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2019/01/09
2019/01/14 01:56 PM
IOL
A new market entrant, Health Squared Medical Scheme, is set to “redefine healthcare funding” through a personalised approach to healthcare cover for members at all income levels.

“In recent years, and largely due to macroeconomic factors, there has not been significant growth in the number of medical scheme members, a trend that received special mention by Dr Sipho Kabane, acting chief executive officer and registrar of the Council for Medical Schemes [CMS], in the Council’s recent annual report. The trend is further exacerbated by rising private healthcare costs, prompting many members to question whether their medical scheme offers true value for money,” says Health Squared spokesperson, Bianca Viljoen.

“In the midst of an industry-wide trend towards members ‘buying down’ on their healthcare cover, we believe that Health Squared’s disruptive approach will clearly illustrate that comprehensive cover can indeed be affordable. In fact, we believe that our new scheme is uniquely positioned to usher in a new paradigm, emphasising true value for money and highly accessible benefit structures that suit the needs of individuals, families and corporate clients.

“In the context of ongoing national economic challenges, employers are generally not keeping pace with healthcare inflation on their employees’ medical scheme subsidies, if these are offered at all. As a result, every Rand spent on healthcare must reflect a notable return on investment. Coupled with productivity measures and the high cost of employment, Health Squared also offers its employer groups Employee Wellbeing programmes that integrate with the scheme’s disease and other risk management programmes – a truly unique value proposition to the market,” she adds.

“For many months, the product development team of the scheme worked long hours to ensure a product and an offering that integrates healthcare risk management with other factors influencing human capital and employee benefit risk management. Therefore employers can now partner with a true expert in understanding human capital risk management and not just a product provider.”

To individuals, Health Squared’s integrated health offering ensures you can “build your own healthcare cover”, yet again a unique and integrated approach to healthcare planning, as opposed to the commodity-based solutions that have become the norm.

“Health Squared, for example, offers one of the most affordable entry-level capitation options where members are required to make use of network healthcare providers. The approach offers much-needed relief for both lower income markets, as well as employer groups that provide healthcare cover for their lower income staff, while still providing comprehensive out-of-hospital and risk benefits.

When Resolution Health and Spectramed medical scheme members voted in favour of merging the two schemes, these industry trends and the growing demand for affordable, quality healthcare cover were carefully considered. The merged scheme, which brings together 80 years of combined experience, is in a stronger position to compete in the highly saturated healthcare funding market, while maintaining financial sustainability and offering exceptional value.

As a standalone independent medical scheme, Health Squared is a strong emerging competitor with more than 40,000 members and some R210 million in reserves.

“The launch of the new scheme offered an opportunity to design our benefit options to specifically fulfil these gaps in the market by providing an array of choice for any income level, life stage or family size, and even allows for preference of benefit structure between traditional, savings and even hybrid structures, and this clearly differentiates Health Squared from its competitors.”

According to Viljoen, many consumers are moving to traditional plans that deliver substantial benefits at an affordable price. “The significance of the benefits typically offered by traditional options cannot be overstated. The combined value of out-of-hospital benefits on traditional plans are considerable, although new generation options also remain popular.

“Each of the 11 Health Squared benefit options offer unsurpassed value and richness of benefits at highly competitive prices, from the entry-level capitation hospital plans, through to comprehensive, traditional, savings and hybrid options, which include traditional benefits and personal medical savings accounts in one structure,” she adds.

“Our promise is to make sure our members are covered from every angle. Core to this promise is understanding the wants and needs of our members while remaining agile and adaptable. These principles were built into our business plan, which paves the way for an entirely new approach to the way medical schemes relate to and deal with their members.

“If the industry is to remain sustainable, such an agile approach, which embraces positive change in the interest of both the scheme and its membership base, is essential and ensures we remain relevant and at the cutting edge of what it is possible for healthcare funders to offer beneficiaries,” Viljoen concludes. 
  
2019/01/09
2019/01/14 01:57 PM
MEDICAL BRIEF
The total cost of South Africa’s Competition Commission inquiry into the private healthcare sector amounted to R197m, The Times reports Economic Development Minister Ebrahim Patel has disclosed. The commission was established in 2013 to investigate the state of competition in the private healthcare market and delivered its final report in 2018. The commission, chaired by former chief justice Sandile Ngcobo, engaged the services of panellists and specialists to assist with its work.

The report says in a written reply to a question in parliament by Democratic Alliance (DA) spokesperson on economic development Michael Cardo, Patel itemised the costs as follows: human resources and operational costs R78.6m; economic experts R39m; panel members R36.8m; data warehousing and actuarial services R13.5m; legal expertise and litigation R12.5m; data de-identification and security R9.6m; health care sector experts R5.6m; and media and communications R1.4m.

Ngcobo was paid R5.9m, while the panellists were paid as follows: Ntuthuko Bhengu R9.7m; Cees van Gent from the Netherlands R11.7m, Sharon Fonn R3.3m and Lungiswa Nkonki R6m.

The report says responding to Cardo’s questions, Patel specified that Ndzabandzaba Attorneys — which has received a large amount of work from the Competition Commission in the past — was not appointed to represent the commission in the market inquiry and so no monies were paid to it.

