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2018/03/14 08:27 AM
Community healthcare CHW workers' jobs are no longer under threat.

The Gauteng department of health confirmed this week that their services would not be terminated and that workers would be paid their stipends.

The CHWs were not paid last month.

The department expressed regret, blaming technical glitches in the payment system. These had since been sorted out. "The payments will be made early next week," said the department.

It sought to assure people that CHW services were central to health promotion and community based services. It said the services were important, as they strengthened primary healthcare and national health insurance. "These services will not be terminated as rumoured," it stated.

The role of the CHWs included providing health education, counselling and visiting patients and the elderly at their homes.

"Through this programme, the department aims to empower communities to optimise wellness, encourage early referral to clinics and also to reduce long queues in health facilities through the community based chronic medicine distribution services."
2018/03/14 08:41 AM
Patients on Tygerberg Hospital patients are getting robot assisted prostate surgery thanks to a partnership between private and public hospitals.

John Vraagom, who has stage2 prostate cancer, was the first of 10 state patients who underwent the da Vinci robotic surgery at the private Mediclinic Durbanville last week.

Over the coming weeks, Mediclinic Durbanville, together with urologist Dr Gawie Bruwer, will carry out similar procedures on another nine patients.

The pro-bono procedures part of a collaboration between private and public hospitals — will reduce the pressure on surgical waiting lists at state health facilities.

This is the first time the da Vinci robot at Durbanville Mediclinic is being used as part of this collaboration.

The da Vinci robot was introduced to Mediclinic Durbanville several years ago, and according to Dr Bruwer, it greatly helps patients' recovery.

"The precision of the da Vinci aids the thorough removal of cancerous tissue as well as offering the ability to perform nerve sparing surgery, which enables a faster return of erectile function as well as a better chance for urinary continence," he said.

The most recent series of collaborations have been carried out across the Western Cape, Free State and Limpopo provinces with a number of other provinces still being discussed.

Operations included cataract, urology and tympanoplasty (eardrum repair) procedures.

Provincial Health MEC Dr Nomafrench Mbombo said the partnership was also about strengthening the working relationship between private and public hospitals and working together to change the lives of people.

"I wish to thank Mediclinic for the extension of the collaborative surgeries programme to the patients of Tygerberg Hospital. We are taking hands with our partners in the private sector in seeking a better health future for all the people of the Western Cape, and South Africa," she said.

Tygerberg Hospital CEO Dimitri Erasmus said: "With no current access to the Da Vinci in public hospitals, this will provide a valuable teaching opportunity across the private and public platforms."

Koert Pretorius, Mediclinic Southern Africa CEO, said: "We acknowledge the severe shortage of doctors and nurses in our country and we understand how this can hamper the public sector's ability to deliver care, but by working together in Public Private Initiatives we have the opportunity to reach beyond our traditional patient base and assist these patients."
2018/03/14 08:45 AM
Life Vincent Pallotti Hospital and the Deputy Mayor of the Western Cape, Ian Nielsen, have opened up the first water filtration plant successfully installed at a private facility in the Western Cape, for consumption to combat "Day Zero".

Life Vincent Pallotti Hospital in Pinelands, Western Cape, is the first private business and private healthcare facility in the Western Cape to successfully install a water filtration plant that fully complies with the City of Cape Town's regulations and byelaws.

The Life Vincent Pallotti Hospital Water Filtration Plant is now switched on and the water is suitable for human consumption and for use in a healthcare environment.

The municipal water supply has been switched off and the hospital is operating off the grid. Life Vincent Pallotti Hospital has an emergency storage supply at the hospital which is sufficient for at least 48hours, should there be any technical glitches with the filtration plant.

Life Healthcare Group has a national water security strategy in place which includes the implementation of responsible water management processes and preventative measures to eliminate any impact on our patients, doctors and employees.

Life Healthcare engaged with officials from the City of Cape Town and the Department of Water and Sanitation to obtain permission for their Western Cape hospitals to become self-sufficient in terms of its water supply, in anticipation of the current water crisis the region is facing. Formal approval was granted by the authorities and boreholes were sunk at Life Vincent Pallotti Hospital in Pinelands and Life Kingsbury Hospital in Claremont.

Life Healthcare has confirmed that its hospitals and facilities will not be impacted by the current water crisis in the Cape Town area.

Life Vincent Pallotti Hospital has also implemented further strict water savings measures including the installation of reduced flow valves on taps and showers, recycling of water for instrument sterilisation and the reuse of grey water In partnership with provincial and local government authorities, special contingency measures will also be in place to allow Life Healthcare and specifically Life Vincent Pallotti Hospital, to assist in case of emergencies and to mitigate the risk of water resources being plundered during the crisis.

Life Healthcare Group is committed to being a world-class provider of quality healthcare for all. As part of our quality service delivery we are committed to actively conserving the environment and limiting the harmful impact our business activities may have on the environment.

Life Vincent Pallotti Hospital would like to formally thank the team that built and registered the water filtration plant: The City of Cape Town; The Department of Water & Sanitation WC; Murray & Roberts Water Division; AH L Water; AWS Water; Dr Co — Boreholes; Gottgens Plumbing and Skylark Electrical. Without their effort, time and support this project would not have been a success.

2018/03/14 08:32 AM
The City of Cape Town's environmental health practitioners are set to assist with the recall of products following the national Department of Health's announcement that the source of the listeriosis outbreak has been identified.

In a statement, the City announced that its health practitioners would visit smaller outlets to establish if they were aware of the recall and to record volumes of products being kept on site.

This information can then be used to aid the recall and ensure that the identified products are removed from shelves. City Health is also set to visit fast food outlets and other food traders, and will continue with its education and awareness campaign around personal hygiene, food safety and other risks to human health.

"It is important to note that most people who consume food products contaminated with listeria will not get sick and will remain asymptomatic.

"Of those who do become ill, most will develop self-limiting fever and diarrhoea. However, people at high risk of developing severe disease include pregnant women and their unborn babies, the elderly, people with underlying conditions such as diabetes, cancer, chronic liver or kidney disease, and people with weakened immune systems due to HIV or chemotherapy," said mayoral committee member for safety and security JP Smith.

The Western Cape Education Department said it was taking steps to ensure that pupils and teachers avoided ready-to-eat meat.

"We can confirm that our school feeding schemes do not serve processed meat.

"The SG issued a circular today advising schools to encourage children and staff to avoid all processed meat products. The circular also serves to remind schools to continue monitoring food preparation procedures at school kitchens," said WCED MEC Debbie Schafer's spokesperson, Jessica Shelver.

Shelver added that it was pivotal that food preparation in school kitchens be monitored at all times. "It is equally important to exercise caution when buying food from merchants selling food near schools.

"Handwashing before eating and after visiting toilets is of utmost importance, and also keeping raw and cooked meat separate from other foods," she said.

On Sunday, Health Minister Aaron Motsoaledi announced that the source of listeriosis was Enterprise Foods factories in Polokwane, Germiston and the Free State. Rainbow Chicken was also identified as a source.

"Inspections are conducted routinely at food premises, announced and unannounced. The National Environmental Health Norms and Standards provides that these premises are inspected once a quarter," said Foster Mohale, director of communications for the Department of Health.
2018/03/14 08:42 AM
Ten patients, all currently on Tygerberg Hospital's urology waiting list for urgent prostatectomy surgery, are benefiting from an ongoing relationship between Mediclinic and the Western Cape Department of Health.

During the next few weeks, Mediclinic Durbanville, together with urologist Dr Gawie Bruwer, will be providing these lifesaving prostatectomy surgeries to State patients.

The pro bono procedures reduce the pressure on public surgical waiting lists at local and regional public hospital facilities.

The unique aspect of the partnership at Mediclinic Durbanville is that it is the first time the renowned Da Vinci robot is being used as part of the surgery.

Introduced to Mediclinic Durbanville in 2014, this robotic surgery has remarkable benefits for patient recovery.

More than 60% of Bruwer's patients at Mediclinic Durbanville are discharged the day after surgery, which is much sooner than with traditional open surgery patients who require ICU care before being transferred to a normal ward.

Robotic surgery lowers the risk of infection, and the reduction in blood loss minimises the risk of blood transfusions. Patients' pain levels are also comparatively lower. The Da Vinci has mechanical wrists that bend and turn to mimic the movements of a surgeon's hands during surgery. As the surgeon controls it, the robot operates on the patient, translating the surgeon's hand movements into smaller, more precise movements.

A 10-times magnification of the inside of the body allows surgeons to see even the smallest veins and arteries, which can be seen far clearer than with the naked eye.

"The precision of the Da Vinci aids the thorough removal of cancerous tissue and also offers the ability to perform nerve sparing surgery, which enables a faster return of erectile function, as well as a better chance for urinary continence.

"I firmly believe that this technology is giving patients the option of improved clinical outcomes that may not be possible with open surgery," says Bruwer.

He is one of only 17 surgeons in South Africa who are accredited to operate using the Da Vinci system.

Anaesthesiologist Dr Gerry Brynard will also be assisting with the procedure on a pro bono basis in light of his specialised experienced regarding robotic anaesthesiology.

The most recent series of collaborations have been carried out across the Western Cape, Free State and Limpopo provinces. Operations included cataract, urology and tympanoplasty eardrum repair procedures.

"I wish to thank Mediclinic for the extension of the collaborative surgeries programme to the patients of Tygerberg Hospital. We are taking hands with our partners in the private sector in seeking a better health future for all the people of the Western Cape and South Africa," says Dr Nomafrench Mbombo, Western Cape MEC for health.

