HesaidtheSIU
investigationwouldcostR4.6-mandtheinvestigation,ledbyNgcukaitobi,willcostR10-m.
SpecialNews
READMORE
Doctors:ReadtheNHIBillandhaveyoursay…
FamilypractitionersmustfindthetimetoreadthroughtheNHIBill,takenoteof
thesectionsthatwillaffectthemdirectlyintheirdailypractices,andmake
theefforttosubmitanyconcerns,queriesorpointsofconfusiontheymayhave
whilethebillisoutforpubliccomment.
Itisnotwhatthegovernmentcando,butwhatdoctorscandothatismoreimportantwhenitcomesto
meetingthehealthcareneedsofthecountry’speople,internationally
experiencedandrespectedmedicalpost-graduatelecturerandfamilypracticestalwart,DrGraham
Hukins,indicatedrecentlywhenmoderatingaSAAcademyofFamilyPhysiciansConference
workshop:Younowhavetheopportunitytosaywhatyoucando!
READMORE
FinancialNewsNHIwon’tshiftourfocus,saysDiscoveryCEO,AdrianGore.
Readmoreunder:NewsonMedicalAids
NHIexpenditurewillbeR450-bn-Fitch
FitchSolutions,aunitoftheFitchGroup,projects
thegovernment’shealthcareexpenditurewill
reachnearlyR450-bnby2028,followingits
decisiontoimplementtheNHIsystem,reported
BusinessReport(2September2019).
AccordingtoFitch’sresearchgovernmenthealth
expenditurecouldposta9.9%10-year
compoundannualgrowthrate(CAGR)reaching
R449.9-bnby2028.Itexpectsprivatehealth
expendituretograduallydecline,postinga1.6%
five-yearCAGR,amountingtoR224-bnby2028.
DividendonholdatAspen
AspenPharmacarehasdecidednottodeclarea
dividendforthefirsttimeinalmostadecade,
reportedBusinessDay(12September).
Aspenreporteda15%declineinheadline
earningspershareto1,254c,downfroma
restated1,475cin2018
Meanwhileithasbeenannouncedthat
AspenwillnolongerproduceARV’s
underitsownname.Instead,itwill
producedrugsunderlicenseforan
Indianpharmaceuticalcompany.
AdcockIngramCEOupbeataboutNHIBill
AndyHall,theCEOofAdcockIngram(SA’s
second-largestgenericdrugmanufacturer)said
thereformsproposedundertheNHIBillcould
boostdrugsales,reportedBusinessDayon29
August.
HesaidAdcockIngramalreadyoperatesina
marketconstrainedbyrestrictionsonmedicine
sales,rangingfromgovernmentcapsonannual
priceincreasestotheformularies(listsof
approvedproducts)usedbylargemedical
schemes,anddidnotanticipatestrugglingto
adapttoNHI.
Dis-Chem’srevenuealmostatR10-bn
Dis-Chem’srevenuejumpedtoalmostR10-bnin
thefivemonthstoJuly31,2019.Thegroup
recordeda13.5%jumpingrouprevenueto
R9.9-bn.Retailrevenuejumped12%toR9-bn
fortheperiod.Groupchiefexecutive,Ivan
Saltzman,saidwiththestrikeandwarehouse
decentralisationconcluded,thegroupcontinued
tofocusonreducingandrationalisingitsstock
holdingtoimprovefreecashflowgeneration.
Saltzmansaidthegroupwasontracktoadd
another13storesbeforeyear-endandhad
openedninenewstorestodate.
AdcockIngramCEOupbeataboutNHIBill
AndyHall,theCEOofAdcockIngram(SA’ssecond-largestgenericdrugmanufacturer)saidthe
reformsproposedundertheNHIBillcouldboostdrugsales,reportedBusinessDayon29August.
HesaidAdcockIngramalreadyoperatesinamarketconstrainedbyrestrictionsonmedicinesales,
rangingfromgovernmentcapsonannualpriceincreasestotheformularies(listsofapproved
products)usedbylargemedicalschemes,anddidnotanticipatestrugglingtoadapttoNHI.
GeneralNews
SAmenmorelikelytocommitsuicidethan
women
AccordingtothelatestWHOreport:PreventingSuicide:AResourceforPesticideRegistrarsand
Regulators,meninSAaremorethanfourtimesmorelikelytocommitsuicidethanwomen.Almost
800000peoplediefromsuicideeveryyearglobally.
In2016,theyearonwhichthedataisbased,SArecorded6476suicides,whichtranslatesintoarate
of12.8peopleper100000.5138weremen:asuiciderateof21.8per100000.Thesuiciderateof
womenwasjustmorethan5per100000.
TheSADepressionandAnxietyGroup(Sadag),whichoperatesthecountry’sonlysuicidehelpline,
hasreceived145000callstoits22linessofarin2019.Althoughthemajorityofcallersarefemales,
someofthemoreacuteoremergencycasesarefrommalecallers,especiallysincemenusemore
aggressivemethodsofsuicide.