In reply to a question in parliament in September Patel divulged that the firm of attorneys had been paid R72m by the commission in the period from January 2015 to August 2018, including R11.8m paid to advocates.


  
2019/01/09
2019/01/14 01:58 PM
BHEKISISA
Almost one in four babies born at public hospitals come into the world via C-section but is it costing some women their lives?

For decades, caesarean sections were a last resort for mothers and babies in distress. If you had access to this kind of procedure, you could count yourself among the world’s lucky.

At the dawn of the 21st century, rates of the procedure in almost all African regions save for the continent’s north dragged along at less than 5%, recently published research in The Lancet shows.

Meanwhile, the continent was home to more than half of the 13 countries responsible for the majority of the world’s maternal deaths, World Health Organisation (WHO) data from the year 2000 shows.

At the same time, C-section rates in much of Asia and Eastern Europe hovered around 7%.

Almost 30-million babies will come into the world this year by caesarean if 2015 figures are anything to go by — nearly double the number of infants delivered in this way almost two decades before, a recent article published in The Lancet shows. The journal recently dedicated an entire series of articles that examined why C-section rates around the world are skyrocketing.

South Africa hasn’t escaped the caesarean surge. About 26% of babies born in South African public hospitals are born by caesarean, the latest available figures from the 2015/2016 District Health Barometer report show.

The annual publication charts health data from each of the country’s 52 health districts. In our district hospitals alone the rate is 24%. In 2001, about 13% of deliveries in district hospitals resulted in C-sections, earlier versions of the publication reveal.

But what’s driving this increase? When researchers behind The Lancet study looked at the numbers globally, they told a story of richer and poorer — as well as of progress and peril.

It’s a tale playing out right here at home.

Globally, who gets a C-section is now often determined by factors such as income and education rather than by sheer emergency. When scientists looked at data from 169 countries, caesareans were almost five times more frequent among the wealthiest people in low- and middle-income countries. Educated women in countries such as Brazil and China also often elected to have the procedure even when their deliveries were low-risk, The Lancet study found.

In contrast, many women in low-income and even in some middle-income countries, especially in sub-Saharan Africa, still don’t have access to the procedure — putting them at a higher risk of maternal death.

Almost twice as many procedures were performed in the private sector as in public health facilities, The Lancet study found.
In South Africa, about six out of 10 mothers in the private sector delivered by C-section in 2017, the Council for Medical Schemes’ annual report reveals.

Linda van Wyk* knew she wanted a caesarean section from the moment she realised she was pregnant.

“I didn’t get maternity leave so I had to maintain myself and plan carefully for the four months I was taking o work,” she says.

“I told my doctor that a C-section would allow me to meticulously schedule my daughter’s birth and work until the last moment, and she never told me that I couldn’t.”

In the public sector, there’s no single answer to why C-section rates are climbing, the national health department’s deputy director general for communicable and non-communicable diseases, Yogan Pillay, says.

Instead, reasons lie in everything from better access to services to declining use of other methods for dealing with difficult births.

For instance, the percentage of women who delivered at health facilities and not at home rose by 26 percentage points between 2001 and 2009, a  2010 Statistics South Africa report shows.

Increased access to medical services hasn’t just raised the overall rate of C-sections in the public sector, it has also created “hot spots”.

The largest number of caesareans take place at hospitals able to provide higher levels of care — in other words — regional, tertiary or central hospitals, according to the 2015/16 District Health Barometer.

But not every district has these kinds of facilities, meaning that those that do often cater for cases referred from their neighbours, Pillay explains.

Five district municipalities have C-section rates of 34% or more: the Eastern Cape’s Nelson Mandela Bay and Buffalo City districts, as well as Amajuba, Umgungundlovu and Ugu districts in KwaZulu-Natal.

“[These] are all districts with tertiary hospitals,” Pillay explains.

“These hospitals receive referrals for surrounding districts, and it is expected that the C-section rates will be higher in these areas because of the more complex nature of the cases they see.”

Caesareans may also be on the rise because other traditional techniques — such as the use of forceps or vacuum suction — to help deliver babies are on the decline, he argues.

A 2018 South African Medical Journal study found that less than one percent of births happen with this kind of assistance, a rate researchers say is too low and probably indicative of a lack of skills, equipment or willingness to perform assisted deliveries among healthcare workers.

And more doctors are simply afraid to deliver babies naturally for fear of litigation, Pillay explains.

In 2017, Health Minister Aaron Motsoaledi told Bhekisisa that claims against the health department since 2011 totalled more than R50-billion — or a third of the whole public healthcare budget at the time.

Obstetricians and gynaecologists are particularly vulnerable to allegations of botched births, leading to a ninefold increase in premiums to insure their practices against litigation in the past decade, he said.

“Obstetricians and gynaecologists are the prime targets,” he said. “Why is this so? They work in areas where adverse events or complications are more likely to happen."

Just how many babies should be born via C-sections has been debated for decades. The WHO has historically said “there [was] no justification for any region to have caesarean section rates higher than 10-15%”, based on a 1985 WHO expert meeting.

A 2014 review published in the journal Birth reviewed data from 19 countries, mostly in Europe and North America, and found that, although C-section rates had risen markedly in each over three decades, increases above 10% had no effect on maternal mortality when factors such as increases in quality of life and economy were factored in.