Another key aspect of the relationship between Mediclinic and Tygerberg Hospital is the training element. A team of theatre staff, including a scrub nurse, anaesthetist and fellow urology registrars, will be included — either in the theatre or as part of a live broadcast to the doctors.

"With no current access to the Da Vinci in public hospitals, this will provide a valuable teaching opportunity across the private and public platforms," says Dr Dimitri Erasmus, CEO of Tygerberg Hospital.
2018/03/14 08:33 AM
Building on the gains of recent years Resolution Health Medical Scheme is poised to enter a new phase of growth and security, having attracted hundreds of new members since November last year in a largely stagnant medical schemes market. All of this was achieved while steadily growing scheme reserves.

“With prudent management and a diversified membership base, we have effectively built on the gains of recent years and sought to ensure that our benefit options are enriched with the most pertinent cover for each targeted segment of the market,” says Mark Arnold, Principal Officer of Resolution Health Medical Scheme.

“There are few schemes that can attest to building reserves at the rate that we have achieved, even in the face of challenging factors within the industry and the economic climate, in recent years. By the end of 2017 our solvency ratio reached just under 16% having more than doubled since 2012. What’s more, we project that this trend will continue in 2018 and expect reserves to end the year at approximately 20%.

Arnold notes that a number of factors have contributed to this impressive turnaround, including strategic interventions to diversify the scheme’s membership base in target industries – most notably in agriculture and related industries, as well as hospitality and mining.

“Having broadened the profile of our membership while keeping firmly in touch with the unique needs of each sector we serve, has allowed Resolution Health to grow sustainably,” he adds.

“Enhancing membership benefits year-on-year while keeping contribution increases to a minimum is an attractive prospect for South African private healthcare consumers, and we have been able to offer our members exceptional value while still growing reserves in line with a Council for Medical Schemes-endorsed business strategy.

“The richness of the benefits Resolution Health offers, particularly in areas that we know are especially relevant for our members, and the additional value afforded through implementation of the most sophisticated technology and managed care systems available, have attracted significant attention in the market.

“By looking at the benefits members use most on each of our options, we avoid loading options with benefits that the target market for that option is unlikely to use. This is one of the measures that enable us to contain contributions, as we align our options to suit every member at each life stage.”

According to Arnold, Resolution Health boasts one of the industry’s lowest claims per beneficiary ratios. “This is made possible through our managed healthcare systems that not only take proactive care of our members’ health but at the same time also succeed in containing costs. The system ensures that members’ benefits are used effectively and correctly by providers to avoid wastage and protect allocated benefits,” he notes.

Resolution Health makes use of advanced technology and an artificial intelligence engine, which have been developed to detect improper claiming practices and provide protection against fraudulent claims so that members’ funds are protected, and contribution increases are kept to an absolute minimum.

“The integrated approach to managed care and risk management that underpins the scheme’s administration makes use of an advanced claims management system that actively checks members’ prescribed treatment and health conditions for contraindications and potential health risk.

Where the system identifies problematic claims, a team of clinical professionals review the details and engage with the member and their treating medical professional to establish the clinical and procedural validity of the prescribed treatment and claim, thereby adding meaningful value with an extra layer of protection for the health and wellbeing of members.

“At the centre of all these layers of integrated protection – financial, clinical, technological and administrative – is the health of our members. Through understanding their needs and charting the best possible means of providing relevant healthcare cover within a financially sustainable framework, we foresee vast potential for further growth in the months and years to come,” Arnold concluded.
2018/03/14 08:37 AM
Medical inflation is at its lowest rate I in six years, says a new report.

However, the figure is still relatively high at 10.5% as overall inflation measured by the Consumer Price Index in January is presently 4.4%.

The Discovery Health Medical Inflation Index defines "medical inflation" as the annual increase in claims received by medical schemes.

"It is a function of both changes in the price of healthcare services and frequency. For example, the fee charged by a GP or specialist for a consultation, or the tariff charged by a hospital for a one night admission, combined with changes in the volume of healthcare services used by members of medical schemes the increase in the number of GP consultations, or the number of hospital admissions.

The medical inflation tracker is based on data from the Discovery Health Medical Scheme DHMS, which includes the claims of about 27 million lives, representing 31% of the total medical scheme population for the period under review.

According to Independent Medical Aid Specialists, the inflation in medical aid premiums of medical schemes, both open for the public in general and closed schemes private schemes allowing membership only to people employed by certain corporations served by the scheme, has exceeded both the average household inflation in South Africa, as well as the increase in earning power of the household itself.

"The logical outcome will be that the affordability of medical aid premiums and therefore the ability of the average household to maintain membership of a scheme will gradually decline, with a disastrous effect on the national economy as well as an increasing drain on the public healthcare system, due to more people not being covered by medical aid schemes."

DHMS data indicate that between 2008 and 2017, medical inflation increased by an average of 11.3% a year about 5% above the Consumer Price Index, which averaged 6.1% a year over this period. The group acknowledges that access to quality healthcare at an affordable price is a "critical" priority.

Medical schemes are defined by legislation as not for profit entities that charge monthly contributions in order to pay medical claims on behalf of their members.

Discovery says that almost 90% of the contributions paid by members are used to cover healthcare claims. However as healthcare costs increase over time, so do the claims paid by the medical scheme.

This requires the medical scheme to increase the contributions paid by members to ensure that the scheme can continue to pay claims, as well as to maintain solvency reserves equivalent to 25% of total annual contributions.

The Independent Medical Aid specialists suggest that an increasing drain on the public healthcare system, due to more people not being covered by medical aid schemes will not only drain the economy but the government will need to take its share of responsibility for this overutilisation.

"The government has repeatedly stated its commitment to a National Health Insurance."
2018/03/14 08:41 AM
A growing number of medical students, parents, doctors and prominent legal figures have come out with guns blazing against a policy that makes it difficult for South Africans who studied medicine abroad to obtain Health Professions Council of SA (HPCSA) accreditation.

The council recently ruled that graduates who studied abroad have to first complete an internship in the countries where they studied before writing their board examinations.

This would not be possible for many due to work permits and residency issues in these different countries.

Despite being in existence since 2009, the HPCSA rule has never been implemented until now.

More than 300 affected people attended a meeting at Kampara Conference Centre in Clare Road, Clare Estate, on Friday evening to join a class action against the council.

This followed an urgent application appealing against the rule by a returning KZN doctor, Kapil Sevnaran, in the Gauteng High Court on Friday.

Attorney Annie Tooray of Pravda and Knowles Attorneys said the application had been launched against the HPCSA so that those affected would, hopefully, be able to write the upcoming May board exams.

At Friday’s meeting, other returning doctors said they would join the application.

Prominent legal figures including Judge Shyam Gyanda, advocate Feisal Abraham, and advocate Rajesh Choudree were present to lend their support to the proposed action.

Some pledged to fight on behalf of the returning doctors on a pro bono basis.

Sevnaran’s application states that the HPCSA had “unethically and inefficiently” conducted itself to the detriment and prejudice of young and aspiring South African doctors in a country that faces a dire shortage.

It was only in early February, that many returning medical graduates were advised that they would not qualify to write the examinations before they completed internships in their countries of study.

The doctors were also allegedly told that the department of health could not accommodate them as interns at local hospitals, leaving hundreds of the returning doctors in limbo.

Some of the same doctors had applied to write the HPSCA board exam last year, but the council had overbooked and they were asked to apply to write the exam in May.

Parents and doctors at Friday’s meeting expressed concern that returning doctors were intentionally being side-lined as a result of government prioritising its Cuban medical student programme.

A general manager from the SA Medical Association (Sama) in Johannesburg, Manivasan Thandroyen, also flew to Durban to attend the meeting. He said the association was sympathetic to the plight of those affected.

“Even though the returning doctors cannot be part of Sama until they have registered with the HPCSA, we still understand their difficulties and will lend our support to them,” said Thandroyen.

HPCSA spokesperson Priscilla Sekhonyana said that a meeting with affected parties was scheduled to take place last week, but it had been postponed.

“It will only be taking place in the coming weeks. Only after the meeting has taken place will I be able to provide more information,” said Sekhonyana.

National Department of Health spokesperson Popo Maja said the plight faced by returning doctors was a “complex” issue and of huge public interest.

“The Ministry of Health is sensitive to the issue. We are currently engaging with relevant stakeholders to identify potential solutions. This is inclusive of the deans of our medical schools, the HPCSA, as well as Sama and its affiliates,” said Maja.

Earlier this week, Minister of Health Aaron Motsoaledi said the shortage of doctors should not be used as an excuse to accept students who had qualified abroad into the South African health system.

He made the statement in Parliament when he replied to questions from IFP MP Narend Singh, who raised the issue.

Motsoaledi said the training in medicine around the world was not universal and differed from country to country depending on culture and conditions of living.
2018/03/07 08:43 AM
An innovative partnership driven by a civil society group has resulted in the city's private healthcare sector partnering with Northdale Hospital to help tackle the backlog of 6 000 patients needing eye surgery.

The Active Citizens Movement ACM recently launched the ground-breaking partnership at the Midlands Medical Centre last week bringing together KZN Department of Health and the private healthcare sector in a partnership that will potentially result in a Cataract Centre of Excellence being established at Northdale Hospital.

The following institutions pledged their support to the project: Midlands Medical Centre, Mediclinic, Hilton Life Hospital, Daymed, the newly opened Pietermaritzburg Eye Hospital and McCords Hospital.

Although details of the partnership are still subject to negotiations with the department of health, the ACM's chairperson Roshan Jainath, says the partnering institutions will, later in March, each sign a separate memorandum of understanding with the department.