NewsonMedicalAids
NHIwon’tshiftourfocus,saysDiscoveryCEO
AccordingtoDiscoveryCEO,AdrianGore,thecompanydidnot
predictanydramaticchangeinitsstrategicplanningforthe
medicalschemeadministrationbusiness.Speakingatthe
company’sannualresultsfortheyearendedinJune,Goresaid
theroleoftheprivatesectoriscriticaltothesuccessofNHIand
notincludingitwouldbecounterproductivebecauseSAdoesnot
havesufficientresourcesforit.
Discovery’sresultsshowprofitsfromitshealthbusinessincreased
10%,whilethegroup’sprofitsrose15%toR6.6-bn.
*Inanarticle,publishedinBusinessDay(5September2019)
GorepresentedananalysisontheimplicationsoffundingNHI
thatshowedtheaveragemonthlyhealthcarespendperpersonby
membersofmedicalschemesis
R1726versusjustR372spentbythegovernmentonbehalfof
peopleaccessingthepublichealthsystem.
Werethegovernmenttopursuethemostcomprehensiveversion
ofuniversalhealthcareandreplacetheR206-bnmadein
contributionstoprivatemedicalschemesthroughcontributionsto
NHIviahighertaxes,theaveragespendonhealthcareperperson
permonthwouldonlyrisetoR576,saidGore.
'Singingintherain'
“Ithasbeenoneofthemore
challengingweeksforSA’s
quintessentialcorporate
optimist,AdrianGore,tokeep
thelegendarypepinhisstep”
wroteRobRose&Stepehen
CranstoninFinancialMail(12
September).“Gore,whobuilt
DiscoveryintoSA’slargest
medicalaidadministratorinjust
27years,haslongbeenthe
antidotetothewavesof
negativitythatseemtoassail
SAeveryfewmonths.
”ButwithSAonthebrinkofa
ratingdowngrade,
unemploymenthaving
deepenedto29%,awaveof
xenophobic-basedlootingand
aninexplicablybrutalspateof
violenceagainstwomen,has
Gorechangedhistune?"
ToreadacondensedversionofthearticlepublishedinFinancialMail,clickonthebuttonbelow,markedATTACHMENTDISCOVERY
DISCOVERY
CouncilapprovesthemergerofCompCareandSelfmed
TheCMShasapprovedthemergerofCompCare
WellnessMedicalSchemeandSelfmed.The
amalgamatedschemewillbeknownas
CompCareWellnessMedical
Scheme.
Circulars:CouncilforMedicalSchemes
ThefollowingCircularswerepublishedbytheCMSinAugust/September2019.
Visitwww.medicalschemes.co.zaformoreinfo.
57of2019QuarterlyStatutoryReturnsSubmissionfor2019(Q2)
58of2019ImpositionofLeviesforMedicalSchemes1019/20
59of2019InductionProgrammeforTrustees
60of2019KZNAdvancedBrokerTrainingReminder
61of2019StateHospitalsasaDesignatedServiceProviderforMedicalResearchSurvey
62of2019Auditorapprovals
63of2019CompCareWellnessMedicalSchemeandSelfmedMedicalSchememergerisconfirmed
64of2019RequestforHIV,TBandSTIDATAfortheSANationalAidsCouncil(SANAC)65of2019AdvancedTrusteeTraininginPartnershipwithGIBS
66of2019AdvancedBrokerTraininginCapeTown
67of2019NationalRegistryPilotProgramProjectPlanDeadlines
68of2019Thebemedfinalcuratorshipgranted
SpecialNotices
SocialMediaGuidelines
TheHPCSAhasreleasedabookletonEthicalGuidelinesonSocialMediaBooklet16SocialMediaGuidelines.
Toreadthebooklet,clickonthebuttonbelow.
DoctorscannowsendanSMStospeaktoaMedscheme
MedicalAdvisor
Howdoesitwork?DoctortoaMedschemeMedicalAdvisor(MA):IntheeventthatyouwouldliketomakecontactwithaMA:
1. SendanSMSto44845betweenthehoursof09:00amand16:00pmandincludethefollowing
information:
Yourpracticenumber
Yourfullnameandsurname
Patientmembershipnumberanddependentcode/name
Authorisationorreferencenumber(ifavailable)
Requesteddateandtwo(2)requestedtimesforaMAtocallback(optional)
Indicateinshortthenatureoftheclinicalquery,e.g.Hospital,ChronicMedicineorOncology-
relatedquery(optional).
2. AconfirmationSMSwillbesenttoyouthataMAwillcallbackattherequestedtime.3. TheMAwillcallyouatthescheduledtime.
Itisonlytobeusedtodiscussthefundingofyourpatientsclinicaltreatment.ClaimsquerieswillnotbediscussedastheMedicalAdvisorteamisnotresponsibleformanaging
claimsqueries.ForclaimsqueriescontacttheHealthcareProfessionalContactCentreCall
[email protected]/[email protected]
TheMAwillbeavailabletoreturncallsbetween09:00am–16:00pmfromMondaytoFriday.If
anSMSissentafternormalofficehours,theMAwillonlyattendtothemessagethefollowing
workday.
ToadvertiseinPrivatePracticeReviewcontactMarethaConradie:[email protected].
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owners,andareusedsolelyforinformativepurposesinourpublications.Thereisfurthermorenoimpliedendorsement
ofanyoftheproducts,goodsorservicesmentionedinourpublications.