But there is no universally accepted benchmark for just how many C-sections should happen in countries, the Health Systems Trust says. This is why the research organisation no longer includes it in their District Health Barometer.

“While the caesarean section rate is important in various contexts as an indicator, with no absolute target value, it isn’t necessarily a good option for summarising district health system performance,” the organisation says.

Ultimately, it may be less about benchmarks and more about ensuring women can have a C-section when they need it.

“There is no ideal C-section rate,” Pillay says. “The idea is to ensure that all those women who require a C-section have access to one.”

But that doesn’t mean that the health department isn’t worried about the increase in procedures, which aren’t without expense or risk. C-sections can cost up to almost 60% more in the public sector than a natural birth, according to a presentation by Matan Abraham of Insight Actuaries and Consultants to the Actuarial Society of South Africa in October 2017.

The country’s latest report on maternal deaths also found a sharp increase in deaths from injuries incurred during C-sections between 2014 and 2016. Researchers argue this may indicate, in part, a growing trend as doctors contend with a greater number of difficult repeat caesarean sections. More than half of women who die of obstetric haemorrhage had caesarean deliveries, the report found.
“The mortality rate of women having caesarean sections was three times higher than those having normal deliveries,” the report warns.

Other risk factors for mothers going under the knife included risks associated with poor staffing at hospitals, particularly for anaesthesia.

“It is absolutely unacceptable and unethical that spinal anaesthesia is being administered to mothers by doctors who are unable to deal with the complications ... and who are also unable to ... administer safe general anaesthesia,” authors argue.

“Equally untenable and unethical is the ‘single operator’ for a caesarean delivery, where one doctor administers the anaesthetic and performs the caesarean section.”

In contrast, mothers undergoing the procedure in the private sector are attended to by teams of healthcare workers, including nurses, obstetricians and anaesthetists.

In recent years, the national health department has introduced its safe caesarean delivery programme in a bid to make C-sections safer. The project is supposed to include the development of criteria that would accredit facilities to provide safe C-sections by, for instance, ensuring that they have enough doctors with the surgical and anaesthetic skills to perform the procedures. But the programme and these standards have yet to be implemented, the latest national maternal death audit revealed in January.

Researchers warned that some public facilities would be unable to meet criteria and this was likely to result in some services closing — which could mean that some women would have to travel farther to access caesareans.

"I felt safe with a C-section because it happened in the private sector where a gynaecologist, assisted by a GP, a nurse, an anaesthetist and a paediatrician, performed my procedure. If anything went wrong, there were more than enough qualified staff to take care of my baby and me,” Van Wyk says.
“I’m not sure I would have made this choice if I had to rely on the much less-equipped public sector, where a GP and nurse would most probably have been the only resources,” the mother of one explains.

“Besides, the public sector wouldn’t have allowed me this choice; my choice in the private sector was a luxury.”
  
2019/01/07
2019/01/14 01:58 PM
BIZCOMMUNITY
The cost of healthcare, inadequate benefits and failing public healthcare facilities were very much in the news in 2018 and are likely to continue to feature strongly in headlines in 2019 as South Africa finds its way towards universal health coverage.

Key concerns are the escalating cost of contributions as well as inadequate medical scheme benefits. In combination, these translate into higher out-of-pocket expenditure by beneficiaries. In 2017, it was estimated that beneficiaries had to pay at least R32bn for out-of-pocket medical expenses. This is a significant amount given the challenging economic environment.

Last year indicated a different focus for medical aid schemes as there were several publications relating to reform which will affect the private healthcare space. We witnessed the publication of the National Health Insurance (NHI) Bill and the Medical Schemes Amendment Bill (MSAB), both of which had been long awaited. What the sector found disappointing was that not much was provided to beneficiaries in terms of immediate relief.

What happened in 2018

The Health Market Inquiry (HMI) published its provisional report, which was very comprehensive, soon after the publication of the two bills. There is, however, a sense of a lost opportunity as the inquiry's findings were published afterwards and have thus not made their way into the bills. The HMI findings are comprehensive and provide insights based on years of studying of the environment.

The Council for Medical Schemes (CMS) was also in on the action, they published a circular inviting comment on the framework for consolidation of medical schemes. This circular received much criticism and caused significant anxiety among the schemes, particularly those which were specifically mentioned in the circular. It is evident from the circular that more needs to be done prior to consolidation taking place.

The Presidency announced in the latter part of the year that they will be supporting processes to establish the NHI. To this end, several resources from the Presidency were allocated to drive the collaboration. The Presidential Health Summit brought in most stakeholders from the health sector to map a way forward. It looked like a key moment, as all acknowledged and reflected on the poor state of health in the country. There was excitement that there would be a chance for stakeholders to work together for the sake of the much-needed health reform.

The excitement was, however, marred after a leaked document from National Treasury highlighted some potential challenges within the internal stakeholders. The question is whether this will erode the goodwill from the summit and serve to deepen the existing trust deficit.
This year is certainly shaping up to be an even more dramatic year with many changes looming.

The Health Market Inquiry (HMI) was expected to issue its final report in December 2018. When it does come out, the key questions though are whether the recommendations will be in alignment with the other reforms and their activities sequenced to en-able ease of implementation.