Already, according to Jainath, Hilton Life has donated a R400 000 laser machine while McCords has sponsored a microscopic machine worth around R800 000. Apart from the hospitals assisting with the surgery, one of the biggest costs involved in cataract surgery is the cost of the medical packs, around R4000 per pack. The Department of Health, however, can access these packs for around R2500 each.

Other NGOs have also come on-board with offers to help sponsor the packs. Sham Moodley, a pharmacist from Merebank has facilitated the sponsorship of 2500 packs ACM has also approach a UKbased NGO to sponsor a further 4000 packs. PriceWaterhouseCoopers PwC have waivered their fees for auditing and accounting services. PWC are our auditors and are contributing their services for free. They are willing to sit on the hospital management board to oversee the unit.

Jainath applauded the private sector joining hands with government to tackle the backlog saying the role of ACM in facilitating the partnership demonstrated that "civil society activism must move beyond political vocalism and result in delivering tangible benefits to communities".

"We are drained today but if 6 000 people can get their eyesight back then we all should celebrate a victory for humanity. We as ACM were concerned by the plight of the impoverished Northdale patients, who had to contend with high patient volumes. For this reason, ACM saw a need to act as agents of change. We are delighted by the response of all stakeholders," said Jainath.

Head of the ophthalmology department at Grey's Hospital, Dr Carl Heinz Kruse, who provided an assessment analysis on Northdale, painted a bleak picture of the under resourced institute. He said the freezing of posts by the Department of Health had a detrimental impact.

"In 2016, Northdale was dealt a major blow when it lost medical officers in the unit," he said. As a consequence, the operations were stifled. Also aggravating the situation was the referral pattern that forced the hospital to take in more patients than its resources could handle, he added. Bob Govender, an Industry Affairs executive from Mediclinic, welcomed this initiative.

The health department needs to be proactive. If the momentum is slower than expected next year, we will see yet another bloated backlog. Perhaps 10 000 more patients. "He urged the DOH to put in a "tsunami-like effort" so that the initiative becomes a success.

Director for Non Communicable Disease in the health department, Jimmy Mthethwa, commended the initiative, likening it to government's ambitious national health insurance scheme.

He said the state could commit itself to a memorandum of understanding only if it had no financial implications. He said the state's financial constraints were well documented.
2018/03/07 08:50 AM
The provincial health department has partnered with Mediclinic to bring robotic surgery to patients in the Western Cape. Durbanville urologist Dr Gawie Bruwer will use the Da Vinci robot to perform surgical procedures on 10 prostate cancer patients at Tygerberg Hospital.

The robotic surgical system, designed by American company Intuitive Surgical, allows surgeons to see the prostate and its surrounding tissue in high definition. Using the system reduces the need for blood transfusions and decreases the risk of wound infection. "Patients will not be charged and they can go home after the surgery is done," said Dr Bruwer.

"The robot's precision aids the thorough removal of cancerous tissue. It also gives doctors the ability to perform nerve sparing surgery, which enables a faster return of erectile function as well as a better chance for urinary restraint." The initiative, which was launched in November, will reduce the number of people on the surgery waiting list at public health facilities.

Western Cape Health MEC Nomafrench Mbombo said the department wants to provide quality healthcare to all residents. She thanked Mediclinic for extending its collaborative surgeries programme to Tygerberg Hospital.

"The partnership seeks to strengthen the working relationship between private and public hospitals. "We are working together to change people's lives," said Mbombo.

She said the department is working with partners in the private sector to create a better healthcare system for Western Cape residents. Mbombo said the collaboration allows patients to benefit from increased access to the additional capacity available in Mediclinic facilities as well as the talent of the surgeons practising in their hospitals.

Mediclinic Southern Africa CEO Koert Pretorius said the collaboration is about more than shortening long public sector waiting lists. "Our aim is to touch and save lives," he said.

Pretorius said he was aware of the shortage of doctors and nurses in the country and understood how it could hamper the public sector's ability to deliver care. However, he told the People's Paper that the initiative has given them the opportunity to reach beyond their traditional patient base.
2018/03/07 08:51 AM
Da Vinci brings cutting-edge surgery to hospitals Staff Writer TEN patients on Tygerberg Hospital's urology waiting list will receive cutting-edge prostate surgery thanks to a partnership between Mediclinic and the provincial health department.

The lifesaving prostatectomy surgeries are the latest in a sequence of collaborations between Mediclinic and a number of provincial health departments.

The pro bono procedures reduce the pressure on public surgical waiting lists at local and regional public hospital facilities. These procedures will also help broaden access to quality health care for many South Africans as part of a private public initiative PPI.

Introduced to Mediclinic Durbanville several years ago, this robotic surgery has already provided remarkable benefits to patient recovery.

"The precision of the da Vinci aids the thorough removal of cancerous tissue as well as offering the ability to perform nerve sparing surgery which enables a faster return of erectile function, as well as a better chance for urinary continence.

"I firmly believe that this technology is giving patients the option of improved clinical outcomes that may not be possible with open surgery" said Dr Gawie Bruwer.

Bruwer is a urologist at Mediclinic Durbanville and one of only 17 surgeons in South Africa who are accredited to operate the da Vinci Surgical System. Anaesthesiologist Dr Gerry Brynard will also assist with the procedure on a pro bono basis as a result of his specialised experienced regarding robotic anaesthesiology.

The most recent series of collaborations have been carried out in the Western Cape, Free State and Limpopo, with a number of other provinces still being discussed. Operations included cataract, urology and tympanoplasty eardrum repair procedures.

Provincial Health MEC Nomafrench Mbombo said: "The partnership is also about strengthening our working relationship between private and public hospitals, and working together to change the lives of our people.

"We are taking hands with our partners in the private sector in seeking a better health future for all the people of the Western Cape and SA."
2018/03/07 09:17 AM
Group Advanced Health is courting potential black economic empowerment (BEE) partners, as it sought to bolster its chances of doing business with the government, CEO Carl Grillenberger said on Thursday.

“We are going to start talking to a BEE group interested in acquiring shares. The rationale is we are a South African company and would like to get patients from the state system. They will want to see a BEE grading for the company,” he said.

Advanced Health was in discussion with provincial health departments to provide procedures to state patients and in the longer term hoped to get state business under the banner of National Health Insurance, Grillenberger said.

Advanced Health, which has day hospitals in Australia and SA, listed on the JSE’s AltX in April 2014.

Despite Advanced Health’s continued losses, Grillenberger said he was optimistic the company would break even by early in 2019. Advanced Health reported a comprehensive loss of R25.4m for the six months to December 31, a slightly better performance than the R33.9m loss in the corresponding period the year before.

Group revenue rose 33% to R199.5m and headline losses per share fell 18.7% to 8.56c.

Advanced Health acquired two new hospitals in Australia during the period under review.

While its Australian operations reported a modest profit, the South African business continued to operate in the red despite an increase in patient numbers. The losses were attributable to the fact that it had commissioned a large number of facilities in a relatively short time and encountered stiff resistance from local players.

“The main problem in SA is it is a business competing with hospitals, which are putting pressure on doctors to do most of their work in [their facilities]. Doctors dare not tell patients they can get a better deal at a day facility,” said Grillenberger.

“The playing field is not level and that is something the Competition Commission is looking at,” he said, referring to the commission’s market inquiry, which is investigating barriers to effective competition in the private healthcare industry. It is expected to release its interim report at the end of April.
2018/03/07 09:19 AM
Life Vincent Pallotti Hospital has opened its own water filtration plant, which meets the City of Cape Town and Department of Water and Sanitation's strict water crisis regulations.

Life Healthcare engaged with officials from the City of Cape Town and the Department of Water and Sanitation to obtain permission to become self-sufficient in terms of its water supply. The water filtration plant fully complies with the city’s regulations and by-laws and ensures water is fit for human consumption in a healthcare environment.

“The municipal water supply has been switched off, and the hospital is now operating off the grid. We have an emergency storage supply at the hospital which is sufficient for at least 48-hours, should there be any technical glitches with the filtration plant”, said Lourens Bekker, Life Healthcare CEO - Southern Africa.

In partnership with provincial and local government authorities, special contingency measures will also be in place to allow Life Healthcare and specifically Life Vincent Pallotti Hospital, to assist in case of emergencies and to mitigate the risk of water resources further plummeting during the current water shortage.

The group was also granted formal approval by the authorities to sink a borehole at Life Kingsbury Hospital in Claremont, Cape Town with testing currently taking place before City officials can give the green light for human consumption.

“We hope to soon open the water filtration plant at Life Kingsbury Hospital and remain committed to implementing additional water saving measures, including the installation of reduced flow valves on taps and showers, recycling of water for instrument sterilisation and the reuse of grey water.

2018/03/06 05:07 PM
Governments are often tempted to obfuscate reality through populist promises. South Africa is no different in this regard, writes Michael Settas, a member of the Free Market Foundation’s Health Policy Unit.

For 23 years, health policy has gone from the 1995 policy paper on “free healthcare” for all, to a Social Health Insurance (SHI) proposal in 1999 – hated by labour because it included a payroll tax. By 2004, reality set in. Free healthcare for all was simply not possible.

In 2007, general government policy shifted more to the left and SHI was dropped like a hot potato. The prevailing National Health Insurance (NHI) became official policy the following year, with the same promise: free healthcare for all.

The NHI is predicated on a redistribution of healthcare resources. By unwinding the private sector (read nationalising), and dumping it into the state sector, everyone will ostensibly gain access to quality healthcare.

But, as we have witnessed many times, the long-term success of robbing Peter to pay Paul is virtually zero. To quote Reverend Boetcker: “You cannot help the poor by destroying the rich”.

Elegant and noble notions often stir us to emotively evaluate policies, rather than to starkly strip them down through rational realism. This gives rise to the ubiquitous use of that well-aged political armoury: populist rhetoric. In South Africa, it comes around every five years, promising voters all and sundry, at no direct cost.