What 2019 might look like

The NHI Bill should also come through in early 2019 – probably before elections. In the light of the enthusiasm that surrounded its long-awaited release, we hope it will embrace the input from the various submissions as well as discussions from the consultative meeting and the Presidential Health Summit. The prevailing narrative is that NHI is for the benefit of the citizens, it is so huge a project that there should be more collaboration among all stakeholders across the healthcare spectrum.

While all this is unfolding, we have to be cognisant of the member experience as there are already numerous pressures, mostly economic, that they have been subjected to. With the economy in its current state, other than worrying about job losses, beneficiaries will have to contend with above inflation medical scheme contribution increases. The impact will be worsened by the recently announced interest rate hike by the South African Revenue Service.

Beneficiaries will also be faced with many messages around the future of healthcare, some of which may be confusing as the media will probably be awash with stories and opinion pieces on healthcare and how it should be structured.
  
2019/01/07
2019/01/14 01:59 PM
BIZCOMMUNITY
Ground-breaking technologies are empowering healthcare systems and consumers at an unprecedented rate. And, 2019 will prove no exception to this trend. With disruption in the medical world set to accelerate, which top healthcare technology trends will lead the momentum?

Billions of people are connected to the internet, so digital connectivity is key to solving healthcare challenges. Technology giants such as Amazon, Apple, Alphabet/Google, and IBM are increasingly partnering with big names in healthcare. And many Silicon Valley start-ups have joined the fray, to command and streamline areas of the healthcare value-chain long-plagued by waste and redundancies - and ripe for a digital overhaul.

Whether those technology entities that have healthcare’s future in their crosshairs will prove to offer real customer-centricity and long-term savings through their innovations, remains to be seen. Certain technologies have proven their worth in putting patients at the centre of personalised, quality healthcare. And, three powerful technology trends will continue to do just this, in 2019.

Tele-medicine’s titanic potential

Recently, Doctors Without Borders/Médecins Sans Frontières (MSF) physician Dr Adi Nadimpalli, a specialist in internal and paediatric medicine based in South Sudan, treated a pregnant woman with a likely heart valve problem. Her ultrasound images were digitally sent from South Sudan to a telemedicine doctor in Canada, a cardiologist in the US, a specialist anaesthesiologist in Paris and an obstetrician in Australia, confirming mitral stenosis. An elective C-section and tubal ligation, which saved both mother and baby girl, followed. Since 2010, Médecins Sans Frontières (MSF) has used telemedicine to connect doctors in remote areas with more than 280 global experts, for virtual back up within minutes, 24/7. Up to 10 cases a day are dealt with in this way. Telemedicine, telehealth, or mHealth (mobile health) – remote patient diagnosis and treatment by means of telecommunications technologies – is key to treating patients with reduced access to primary healthcare.

Telemedicine has really enabled a new world of interaction between consumers and healthcare experts, bringing measurable cost efficiencies. Take, the free-to-use, Vula app, founded locally in 2014 and now the official referral system for the Western Cape Department of Health. It is also being used in five other provinces (80% in public sector, 20% private sector). Around 5,550 healthcare workers in rural areas use Vula to connect with specialists in the region, who are often located hours away. In under 15 minutes, they receive advice about whether to treat a patient locally or refer on. Vula facilitates interaction across 17 medical disciplines, helping over 300 patients a day. There’s an average reduction of 31% in physical referrals, saving both time and costs for patients and the healthcare system.

Teladoc, the leading telemedicine provider in the US with a 70% share of the market, has shown a doubling in telemedicine uptake between 2013 and 2017 year on year. Though they calculate their market penetration at only 1%, virtual consultations realized a saving of around $300m to their healthcare system in 2017 alone. This means a total potential saving of $30 billion.

Global telehealth adoption is driven both by the fact that people are living longer and by the global explosion in costly, chronic diseases of lifestyle. In both contexts, telehealth fundamentally reduces barriers to communication between patients and their healthcare providers to work at preventing disease, or existing conditions, from worsening. It’s estimated that virtual consultations may comprise 80% of patients’ first medical contact in both Israel and parts of the USA.

Telemedicine’s applications abound. Discovery Health’s DrConnect app allows users to access vetted medical information through a worldwide network of over 105,000 doctors, or search a library of over five-billion doctor-created answers to common medical questions. As users pose personal medical questions, the app’s AI system narrows down possible diagnoses, with advice on whether to consult a doctor, and how urgently. Patients can use the app to book virtual consultations with doctors they’ve seen face-to-face in the previous 12 months.

There will be continued efforts to realise telemedicine’s profile in South Africa in 2019 - as we strive to define regulations governing everyday doctor-member interaction via these platforms, as well as reimbursement for remote patient-monitoring.

Cutting-edge drugs defining a new world of healthcare

Cutting-edge, targeted drugs therapies, have revolutionised the way we treat common illnesses. In fact, the 2018 Nobel Prize in Physiology or Medicine went to Immunologists, Dr James Allison and Tasuku Honjo who each discovered ways to stimulate the inherent ability of the immune system to attack tumour cells. This sort of research has, since 2011, fuelled the development of various so-called immunotherapy drugs, revolutionising and personalising the care of previously untreatable cancers. During 2019, billions will continue to be invested in the development of new compounds that could form the basis of similarly life-extending or -saving drugs.

Yet, the challenge will remain providing access to these medications universally, as their high development costs mean they come to market at a premium. In 2016, 89 Discovery Health Medical Scheme (DHMS) members requiring these high-cost medicines each claimed an average of R1.4m. Compared to the R608m spent on such drugs in 2010, the scheme paid out R1.5bn in 2017 - almost a tripling in costs. The number of members claiming towards these medications has increased seven-fold since 2008 - and this trend will continue into 2019.

Big data analytics and machine learning enable greater personalisation of care for all

Forecasts suggest that by 2025, the global data sphere will grow to 163 zettabytes (ZB) or 163-trillion gigabytes - 10 times the 16.1ZB of data generated in 2016. Our increasing ability to accurately analyse new kinds of health data, means 2019 will propel us further from a one-size-fits-all approach to treatment and deeper into personalised medicine. This is due to machine learning, a facet of artificial intelligence (AI), which allows for analysis of enormous data sets from thousands of people, yielding insight applicable to predicting health risk, in a single individual.

Machine-learning is also what enables the latest Apple Watch Series 4 to detect an irregular heart rate and rhythm and send an electrocardiogram to a doctor so that high-risk patients can access timeous medical care. The watch also detects hard falls and alerts emergency services. In a world in which older people are living longer, and in which heart disease is a leading global killer, this sort of technology literally saves lives.

In 2019, Discovery Health will launch a machine-learning powered platform which, on admission to hospital, will predict a patient’s risk of complications, hospital-acquired infections, future re-admissions or mortality. A good, early understanding of these risks allows for the right interventions and better outcomes.

We are also using machine learning to develop an app-based platform that will offer medical scheme members a personalised prediction of their risk for developing diabetes, hypertension or hyperlipidaemia, based on their unique health metrics. Members of the DHMS will also have access practical and specific advice - through the Discovery app - to address the underlying behaviours that are fuelling their risk, with rewards for following the individualised advice.

There will be significant volumes of data emanating from the Medical Internet of Things - wearable fitness devices and other connected health monitors. These allow for remote patient-monitoring by sending out continuous biometric data to healthcare providers. Wearable and ingestible devices can track systems as varied as gut health, heart rate, activity levels, stress and insulin levels, and more.

Globally, the world of wearables now features research into bio sensing patches and digital tattoos that monitor metrics such as blood sugar levels for people with diabetes, sensor-embedded bandages, implantable and ingestible medical devices, at home vision-testing devices and even tiny tooth-mounted sensors that aim to track a person’s food intake.

In summary, as public support for AI-based platforms grows, 2019’s technology-driven, digitally-enabled offerings will continue to empower patients and providers alike, realising their aims to contain costs, remove bottlenecks and improve quality of care across the healthcare spectrum.
  
2019/01/02
2019/01/14 02:07 PM
THE TIMES
The total cost of the Competition Commission’s inquiry into the private healthcare sector amounted to R197m, economic development minister Ebrahim Patel has disclosed.

The commission was established in 2013 to investigate the state of competition in the private healthcare market and delivered its final report in 2018.

The commission, chaired by former chief justice Sandile Ngcobo, engaged the services of panellists and specialists to assist with its work.

In a written reply to a question in parliament by DA spokesperson on economic development Michael Cardo, Patel itemised the costs as follows:

• human resources and operational costs R78.6m;
• economic experts R39m; panel members R36.8m;
• data warehousing and actuarial services R13.5m;
• legal expertise and litigation R12.5m;
• data de-identification and security R9.6m;
• health care sector experts R5.6m;
• and media and communications R1.4m.

Ngcobo was paid R5.9m, while the panellists were paid as follows: Ntuthuko Bhengu R9.7m; Cees van Gent from the Netherlands R11.7m, Sharon Fonn R3.3m and Lungiswa Nkonki R6m.

Responding to Cardo’s questions, Patel specified that Ndzabandzaba Attorneys — which has received a large amount of work from the Competition Commission in the past — was not appointed to represent the commission in the market inquiry and so no monies were paid to it.

In reply to a question in parliament in September Patel divulged that the firm of attorneys had been paid R72m by the commission in the period from January 2015 to August 2018, including R11.8m paid to advocates.
  
2018/12/07
2018/12/10 04:19 PM
MEDBRIEF AFRICA

It is back to the drawing board for the Department of Health on the National Health Insurance (NHI) Bill after Cabinet decided to send it back to the department for more work. The Bill was presented to Cabinet yesterday, but statements on its website indicate that it was not approved during yesterday’s session with various other draft legislation destined for Parliamentary approval.  Presidential spokesperson, Khusela Diko confirmed to MedBrief Africa last night that the Bill was presented to Cabinet but that it was not approved and will only be finalised early next year.

According to a report by Health-e News government sources have confirmed that a special Cabinet meeting will now be held at the end of January next year to discuss the Bill and decide on the way forward.

The decision by Cabinet to refer the Bill back comes amidst fierce criticism from stakeholders in the healthcare sector and civil society warning that rushing the legislation through in its current form could lead to a total collapse of the healthcare system. However, in a strongly worded statement last week, Health Minister Aaron Motsoaledi slammed critics of the Bill and media reports that a team led by presidential advisor Dr Olive Shisana made changes to the document initially approved by the then Minister of Finance, Nhlanhla Nene and the Health Minister for presentation to Cabinet.