The NHI has walked a long road already – 10 years – but has delivered very little. Government documents published in support of the NHI all lacked lucidity on how it will be implemented and funded.

There is yet another healthcare policy framework being developed – this time within the existing private sector.

Most private sector healthcare funding occurs via medical schemes, which are regulated under the Medical Schemes Act (MSA). The MSA contains some noble policies, such as open enrolment, community rating and a set of prescribed minimum benefits (PMB).

But these noble policies have created an expensive set of benefits for all medical schemes to cover, thereby making the MSA distinctly anti-poor. At a current average monthly cost of around R4,000 per family, medical scheme cover is the exclusive domain of higher income earners, so it is no surprise that only about 15% of South Africans can partake.

This has twice led to private sector attempts to create a parallel, lower cost dispensation. In 2004, the creation of the Low Income Medical Scheme (LIMS) initiative and, in 2015, its resuscitation as the Low Cost Benefit Option (LCBO).

Both initiatives were blocked by government. However, by December 2016, after 10 years of negotiating, government had finally drafted a set of Demarcation Regulations (DR) acceptable to most stakeholders.

These regulations exempted some healthcare products that insurers could provide, with the rest being allocated as the exclusive domain of the MSA. The DR had one exception: it did not allow for any alternative, lower cost healthcare products – only expensive medical schemes, which was clearly exclusionary for the poor.

In essence, government had tied itself up in a constitutional knot and had to seek some respite.

This resulted in the creation of what is now known as the Demarcation Exemption Framework (DEF) for health insurers who are technically undertaking the business of a medical scheme, i.e. products that meet this technical definition but are not listed as exempt in the DR. This is an exemption framework for the exemption framework.

The DEF has only been granted up until 30 April 2019 to allow the Council for Medical Schemes (CMS), the industry regulator, time to revitalise LCBO.

Where am I going with this?

The introduction of LCBO is laudable, but to simply place it alongside the existing industry is likely to be destabilising.

The MSA’s minimum benefits are too expensive for current medical scheme members, who would opt out of the system were they able.

What prevents total exit for the majority of members, however, is the common labour practice of medical scheme membership as a compulsory condition of employment. If lower cost alternatives were put on the table by employers, there is no doubt whatsoever that many current members would make the transition.

This is problematic, since it will be the younger and healthier who will downgrade to LCBO, forcing the cost of the traditional products higher than they currently are. This could destroy the medical schemes industry, with LCBO being the catalyst.

What’s the alternative?

Deregulate the market, remove prescribed minimum benefits, and allow people to freely purchase healthcare at levels they can afford. The provider market will adapt and create products that are aligned to consumer needs.

Overall, millions more will partake in the private sector, and finally government will fulfil its mandate by enabling access to healthcare for the poor.

Perhaps with a revitalised government in place, this could be a possibility.
2018/03/06 05:08 PM
In the face of divided public opinion, the much touted National Health Insurance NHI system looks set for full implementation in the coming years after the white paper gazetted by Health Minister Dr Aaron Motsoaledi in June 2017.

The government plans to fully implement the NHI by 2025. And it will be mandatory for every citizen to belong to the NHI, and all state medical schemes will be made redundant. But it is unclear how the NHI will affect private medical schemes, although it is likely that smaller schemes will cease to exist.

According to the white paper, "the NHI is a health financing system designed to pool funds and actively purchase services with these funds to provide universal access to quality affordable personal health services for all South Africans based on their health needs, irrespective of their socioeconomic status.

"The NHI will be implemented through the creation of a single fund that is publicly financed and publicly administered."

The white paper says the NHI will be financed by the NHI Fund, which must be established through legislation. The fund will be financed out of general taxes and from payroll and surcharge taxes. The main features of the NHI include the following:

Integrating all sources of funding into a unified health financing pool that caters to the needs of the population.

Paying for all healthcare costs for the population.

Mandatory prepayment of health care, which differs from other modes of payment, such as voluntary prepayment and out-of-pocket payment.

Ensuring that individuals do not suffer financial hardship and/or are not prevented from accessing health services. This means eliminating various forms of direct payment, such as co-payments.

Purchasing healthcare services for everyone, and will use its power as a single purchaser to identify the country's healthcare needs and determine the most appropriate, efficient and effective mechanisms for drawing on existing healthcare service providers.

The NHI Fund, in consultation with the health minister, will determine its pricing and reimbursement mechanisms. Healthcare providers who want to contract with the NHI Fund will have to comply.


Director-general of the Department of Health Precious Matsoso said the white paper stipulates that, until the NHI is fully implemented and mature, the role of medical schemes will not change.

However, she said this doesn't preclude any changes to the business of medical schemes or transformation required in medical schemes.

"Currently, the medical schemes' role under the fully matured NHI is that of complementary services cover. This means that only services not covered by the NHI can be offered as cover. If medical schemes undergo both voluntary and regulatory reform to become aligned and consistent with the objectives of the NHI, there will be a need to relook this," Matsoso pointed out.

The Council for Medical Schemes CMS has announced plans to consolidate the medical schemes industry by dissolving or consolidating small schemes in line with the white paper.

More than 228 000 people belong to 31 medical schemes that had less than 6 000 members at the end of December, 2015, according to the CMS's 2015/16 annual report.

The Department of Health said only 8.8 million people belong to medical schemes out of about 55.5 million.

Gerhard van Emmenis, the principal officer of Bonitas Medical Fund, said it's imperative that measures are put in place that will enable medical schemes to work in tandem with the NHI to prevent duplication of services, improve access to healthcare and deliver quality service.

"If the future means there is only complementary cover from medical schemes, it will be very limited in its offerings, with cover for services such as dentistry and rare conditions. This means the number of medical schemes will greatly reduce," Van Emmenis added.

Martin van Staden, a legal researcher at the Free Market Foundation, said there is no doubt that South Africa needs serious healthcare reform, but the NHI as it is currently proposed is unrealistic, and if it is attempted it will do more harm than good to the economy.

"With the 2010 cost estimation inflated with the Consumer Price Index, in 2017 terms the NHI will cost the taxpayer not R255.8 billion but R368.8bn, by 2025. Even this, however, is a conservative estimate in light of overly generous future growth estimates provided by the government.

 "Furthermore, in 2017 terms, the NHI will cost South Africa R156bn every year from 2025 onwards assuming we achieve 2% growth which is roughly equal to four 2010 Soccer World Cup tournaments or 1.4 million government houses a year. The NHI would double South Africa's health budget," Van Staden warned.

In its response to the white paper, the South African Institute of Race Relations SAIRR said the NHI was premised on a number of flawed assumptions, and it overlooked many of the gains already made in managing the burden of disease.

The SAIRR said the white paper disregards the main reasons for the poor performance of the public healthcare system, and this failure results in a skewed diagnosis of the problems in the healthcare sector, resulting in a skewed assessment of how these problems can be overcome.

"The government should increase the affordability of medical scheme cover and health insurance by introducing state funded healthcare vouchers for households earning less than R15 000 a month," the SAIRR pointed out.

"The current medical tax credit could be combined with a portion of current provincial health expenditure to yield significant amounts of annual revenue. This could be used to provide every household within this income range with a voucher that could be used solely for the purchase of healthcare services from either the public or the private sectors," the SAIRR suggested. In Switzerland, healthcare is universal and is regulated by the Swiss federal law on health insurance.

There are no Free State provided health services, but private health insurance is compulsory for everyone. The government subsidises health care for the poor on a graded basis, with the goal of preventing individuals from spending more than 10% of their income on health care.

In Singapore, the government controls and heavily subsidises the population's health care, but a principle is that no medical service is provided free of charge.
2018/03/06 05:09 PM
Member satisfaction @ medical schemes… from bad to worse?  Why?

2017 was the lowest SAsci score

With premiums increasing well above inflation by approximately 10% each year, expectations around value for money in private healthcare are constantly under the magnifying glass.  According to Consulta’s 2017 South African Customer Satisfaction Index (SAcsi) survey for medical schemes, customer loyalty measured at 66.7%, its lowest score recorded to date.

Specific areas of member dissatisfaction arise from the perception of poor value for money, complexities surrounding the understanding of scheme rules, exclusions and co-payments.  This is amplified by the perception that schemes continue to increase premiums whilst at the same time, continuously reduce benefits.

Unique challenges

If medical schemes are not for profit organisations and the members are the shareholders, how did we get to this point where our industry has one of the lowest satisfaction scores compared to other industries?

Parallel to members that are at the receiving end of private healthcare services and financial cover, are schemes in their challenges to provide a sustainable funding model to its members.  Medical schemes are price takers; not price makers.

Schemes are more than ever before strained by a flurry of challenges concerning an open-ended liability with no ceiling w.r.t. the funding of PMB claims, the absence of price regulation from medical service providers, fraudulent claims from both service providers and members, the over-servicing of members, over-coding on the side of providers, member anti-selection and non-declaration of medical information, the ever-increasing cost of private healthcare, as well as the rise of the empowered patient.

The only source of income for medical schemes is derived from its members’ contributions and interest earned on their reserves.  Put differently, the contributions paid by members, plus some interest earned, must fund the all healthcare claims of all the members and factored into this cost are all the challenges as mentioned.

Expectations not met

Given the fact that “empathy”, followed by “reliability”, are generally accepted as the two biggest considerations when measuring customer satisfaction, it is no wonder that member satisfaction is at an all-time low.

Members naturally expect that all claims must always be settled in full.  Private healthcare providers derive approximately 95% of their income from medical scheme members and the current status quo seems to be to maximize revenue income in the absence of any price regulation, while it lasts.

Medical schemes, on the other hand may, according to the Medical Schemes Act, only reimburse claims in line with their rules, which contain benefit limits.  Therefore, when claims aren’t paid in full, members’ expectations are not met.  An additional financial burden transferred to the member not only triggers dissatisfaction in respect of an expectation not being met; it also touches a heart issue.

The main gripe then centres around why a claim was not paid in full, when the real question ought to be – why does the doctor charge so much?  The blame is laid at the door of the medical scheme whilst some doctors are charging more than R60 000 per hour to treat non-life threatening conditions.

What is the answer?

The future and sustainability of private healthcare in South Africa is currently at a juncture.  Considering the potential impact of government’s plans around National Health Insurance (NHI), only a major disruption with radical changes will save it from a complete collapse.

Private and public healthcare must remain separate.

As far as public healthcare is concerned, we must forget about NHI.  We in fact have NHI in our country – it is just not managed.  Affirmative action in public hospitals must be suspended and whoever is capable and qualified to run and manage it must do so with the provision that there is a mentor programme in place.  The quota system at our universities should be abolished to train more doctors, as we need more doctors, irrespective of colour.

Medical schemes should be privatised to make them companies under the Companies Act.  Private hospitals should be allowed to employ doctors and doctors should be left to charge a reasonable fee with the proviso that patients and medical schemes are not compelled in law to pay a blank cheque, as is currently the scenario with regulation 8 and the Council for Medical Schemes’ interpretation thereof.

Will this happen?

Probably not before the total collapse of private healthcare in South Africa.
2018/03/06 05:10 PM
The idea behind National Health Insurance (NHI) is that it will operate as a single publicly financed and administered fund to which all South Africans will make compulsory contributions, based on their ability to pay. It would therefore promote cross-subsidisation on a bigger scale than is currently the case with individual medical aid schemes.

“The intention behind the NHI is said to provide free access to healthcare at the point of service for all South Africans and legal residents,” says Christel van Wyk, South African Institute of Chartered Accountants (Saica) project director: tax. “The primary long-term objective is to provide access to healthcare based on individual need, instead of financial ability, and to cover unplanned health events for everyone.”

The 2018/19 Budget outlines a number of transitional arrangements, although not as many as was originally anticipated in the run up to the speech.

Medical tax credits

In the meantime, whilst the plans for implementing the NHI are being streamlined, taxpayers have for the past few years been given some benefit in the form of medical tax credits, which have been the topic of much controversy in itself. This takes the form of rebate and has provided some tax relief for defraying expensive medical costs. It was always known that this would be an interim measure until such time that the NHI is fully operational, but there have even been talks of a complete scrapping of this rebate in the months before leading up to the Budget, but there were no such drastic measures, which is somewhat of a relief for the moment.

It was noted in the Budget, in relation to these medical tax credits, that some individuals are excessively benefitting from the medical schemes contribution rebate, specifically where multiple taxpayers contribute toward the medical scheme or expenses of another person. The example used is where adult children jointly contribute to their elderly mother’s medical scheme and where each contributor currently enjoys a full rebate, although the joint cost is for a single beneficiary. The Budget proposes that in such cases the medical tax credit should also be apportioned between the various contributors.


The monthly medical scheme fees tax credit will, from 1 March 2018, be slightly increased from R303 to R310 per month for the first two beneficiaries. For each additional beneficiary, the increase will be from R204 to R209. It is important to note that these increases are by design below inflation, the purpose being that government has earmarked the additional revenue that will flow from the below inflationary rebate to contribute towards funding of the NHI.

The expected impact is additional revenue of R700m in 2018/19, R640m in 2019/20 and R586m in 2020/21, and these benefits are therefore projected over a three-year period. While this proposal is in line with the proposals made in the NHI White Paper released in June 2017, it seems that this will not have a significant impact on the NHI cost, given that the 2025 estimated cost is in the region of R256bn. In the 2017/18 Budget, the then Minister of Finance, Pravin Gordhan set aside R5.2bn for the NHI fund, which although much more than this year, is still not significant considering the overall funding need,” concludes Van Wyk.

The NHI is therefore still pretty much a work in progress and significantly more work needs to be done before it goes live.

2018/03/07 08:54 AM
Private hospital group Mediclinic is offering a limited number of free procedures to state patients, as it seeks to build closer ties with the government. The state has historically been wary of entering into public-private partnerships, but private hospital players hope the implementation of the National Health Insurance (NHI) scheme will open up new opportunities.

In the latest of a series of collaborative ventures with provincial health departments, Mediclinic announced on Tuesday that it would provide 10 prostate cancer patients from Tygerberg Hospital with cutting-edge precision surgery using the Da Vinci robot.

The technology is not currently available in the state sector, so they will be the first state patients to benefit from it. Mediclinic has already provided dozens of cataract, urology and ear drum repair procedures at no cost to the state in the Western Cape, Free State and Limpopo.

The latest collaboration with the Western Cape health department will also provide a training opportunity for registrars, who are studying to become specialists.

The biggest obstacle to public-private partnerships was the lack of trust between government and business, said Mediclinic Southern Africa CEO Koert Pretorius

"We think there should be a lot more co-operation between the public and private sectors, as it would (optimise) scarce skills," he said. "We are very positive about public-private partnerships, as we often have spare capacity," he said.

"We could do it on a marginal cost basis, but could do it at a significantly reduced cost if we got state pharmaceutical prices and [did] not have to pay VAT," he said.

Western Cape health MEC Nomafrench Mbombo said universal healthcare would require strong public-private partnerships. "It’s not about whether the state should work with the private sector, but how …. The Western Cape can pilot this," she added.

The precision of the Da Vinci robotic surgery means there is less nerve damage and better removal of cancerous tissue than with open surgery, and patients generally spend less time in hospital and have fewer complications, urologist Gawie Bruwer said. "It is like doing a procedure under a microscope," he said.
2018/03/06 05:11 PM
The country cannot afford the National Health Insurance NHI without much faster economic growth rates.

This was said by the head of policy research at the Institute for Race Relations, Anthea Jeffery.

Jeffery said the government should not be taking any further steps to implement the NHI when there are far better means available to achieve universal health coverage. Jeffery's statement comes after Finance Minister Malusi Gigaba's maiden budget speech in which he announced that the Department of Health will receive R205bn.

The amount is expected to grow to R240bn by the 202021 financial year. Gigaba announced that R4.2bn has been allocated to the NHI with below inflation medical tax credits used to fund the NHI.

He said medical tax credits will increase from R303 to R310 per month for the two first beneficiaries and thereafter from R204 to R209 for the remaining dependants.

"Reducing the medical tax credit will make it harder for many people to maintain their medical scheme membership and is likely to leave them dependent on the failing public healthcare system," Jeffery said. "Instead of putting this further pressure on already struggling households, the government's key priority should be to ensure that its extensive tax revenues are far better spent, both in the healthcare sector and all other spheres."

Gigaba's announcement that tax credits will be used to fund the NHI comes after Health Minister Aaron Motsoaledi last year during a media briefing proposed that the government withdraw its tax incentive to medical aid schemes, labeling the R2Obn tax credits "unfair".

Motsoaledi argued that the tax credits should rather be used to establish the NHI fund.

2018/03/06 04:56 PM
As the country celebrates 2018 as the year to honour Nelson Mandela, Health Minister Dr Aaron Motsoaledi says the biggest tribute that the country can pay to Madiba would be to accelerate the implementation of the NHI

The greatest heritage that Nelson Mandela has bequeathed to us is reconciliation. But without social justice, without a genuine quest for true humanity, without narrowing the gap between rich and poor and without the removal racial barriers, reconciliation rings hollow It is just a word.

The governing party, the ANC, through its new president Cyril Ramaphosa, has declared this year to be the year of our former president Nelson Mandela. Had he lived, Madiba would have turned 100 in July this year.

As the Ministry of Health, we are of the view that the greatest tribute to honour Mandela and his legacy would be to accelerate the implementation of the National Health Insurance NHI. The NHI is a funding mechanism that will enable all South Africans to access health care regardless of their social and economic status. NHI is our version of the World Health Organisation's Universal Health Coverage UHC.

As the icon of our freedom and democracy, Mandela was president when the country adopted its first democratic Constitution in 1996. In terms of the Constitution, access to health is a right. The architects of our Constitution realised that the ultimate dividend of freedom and democracy is access to health. 

This is in keeping with the Alma-Ata declaration of the WHO in 1978 which states that "the attainment of the highest standard of health is the most important worldwide social goal, whose attainment needs action from other sectors, economic and social in addition to the health sector".

That is the reason we have decided to implement the NHI in South Africa. We wanted to end apartheid in the provision of health care and ensure that the resources the country spends on health are shared between the haves and have nots.

Some among us may have forgotten that we used to have a fragmented health system in the country. There were various departments of health in the homelands and a different one that served mainly white South Africans.

There were hospitals which catered only for the white section of the population and others that served black people. We have been able to establish a single National Department of Health. Race is no longer supposed to be used to determine which hospital can serve a patient.

There is no doubt that Mandela was central in ushering a non-racial democracy in our country That is why when we dedicate this year to honour his legacy, we should also ask ourselves the question how have we moved to his ideal of attaining racial harmony and eradicating the legacy of apartheid.

While apartheid has been removed from the statutory books, there is a new form of discrimination that is based not on race but on social and economic status. In health for instance, poor people are unable to access quality health care because of the manner in which the resources of the country are shared. Too much money is being spent on two few people to address their health needs.