This was confirmed in a letter written by the deputy director-general of Treasury, Ismail Momoniat to Shisana and leaked to the media last month. It was also revealed that the Director-general of Health, Precious Matsoso was side lined in the process and not provided with a copy of the revised Bill as it made its way to Cabinet. A version of the Bill which contains the changes referred to in the letter to Shisana is dated 5 October indicating that the Department of Health couldn’t possibly consider the hundreds of comments on the draft Bill released in June this year as the deadline for submissions was only the 21st of September.

The delay of the Bill comes only a few days after the Health Market Inquiry into the private sector announced that it had postponed the release of its final report and recommendations to the end of March next year to provide it with enough time to seriously consider all input it had received from stakeholders on the provisional report. It was expected that the Department of Health would consider the final recommendations of the HMI report for inclusion in the NHI Bill.
  
2018/12/07
2018/12/10 04:20 PM
BUSINESS DAY
Thursday’s statement makes it clear the cabinet has not given the bill the green light, but it is unclear what its concerns are.

The cabinet has rejected the fiercely contested National Health Insurance (NHI) Bill, sending it back to the health department for further work, it emerged on Thursday.

The bill paves the way for far-reaching health reforms aimed at achieving the ANC-led government’s ambition of providing universal health coverage. Its main aim is to establish an NHI fund that will purchase health services on behalf of patients from public- and private-sector providers, which will be free at the point of care. A key aspect of the bill is the future role it envisages for medical schemes, which currently provide cover to about 8.9-million people.

The bill has been mired in controversy in recent weeks, after a leaked Treasury letter laid bare conflict between its officials and presidential adviser Olive Shisana after she reversed aspects of the bill previously agreed to by the ministers of health and finance. The Treasury raised a host of concerns, ranging from the sharply diminished role of medical schemes laid out in the revised version of the bill to a lack of consultation about far-reaching proposed changes to the role of provincial health departments.

Shisana heads the NHI "war room" in the presidency, which took control of the NHI process in August.

Shortly after the Treasury letter was leaked in mid-November, health director-general Precious Matsoso went public with her concerns, saying she had been completely side lined in the process of revising the bill after the public comment period close, despite being the department’s accounting officer. The bill was redrafted by Shisana and two people selected by health minister Aaron Motsoaledi — his adviser, Aquina Thulare, and deputy director-general Anban Pillay.

Without directly alluding to it, a statement issued on behalf of the cabinet on Thursday made it clear that it had not approved the bill for submission to parliament at its latest meeting on Wednesday. It was not on the list of bills and policies approved for public comment, nor was it on the list of draft legislation that had been given the green light to enter the parliamentary process.

Presidential spokesperson Khusela Diko confirmed the bill came before cabinet on December 5 and had not been approved. "It will be finalised in the New Year," she said.

She declined to elaborate on the cabinet’s concerns about the bill, saying she was unable to comment on the processes.

Attempts to obtain comment from acting cabinet spokesperson Phumla Williams were unsuccessful on Thursday.

Motsoaledi’s spokesperson, Popo Maja, declined to comment on the cabinet’s deliberations or the status of the NHI Bill, as did finance minister Tito Mboweni’s spokesman, Jabulani Sikhakhane.

Motsoaledi had previously defended the government’s approach to crafting the bill, saying that there had been nothing irregular in the manner in which it was being processed.
  
2018/12/07
2018/12/10 04:35 PM
IOL
A new procedure that can drastically improve the lives of leg amputees was recently performed for the first time in South Africa.

The procedure involves a revolutionary new type of prosthesis that does away with traditional suction sockets by directly attaching an amputee’s prosthetic limb to their skeleton.

Professor Nando Ferreira from Stellenbosch University’s Division of Orthopaedics, who was the lead surgeon, collaborated with the Institute for Orthopaedics and Rheumatology at Mediclinic Winelands, prosthetist Eugene Rossouw, and associate professor Munjed al Muderis of the Osseointegration Group of Australia, to perform South Africa’s first osseointegration prosthesis implant on November 5.

The recipient was a 28-year-old woman who suffered a traumatic above-knee amputation in 2009. Since then, she has struggled with her socket prosthesis, which interferes with her occupation and daily life.

The patient has progressed well, and her first prosthesis fitment was done two weeks after the surgery.

She has begun a 12-week rehabilitation protocol that involves progressive weight bearing while using two crutches for six weeks, followed by another six weeks using one crutch.

The procedure was originally developed in Australia by Al Muderis, the Australian surgeon who pioneered osseointegration and developed the Osseointegration Group of Australia Osseointegration Prosthetic Limb (OGAP-OPL) prosthesis, the surgical technique, and the rehabilitation protocol over the last decade.

About 750 surgeries have been performed, mostly in Australia.

“The OGAP-OPL is a revolutionary prosthesis that does away with traditional suction sockets by attaching an amputee’s prosthetic limb to the skeleton. This affords amputees unique advantages and can drastically transform their quality of life,” Ferreira said.

Amputees frequently suffer problems with traditional suction sockets, including skin irritation, poor fit due to sweating and volume changes of the stump throughout the day, discomfort while sitting, and the time it takes to attach and remove a prosthesis.

These socket-related problems are eliminated with an osseointegration prosthesis.