It must be a source of great concern to all of us that of the 8,5% of the Gross Domestic Product GDP that is spent on health in the country a whopping 4,4% is spent on only 16% of the population. The remaining meagre 4,1% is spent on 84% of the population. This constitutes the biggest inequality which exists nowhere else in the whole world.

Clearly unless we radically reorganise the health system, we will not be able to deal with the legacy of inequality in health.

The unfortunate reality in South Africa is that the gap between the rich and poor is widening. The manner in which health resources are allocated further reinforces inequality between rich and poor. NHI seeks to reduce this inequality.

Mandela had special focus on health. His contribution in the fight against the HIV/Aids pandemic will never be forgotten. At a time when our country was trapped in Aids denialism and high incidents of stigmatization, Mandela came out publicly to attack the HIV Aids stigma, demanded ARVs for people infected with the virus and advocated for treatment of people with TB. In the instance, he even announced publicly that his own son Makgatho died of Aids.

As a country we have come a long way in intensifying the war on HIV and Aids. Our country now has the biggest antiretroviral programme in the world. But the fight continues.

In his January 8 address, Ramaphosa said: "We will intensify efforts to improve the health of our people, particularly in the context of the devastating impact of the Aids epidemic and the emergence of other diseases. As South Africans, we must never accept as permanent or irreversible our status as the country with the world's biggest HIV epidemic.

"We need to take decisive steps to bring an end to the epidemic through systematically implementing the 909090 strategy which will entail, among other things, the addition of 2 million more people to our antiretroviral treatment programme."

As we honour Mandela, we should ensure that we implement the 909090 strategy so that we free our country from the Aids pandemic. The Department of Health will make further announcement on this strategy in due course.

It was also under Mandela's presidency that pregnant women and children were given free treatment in public clinics. His administration also built hundreds of clinics throughout South Africa, especially in rural areas.

More than his leadership skills, Mandela was full of compassion, particularly for the weak and vulnerable. Of serious concern to us as the Department of Health are continued reports of ill treatment of patients in our health care facilities. As we honour Mandela, we urge our health workers at all levels to be true to their professional and treat all patients with the outmost care. We can build new and well equipped hospitals but only warm and professional conduct by our health professionals can make the real difference and improve quality of care of the patients.

It was Mandela who passionately spoke about the RDP Reconstruction and Development Programme of the soul. He understood that apartheid and colonialism had damaged our minds and the manner in which we treat one another. He appreciated that we have to change the manner in which we deal with other people. If our health care workers can heed his call, there can be a huge improvement in the provision of health care in the country.

It was because of Mandela and the ANC's proximity to Cuba that our country developed a strong relationship with Cuba. That relationship saw Cuba sending hundreds of doctors to South Africa to equip our rural hospitals which had critical shortage of doctors.

While the programme started with the importation of Cuban doctors, this has changed. Currently we send hundreds of learners to study medicine in that country and the programme has played a significant role in reducing the shortage of doctors in the country. Because most of those that we place on the programme come from disadvantaged backgrounds, this has also assisted to improve the financial fortunes of hundreds of families.

Given that Cuba is internationally renowned for its primary health care, those who are trained in that country will become priceless assets in the rolling out of the NHI. We have repeatedly stated that primary health care is the heartbeat of the NHI.

When our people fully appreciate and understand the role that can be played by the local clinic, the overcrowding in hospitals will be reduced as many of them would realise that most of their needs can be addressed by the staff at the clinic.

There are few global icons whose love for children can match that of Mandela. Mandela loved children so much that he initiated the construction of a special hospital for children. The Nelson Mandela's Children Hospital, which was officially opened after he had passed on, is Madiba's enduring legacy for his love of children. If we were to give a report to Mandela, we would tell him that his vision of the hospital has become a reality.

We would tell him that we are not just fighting the Aids stigma, but that we are giving millions of people ARVs. We would tell him that we are testing everybody for HIV and those that are found to be HIV positive are placed on the ARV programme regardless of their CD4 count.

We would tell him that the idea of Universal Health Coverage is no longer just an idea but is being implemented through the rolling out of the NHI. We would tell him that we have increased the life expectancy by more than 10 years. We would tell him that his dream of a non-racial democracy is a reality.

As we celebrate the life of Mandela, we pledge to move with speed to implement the NHI and ensure that the legacy of apartheid in health is dead and buried.
2018/03/06 05:00 PM
Medical aid schemes were defrauded to the tune of R10-billion in 2017 alone, the Board of Healthcare Funders said.

The organisation said both professionals in the healthcare sector and members commit the offences.

In 2017, R151-billion in medical aid claims was paid out with between five to 15 percent of those being fraudulent.

"We see a lot of collusion between members of schemes and service providers (which) relates to issues like identity fraud - your uncle falls ill and you pass him (off) as you or another member," said Dr Katlego Mothudi, MD of the Board of Healthcare Funders.

South Africa's biggest medical aid scheme, Discovery Health, said it was defrauded to the tune of over R500-million in 2017.

The company has identified several scams.

"In the pharmacy environment what we see, for example, is a pharmacist selling to a member cosmetic and other front-shop items but submitting claims for medicine to the medical scheme, or we see a pharmacist dispensing a low-cost generic medicine, but submitting a claim for a higher-cost, original brand medicine.

"In the doctor environment, we see an abuse of codes, the doctors treating and doing one thing but sending in a claim for much more money," explained the Discovery Health's CEO Jonathan Broomberg.

The Council for Medical Schemes said forensic audits might become necessary to protect the interests of members, while the Board of Healthcare Funders believe awareness campaigns could help.

Several health professionals and service providers have already been criminally charged or convicted. Back to top
2018/03/06 05:01 PM
One would ask why there are anti-forces brewing brouhaha against the National Health Insurance (NHI) model which the government of the day through the Department of Health, intends to roll out to our people, especially the poorest of the poor.

Should I remind the anti-forces that healthcare is a human right and this is a widely accepted international principle and this right should not depend on how rich we are or where we happen to live. The right to obtain healthcare is written into our Constitution.

The truth is that those who are opposing this noble direction are those who have unlimited financial resources, especially the private hospital sector players, who want to continue making more profits through their exorbitant service costs, while the health of poorest of the poor is in bad state. National Health Insurance is a health system that seeks to provide access to quality and affordable healthcare services for all South Africans based on their health needs irrespective of their socio-economic status and as such the call against this noble move is uncalled for and anti-social in many ways.

Britain is a practical example of such a model doing wonders for its population, the National Health Service (NHS) which has been implemented since the 1940s and the British have nothing but praise for this system. The Britons claim that through the NHS, 1 million people gain access to healthcare every 36 hours. Funding for the NHS comes directly from taxation.

Since the NHS transformation in 2013, the NHS payment system has become underpinned by legislation. The Health and Social Care Act 2012 moves responsibility for pricing from the Department of Health to a shared responsibility for NHS England and NHS Improvement.

Clearly capitalism is a wicked system to some extent, this can benefit our people who are drowning in poverty. Martin Luther King, Jnr was undoubtedly on point when he said: "Capitalism forgets that life is social. And the kingdom of brotherhood is found neither in the thesis of communism nor the antithesis of capitalism, but in a higher synthesis."

Our people continue to die prematurely and to suffer unnecessarily from poor health. Treatable conditions are not being treated on time and preventable diseases are not being prevented. The notion from many of the oppositions is that the NHI will compete with healthcare providers, which is not a case in this instance.

Should I remind them that healthcare is about saving lives and NHI is simply there to provide options, so that even those who have limited healthcare resources will be catered for. It's very sad that we now live in a society where professionals have all become fully commercialised. It's no longer about service to humanity but profit.

Medicine is now a trade like any other, where only those with resources are able to acquire quality healthcare. My call is that commercialisation of healthcare at the expense of the poor must fall and we must support the NHI.

Now is the time for the poor to also have quality healthcare and good healthcare professionals. What we must strive for is a more equitable system of healthcare services distribution. National Health Insurance is envisioned as a financing mechanism that will move us towards universal health coverage and it will have a significant impact on access to healthcare for all South Africans. NHI is aimed at ensuring that all South Africans, irrespective of their socio-economic status have access to quality healthcare irrespective of their socio-economic status, health services are delivered equitably, the population does not pay for accessing health services at the point of use and that the population has financial risk protection against catastrophic health expenditure.

The NHI will also realise what the National Development Plan envisions in 2030, a health system that works for everyone that produces positive health outcomes and is accessible to all. The ultimate aim of the NHI is to provide the population of South Africa with free healthcare when they need it, to encourage the expansion of primary healthcare services, to create fairness in the sharing of skilled healthcare professionals, healthcare finances and other resources.

The government aims to achieve a healthier nation, where people live longer and suffer less. When it comes to financing, we should not get caught up in terminology. Worldwide National Health Insurance or schemes are classified according to functions and policies for collection, pooling and purchasing.

Tshepo Seloana, editor at HPCSA. She writes in her personal capacity.
2018/03/06 05:02 PM
The provincial branch of the Democratic Nursing Organisation of SA (Denosa) is stopping its members from escorting patients from one health care facility to another.

The union said its members had been exploited and overworked for too long, with the Health Department “dragging its feet” on employing paramedics qualified to handle referrals and transfers.

Mandla Shabangu, Denosa provincial secretary, said the department had disregarded their demand to stop using nurses to escort patients who were being transferred to other facilities.

“We told the department to stop this by the end of this month, but in a circular issued on January 10, the department said it would do away with the practice by May," he said.

"This practice forces nurses to work outside of their professional scope and has been unfair to both nurses and staffing levels at health facilities. It is paramedics who should be doing this task as they are trained to do so,” Shabangu said.

He said this practice undermined the nursing profession.