Recipients also have a better perception of the body’s position and movement and can feel the surface they are walking on, allowing them to walk with more confidence.

The osseointegration prosthesis restores the normal anatomical alignment of the thigh bone, which significantly reduces common gait deviations in above-knee amputees.

However, the procedure is not without complications, most significantly infection around the implant and fractures of the remaining bone.

“Candidates are carefully screened for suitability and currently only individuals suffering severe socket problems that significantly interfere with work and daily life are considered for this procedure,” Ferreira said.

“The unique design, materials and manufacturing process of the OGAP-OPL allows bone to grow into the surface of the implant.”
  
2018/12/06
2018/12/10 04:20 PM
HEALTH-E NEWS
A special Cabinet meeting will be held on 30 January with the NHI, which lays the groundwork for a single health system, the only item on the agenda.

The Bill was presented to Cabinet on Thursday, where state law advisers assured members that the Bill did not contravene the Constitution.

The Cabinet statement made no mention of the NHI, leading to speculation that the Bill had been rejected.

However, two well-placed sources confirmed to Health-e that, as the Cabinet agenda was full, Cabinet members had decided to defer the Bill to a special Cabinet meeting on 30 January. The NHI, which lays the groundwork for the establishment of a single health system, will be the only item on the agenda at this meeting.

The Department of Health declined to comment on the process, with spokesperson Popo Maja saying it was a Cabinet matter.

The NHI Bill sparked controversy recently when the Director General of Health, Precious Matsoso, said she had neither seen the final draft nor signed off on it before it had been referred to a Cabinet sub-committee last week.

However, Matsoso confirmed this week that she had since received a copy of the Bill, and confirmed that the NHI process was being driven by a “war room” located in the Presidency convened by Dr Olive Shisana.

Health Department Deputy Director General Anban Pillay has been seconded to the Presidency to assist Shisana.

The NHI proposes a radical shake-up of the country’s health system based on compulsory contributions from all working people towards an NHI Fund. The fund will then disburse funds to health institutions – public and private – that meet certain basic criteria and are accredited as service providers by the Office of Health Standards Authority. All citizens will then be able to get health care from any accredited facility based on their needs.

It is unclear whether private medical aids will continue to exist as most working people will be unable to afford to pay contributions to both the NHI Fund and private schemes.

At the recent Presidential Health Summit called to discuss the NHI, a number of civil society organisations called on government to fix the ailing health service before introducing the NHI.

However, Health Minister Aaron Motsoaledi has condemned them as being against universal healthcare.
  
2018/12/06
2018/12/10 04:21 PM
DAILY MAVERICK
The opinion piece by Busani Ngcaweni is misplaced, inaccurate and at best wishful thinking.

In an opinion piece, Busani Ngcaweni contends that the National Health Insurance (NHI) is a cure-all to all South Africa’s health needs while the reality is that the public healthcare system is on life support.

While the goals of providing universal healthcare are important it is clear that the ANC government lacks the political will and capacity to deliver it. Plans by the Minister of Health, Dr Aaron Motsoaledi, to push ahead with the National Health Insurance are an act of desperation and form part of the ANC’s electioneering tactics. It is a decision doomed to failure from the outset.

The NHI proposal has never been properly costed with Motsoaledi admitting that he had no idea how much it would cost or where the money would come from. Meanwhile, NHI pilot projects have failed abysmally wherever they have been trialled.

What Ngcaweni fails to mention is the backdoor dealings of Motsoaledi following the introduction of the NHI Bill. It was reported that Motsoaledi had made substantive changes to the Bill and presented a new version to Cabinet without consulting with National Treasury or senior members of his own department. Instead, reports suggest that the changes are the brainchild of Motsoaledi and presidential adviser Dr Olive Shisana.

The Minister made substantive changes to the existing Bill that effectively kill the private healthcare system. This includes restricting medical aid or other private health insurance schemes to providing only complementary cover, effectively making NHI the only game in town. The effect of this is nothing short of nationalising the private healthcare industry by making the State the sole purchaser of healthcare services. The Minister did not take any input from the public seriously, as the proposed changes are substantive, and the public and other stakeholders have not had an opportunity to raise their concerns.

The proposed creation of a single National Health Insurance Fund is little more than the creation of another enormous state-owned entity (SOE). This is greatly concerning considering the government’s dismal performance in managing SOEs, endemic corruption and its equally dismal performance in providing healthcare. Much like government’s failed management of Eskom, South Africa will surely be heading towards a healthcare “blackout” if NHI is fully implemented.

The Minister is completely out of touch with the crisis in the South African public health system, and this was highlighted by his denial of the ongoing health crisis.

DA visits to hospitals and clinics around the country have exposed medicinal shortages, equipment shortages and a severe shortage of beds. In most hospitals visited, infrastructure is collapsing and lack of maintenance in facilities is painfully obvious. Doctors are leaving the public health sector in droves. They cannot work under the present conditions with lack of resources, very long hours due to lack of effective personnel and maladministration at every level. While the Western Cape has 33 specialists per 100,000 residents, Limpopo only has 1.3 specialists per 100,000. The MEC of Health in Limpopo stated: “If people are one day sick and require a specialist, they will wish they were born in the Western Cape.”

The current and revised NHI Bill fails to address the real crisis in the health sector.