“When a nurse escorts a patient, there is no replacement for this nurse in a ward. And this escorting has been used by the department as means to avoid addressing the shortage of paramedics.

“Nurses are being used to fill the gap, worsening the already dire shortage of nurses in government health care facilities. This is exploitation and must be stopped by end of this month,” he said.

He blamed the poor treatment meted out by nurses to patients on work overload.

“One colleague less in a ward means work overload to the remaining colleagues, hence the grumpiness and sometimes the never-ending complaints about poor treatment of patients by nurses,” Shabangu said.

Dr Imran Keeka, DA spokesperson for Health, said the problem was the shortage of paramedics in the province.

“Using nurses as escorts reduces the ability of nurses to function. The province has an average of 180 ambulances on the roads.

"On average, we should have 10 paramedics per shift as per the national health norms and standards.

“During visits to two ambulance bases in the Amajuba and uThukela districts last year, the bases operated on 30% to 50% less ambulances.

"This escorting increases workload and stress, and it creates angry nurses,” Keeka said.

Department spokesperson Ncumisa Mafunda did not address specific questions regarding the number of paramedics needed in the province.

“The department has now approved a new policy to escort transferred patients. However, nurses will still be required to accompany mental health care users. The new policy will take effect on May 1,” she said.
2018/03/06 05:03 PM
Cardiologist Dr Wouter Basson got a lifeline when the Supreme Court of Appeal ordered the Gauteng High Court, Pretoria, to reconsider his application for the recusal of the chairperson and a committee member in his disciplinary inquiry.

Basson wanted the Health Professions Council of SA (HPCSA) professional conduct committee chairperson, Professor Jannie Hugo, as well as committee member Professor Eddie Mhlanga recused on the grounds they were biased.

They were allegedly connected to an organisation that endorsed a petition to scrap him from the register of medical practitioners.

Basson, who practised in the Western Cape, was charged in 2007 with unprofessional conduct. His alleged conduct related to his involvement in the apartheid regime’s chemical and biological warfare research during his employment with the SA Defence Force in the 1980s.

Basson, who was nicknamed in many quarters as “Dr Death” years ago, faced a lengthy trial in the high court stemming from his research project at the time, called Project Coast.

Evidence was presented to the court during his criminal trial of James Bond-type gadgets such as a deadly umbrella, allegedly with poisoned spikes used to eliminate "the enemy”. The court acquitted Basson in 2002 of all wrongdoing, but complaints were lodged against him with the HPCSA that he had acted unethically by, among others, making cyanide capsules available to operatives.

Basson, in his defence, claimed he acted as a soldier and not a doctor as head of the project. But the committee found in 2013 that Basson had breached the ethical rules of the medical profession and he was convicted on four charges.

The pro forma prosecutor called Martin Heywood, a director of a law clinic, as a witness in aggravation of a sanction against Basson.

Heywood submitted two petitions to scrap Basson’s name from the register of medical practitioners. One of the petitions was supported by various organisations, including the SA Medical Association and the Rural Doctors Association of SA.

Basson’s advocate, Jaap Cilliers SC, at the time asked whether the members of the committee were members of any of these organisations. They refused to divulge this information and the sentencing proceedings were ordered to go ahead.

Basson and his team then staged a walkout and turned to the court to have the members recuse themselves. His sentencing proceedings have since been placed on hold.

The high court turned this application down, but then Acting Judge David Unterhalter found that Basson had not exhausted his internal remedies.

The judge found that Basson had the right to appeal any finding at the end of the disciplinary hearing.

Judge Unterhalter also found that the appeal body of the HPCSA committee should address Basson’s concerns rather than the courts.

Basson appealed this ruling before the Supreme Court of Appeal and said it would cause him irreparable harm if he was sanctioned by the same people he wanted to have recused.

His said this case was exceptional and warranted the court to step in before it was too late. Five judges of the Supreme Court of Appeal agreed.

In upholding Basson’s appeal, they ordered that the matter had to be remitted to the high court to decide afresh on his recusal application. Back to top
2018/03/06 03:49 PM
Dr Yogan Pillay from the Department of Health was not being truthful in his opinion piece, "Health of people key to economic health", published on January 11. The World Bank and World Health Organisation report did not indicate that South Africa was well on its way to universal health coverage UHC with its National Health Insurance scheme NHI.

The report was evaluating the current situation of health care in South Africa. There is thus an indication that South Africa is well on its way to UHC, despite NHI, which hasn't been implemented yet.

The department is continuing with its narrative that NHI is the only way to achieve UHC in South Africa, when credible research shows the current health system is well on its way to achieving this. The report states that the missing element of UHC is quality of care.

The department should be focusing on improving the quality of care in the public sector, without trying to radically overhaul the entire health care system through NHI. The underlying; evidence for why the NHI mode was chosen for South Atria has never been provided, and with a lack of specifics when it comes to costs and funding; thereof, we should be looking; at improving the current system and not at replacing it with something unaffordable. Back to top
2018/03/06 04:54 PM
Private hospital group Netcare will not provide its UK business, BMI Healthcare, with a £20m injection and credit support, as the company has implemented a short-term arrangement with its lenders, Netcare says.

BMI Healthcare, a subsidiary of General Healthcare Group (GHG), in which Netcare holds a 56.9% stake, is the UK’s biggest private hospital provider.

Netcare said in November that in light of its planned acquisition of the interests of the minority shareholders in GHG and BMI’s poor financial performance it had been assisting BMI to renegotiate the terms of its banking facilities and would invest £20m into the business.

BMI delivered an operating loss of £20.6m for the year to September 30, compared with a profit of £28.7m in 2016, as patient volumes dropped.

Numbers fell for both those funded by the National Health Service and those paid for by private medical insurance.

"At the end of December and with the support of its lenders, BMI implemented a short-term arrangement without the need for Netcare to contribute any capital or provide any other credit support. BMI continues to pursue a long-term financing arrangement with its lenders, which remains a condition precedent to the transaction for Netcare to acquire GHG minority interests," Netcare said.

"Netcare remains committed to BMI and is in discussion with its largest landlord, TheatrePropCo, to agree a rent reduction transaction that would be beneficial to all.... Further financial support from Netcare to BMI will remain subject to a resolution of the [rental agreement]."

PropCo is GHG’s property business and leases facilities to the group’s operating arm, Opco. Netcare has been trying to renegotiate a more favourable rental agreement but has yet to strike a deal.

Investec portfolio manager Andrew Joannou said some shareholders had been concerned about the announcement in 2017 that Netcare intended to inject £20m into BMI, as they preferred the UK business to be self-funded. They would regard the latest developments as positive, he said. "This is quite important, as management has re-established the ring-fenced nature of the South African business versus the UK."

Fairtree Capital portfolio manager Jean-Pierre Verster interpreted the announcement by Netcare as a signal that it would not inject more money into BMI without a rent reduction agreement with PropCo.
2018/03/06 03:39 PM
A medical qualification is useless if you can’t afford to practice. The resultant emigration of healthcare professionals adds to SA’s doctor shortage – a situation which is placing the country’s entire healthcare system at considerable risk.
It’s no secret the brain drain of SA’s medical practitioners to foreign shores has potentially devastating consequences for the SA healthcare system. But with medical malpractice insurance costs reaching exorbitant highs, newly qualified specialists (who’ve taken up to 15 years to qualify) are left with little choice when they can’t afford to set up a practice as they don’t have the revenue stream to provide for malpractice insurance.

It’s no secret the brain drain of SA’s medical practitioners to foreign shores has potentially devastating consequences for the SA healthcare system

According to an Econex survey commissioned by the Hospital Association of South Africa (HASA) in 2015, there were just 60 doctors per 100 000 people in 2013; and the world average is 152. “While it is uncertain how many doctors have emigrated”, said Volker von Widdern, group chief executive officer of Constantia Insurance Company Limited (CICL), “Econex reported that between 2004 and 2009, 17% of doctors who had qualified did not report for community service. It is estimated that there are currently only 7 000 medical specialists practicing in SA.”

The issue around the cost of insurance premiums is a very real consideration for doctors currently in practice and those looking to start a career in medicine. Over the last 15 years premiums have reportedly doubled every five years with doctors being given little if any data that supports the reasons behind premium hikes. “Many of these professionals have felt trapped by spiking medical PI premiums, hindering their retirement plans and leaving them feeling they have little control over their destinies,” said Von Widdern.

Litigation for alleged negligence by healthcare institutions is claiming increasing proportions of health spend, he says, pointing to the fact that over the last ten years, settlements have shot up from below R15 million to some that reach R40 million.

“Doctors are an indispensable national asset and should be protected,” says Von Widdern. “We believe up to 90% of South Africa’s doctors are good quality risks. And the way we approach our business makes for a realistic and sustainable pricing of premiums”.

10 Facts: Impact of medical malpractice suits on SA healthcare

1. In 2014 doctors warned the health system could collapse as medical negligence lawsuits were driving up the cost of private insurance for doctors, making practising certain specialities of medicine too expensive and risky. (South African Medical Journal, Volume 104, 11, 2014)

2. The number of claims against healthcare professionals in SA rose by 35% between 2011 and 2016, and the value of the claims during this period increased 121%. (Medical Protection Casebook, August 2017)

3. Complaints to the Health Professions Council of SA have risen by 100% to 2500 a year against doctors, dentists, and other healthcare professionals (Medical Protection Casebook, August 2017)

4. Malpractice claims have become more complex and frequently involve multiple experts. Wrongful life claims, wrongful birth claims, cerebral palsy, Down syndrome, and birth defect claims are examples of new types of claims. (Medical Protection Casebook, August 2017)

5. SA Association of Obstetricians and Gynaecologists president, Dr Johannes van Waart said in 2013, insurance against potential malpractice suits cost R250 000 a year; it is R850 000 in 2017, and expected to be R1m within a year. (Ethics under scrutiny as medical malpractice claims soar, Business Day, 26 September 2017)

6. According to Health Minister, Aaron Motsoaledi, from the 2014/15 financial year to the 2016/17 financial year, more than R2.3 billion was paid to cover medical negligence claims – with the state’s contingent liability for the claims sitting at R56 billion. (Taxpayers fork out over R2.3 billion for medical negligence at state hospitals, BusinessTech, 31 October 2017)

7. Motsoaledi says 360 claims have been lodged in the current (2017/18) financial year so far, amounting to R241 million. Although some of the claims are legitimate, many of them are excessive and unjustified. (Tax payers fork out over R2.3 billion for medical negligence at state hospitals, BusinessTech, 31 October 2017)

8. Rising medical PI insurance costs are also having an impact on doctors’ and hospitals’ costs. The rising cost of funding malpractice insurance is having a serious impact on obstetricians, often forcing doctors to charge a co-payment for their services. (Obstetrics in a State of Crisis, IOL News, 4 September 2016)

9. Doctors are the backbone of hospitals. SA’s three biggest private hospital groups make a significant contribution to the economy, generating R55.5 billion, or 1.3% of gross domestic product (GDP), in 2016, according to research by Econex. (Private hospitals’ contribution to the South African economy 2016/2017, Econex, September 2017)

10. Econex reports that for every person directly employed by private hospital groups, almost five additional formal and informal jobs are supported in the SA economy, and for every R10 million of capital investment, private hospital groups create 20 jobs. (Private hospitals’ contribution to the South African economy 2016/2017, Econex, September 2017)
2018/03/06 03:44 PM
Medical tourism, with an estimated growth of between 15 percent and 25 percent each year globally, is an industry that tourism and medical entrepreneurs in South Africa can cash in on.

This is according to Charnel Kara, tourism specialist at FNB Business. She said research by SA Tourism showed that foreign spending on medical care in South Africa increased to R916-million in 2015, as the number of tourists originating from Europe and those coming by air from other African countries increased.

Kara said travellers coming to South Africa for medical treatments do so for cost savings, South Africa’s infrastructure, medical technology, qualified and skilled doctors at an international standard, and most advantageous is the fact that the English language is widely spoken in South Africa. Kara added that globally, medical tourism is estimated to be worth between $45-billion (about R558-billion) and $72-billion (about R892.8-billion) and it is estimated that the industry will continue to show growth of between 15 percent and 25 percent each year, making it a growth industry that medical entrepreneurs could build a business towards.

She said the downstream impact of medical tourism acts as an important feed into the rest of the tourism industry as the average tourist stays in South Africa for an estimated six days. Businesses can tailor or enhance their product offering to cater to this growing demand. Tim Harris, chief executive of Wesgro, Cape Town and the Western Cape’s tourism, trade and investment agency, said although leisure remains the top motivation for travel to South Africa and the Western Cape, marginal growth can be seen in the share of tourists who visit the province specifically for medical reasons.

Harris said in 2016, 0.9 percent of the total tourist arrivals travelled for medical reasons. He said despite the marginal share of medical tourists when compared with the leisure and business segments, the medical tourism market has portrayed a steady increase in the average total foreign direct spend in South Africa, a trend which indicates a strong and consistent economic contribution to the country. Enver Duminy, chief executive of Cape Town Tourism, said there are many opportunities to boost this form of tourism and Dubai is one example of a city aggressively targeting medical tourists with its plan to attract more than half a million arrivals by 2020.
2018/03/06 03:51 PM
New medical insurance demarcation regulations coming into effect from April this year will rob millions of South Africans of access to affordable private healthcare, while forcing them to hang around for “pie in the sky” low-cost services provided by the NHI.

This is according to Leon Louw, executive director of the Free Market Foundation, who said that the government’s interference in the private healthcare sector should be seen as “insidious assault on personal freedom”.

“The demarcation regulations penalise us for protecting our health, force us to buy insurance for strangers, and subject us to the biggest and most costly bureaucratic empire on the continent – National Health Insurance (NHI).

“It is minimising our choices and maximising inefficiency. Basic principles of economics and the rule of law, especially the separation of powers, are being compromised to vanishing point,” Louw said.

National Health Insurance is government’s plan to put in place a compulsory, state-run universal healthcare scheme, that is partly funded by private medical aid users (through tax credits) and other measures.

According to health minister Aaron Motsoaledi, the scheme is seen as a replacement for medical schemes in the country, but will not banish the role of private healthcare outright – though it is expected that private medical insurance must transform to fit into the new landscape.

Among these transformations is the closing down of smaller schemes (with fewer than 6,000 members), and bringing all medical aids under the Medical Schemes Act.

These changes have been met with criticism from the private healthcare sector, with various reports showing how medical aid users stand to lose thousands of rands each year to the NHI, while many more will lose their health plans altogether.

More losses

One of the biggest casualties of government’s plans are low-cost medical schemes, which, under the new regulations, will be forced to operate as fully-fledged medical aids, making their business models and processes obsolete.

Until deregulation, the private insurance companies were not as highly regulated as medical aid schemes and could afford to offer cheaper and more innovative products to target groups of consumers.

Now, under the demarcation regulations, they must offer expensive prescribed minimum benefits which, at today’s rates, costs on average R680 per month.

Also, they are precluded from risk profiling members and prevented from charging late joiners a higher premium except in certain circumstances.

“This may sound good for the consumer but, in reality, drives up costs and restricts choice for the majority of medical insurance subscribers. The demarcation regulations are not in consumers’ interests,” Louw said.

The end result of the process – limiting the insurance sector – is to immediately remove access to low cost medical care for millions, he said.

“By forcing insurance companies to behave like medical aid schemes means that low cost benefit options for low- to middle income earners will effectively disappear. Meanwhile, we wait for NHI and low cost benefit products for all – pie in the sky.”

Louw said that the government should leave the private sector to those who can afford it and focus on financing health care for those who cannot.

“With the demarcation regulations, government has introduced more heavy-handed regulation into one of, if not the most, regulated sectors of the economy.”
2018/03/06 03:57 PM
Finances plague NHI pilot project Doctors' and pharmacists' debit orders have been bouncing because they haven't received salaries

The long-term viability of the National Health Insurance NHI system is in doubt because its pilot project sites appear to have financial problems and have failed to pay the salaries of its medical professionals.

Doctors and pharmacy assistants contracted to assist in the project have seen their debit orders bounce while they wait for salaries from the department of health's appointed payroll administrator.

The department appointed the Foundation for Professional Development FPD as a service provider to deal with administrative processes, including the payroll. In emails sent on December 14, which City Press has seen, the foundation's payroll manager, Jackie Swanepoel, told doctors and pharmacists that the FPD was unable to pay their salaries.

"Due to unforeseen circumstances beyond our control, we will not be able to settle payments due on the 15th of December to department of health employees.

"We are aware and understand the inconvenience caused by this, and are committed to resolving the matter with the department of health and the Treasury as soon as possible. We kindly request your understanding in this matter," Swanepoel wrote in the email.

One doctor, who spoke on condition of anonymity, said the financial problems were not limited to December. "We had similar problems in September, October and November. The salaries are not paid on time and when we inquire, we are informed the department did not pay the service provider. "We are still expected to wake up every morning and work as if everything is normal. Several doctors and pharmacy assistants have already quit their jobs and more will follow if the problems are not resolved," he said.

The foundation's chief operating officer, Henk Reeder, said he understood the concerns raised by the health practitioners but, "unfortunately, FPD is contracted by the health department to provide only a payroll administrative service and, as such, we are not in a position to comment on the health department's structures and processes".

The pilot project, which started in April 2012, has 326 pharmacy assistants and 203 general practitioners doctors on the books. It will end in March, when government is expected to announce when the full NHI system will be launched. Issues surrounding NHI funding were investigated by the Davis Tax Committee, which delivered its report on the financing of the NHI in October 2016.

The government's white paper on the NHI previously said it would require R256 billion in annual funding at 2010 prices. The report estimated that, by 2025, a funding shortfall of R72 billion would be expected at an assumed average growth rate of 3.5%.

The report said that, at the real economic growth rate of just 2%, it would result in a shortfall of as much as R108 billion by 2025. Health department spokesperson Popo Maja confirmed that external payroll administrators were dealing with the project.

"The general practitioners and pharmacy assistants received their monthly payments after the 15th of the month for September and October 2016 due to a change of payment administrators, and after the 15th of November because the health department experienced an unforeseen glitch in the administrative support for this project," he said.

Maja said these payments were not necessarily late because the contract with the health professionals stated that "payment will be made by the department of health within 30 days from the date of receipt of a valid time sheet, authorised by the district manager".

He said the affected health professionals were not employees, but service providers. "Except for the periods mentioned above, the department has, however, out of our high regard for their services, persevered to pay them on the 15th of every month," he said. Maja said the problem would not affect the introduction of the NHI as the doctors and pharmacists have received payments for more than 50 months without a problem.

"This does not set the tone for what will happen under NHI. This is a pilot programme managed by the health department. It was mainly conducted to gauge interest from private health practitioners, to test models for cooperation between health practitioners and other clinic staff, and to test payment and administrative mechanisms.

"The NHI fund will be a separate entity with its own administrative processes." Asked about the resignation of some medical professionals, Maja said it was not true that professionals were leaving the pilot project because of late payments. "Whenever people have an issue with the public sector, they drag in the NHI. The issue of late payment has been resolved."

Several doctors and pharmacy assistants have already quit their jobs, and more will follow if the problems are not resolved.
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