First, it cannot be implemented due to failure in the current health sectors which cannot deliver effective healthcare to the majority of South Africans.

Second, the Minister himself cannot tell us what the costs of implementing the Bill will be and advises that it will take up to 15 years to effectively implement. The provinces cannot manage current budgets and have all declared they are under-financed.

Third, the NHI pilot projects have failed abysmally already. If a pilot project is unsuccessful, there is no chance that it will be successful nationally. Lastly, the NHI aims to put a cap on the amount of private health insurance providers and medical aids. This creates a risk of monopoly in the industry, price fixing and collusion.

There is however hope for quality universal healthcare.

After extensive consultation with both academia and the industry, the DA’s offer, titled Our Health Plan – to uplift the health sector and introduce a practical and sustainable health plan – is far more effective. It can be rolled out and put into effect within five to eight years, takes into account the needs of all South Africans and, where put into practice, has proved itself.

Furthermore, Our Health Plan will provide quality healthcare which is affordable and can be implemented using our current health budget. This would mean that medical aid contributions would no longer be tax deductible. The additional revenue would go to reducing the costs of medical aid.

Where the Our Health Plan is implemented in the Western Cape, the province has shown that it can deliver better healthcare than in any other provinces, a fact recognised by the MEC of health in Limpopo. Mortality rates are lower – half of any other province, it has attracted the highest number of South African doctors and has the highest number of specialists per capita. Hospitals and clinics are better maintained and have far better resources.

The Minister aims to rob Peter to pay Paul. The current health system has collapsed and is in the severe financial crisis. It can be fixed but will require proper leadership, less corruption and better management and appropriate use of budgets.

The DA health plan is the only alternative to resuscitate a broken system.

Lindy Wilson DA Deputy Shadow Minister of Health.
  
2018/12/06
2018/12/10 04:21 PM
BUSINESS DAY
Thursday’s statement makes it clear cabinet has not given the bill the green light, but it is unclear what its concerns are.

Mystery surrounded the status of the National Health Insurance (NHI) Bill on Thursday, after the government issued a post-cabinet statement silent on the hotly contested draft legislation. The bill paves the way for a suite of far-reaching reforms aimed at achieving the ANC-led government’s ambition of providing universal health coverage. It proposes establishing an NHI fund that will purchase health services on behalf of patients from public- and private-sector providers, which will be free at the point of care.

A key aspect of the bill is the future role it envisages for medical schemes, which currently provide cover to about 8.9-million people. Last week presidential spokesperson Khusela Diko said the bill had been due to be tabled before the cabinet on December 5. While Thursday’s statement makes it clear that the cabinet has not given the bill the green light, it is unclear what its concerns were and what action it may have subsequently demanded of either the health department or the presidency.

The statement contains a list of bills and policies that have been approved for public comment, as well as legislation approved for submission to parliament. The presidency has established an NHI “war room” led by presidential adviser Olive Shisana. Working closely with two people selected by health minister Aaron Motsoaledi, she has led the process of revising the NHI Bill, which was released for public comment in June. The submission period closed on 21 September.

Motsoaledi’s spokesperson, Popo Maja, declined to comment on the cabinet’s deliberations, or the status of the NHI Bill. Acting cabinet spokesperson Phumla Williams and presidential spokesperson

Khusela Diko was not immediately available for comment.
  
2018/12/06
2018/12/10 04:36 PM
NETWERK24
’n Opwindende nuwe prosedure wat die lewe van mense met onderste ledemaat-amputasies drasties kan verbeter, is onlangs vir die eerste keer in Suid-Afrika uitgevoer.

’n Professor aan die Universiteit Stellenbosch (US), in samewerking met die Instituut vir Ortopedie en Rumatologie (IOR) by die Mediclinic Winelands, die prostetikus Eugene Rossouw, en medeprofessor Munjed Al Muderis van die Osseo-integrasiegroep van Australië, het op 5 November vanjaar Suid-Afrika se eerste osseo-integrasie-prostese-inplanting uitgevoer.

Die US se fakulteit geneeskunde en gesondheidswetenskappe (FGGW) sê in ’n verklaring die prosedure is oorspronklik in Australië deur Al Muderis ontwikkel, en behels die chirurgiese inplanting van die Osseo-integrasiegroep van Australië se osseo-integrasie- prostetiese ledemaat (OGAP-OPL).

“Die OGAP-OPL is ’n revolusionêre nuwe soort prostese wat wegdoen met die tradisionele prostetiese vassuig-sok deur die prostetiese ledemaat direk aan die persoon se skelet te heg. Dit bied unieke voordele wat die lewensgehalte van mense met amputasies drasties kan verbeter,” sê prof. Nando Ferreira van die US se afdeling vir ortopedie aan die FGGW.

Ferreira is die chirurg wat die prosedure gelei het.

Mense met amputasies ervaar gereeld probleme met die tradisionele sok-prostese, insluitende velirritasie, probleme met hoe dit pas weens byvoorbeeld sweet en veranderinge in die volume van die stompie deur die loop van die dag, ongemak wanneer hulle sit, en die tyd wat dit neem om die prostese aan te sit en af te haal.

“Kandidate word versigtig gekeur vir geskiktheid en tans word slegs individue vir die operasie oorweeg wat ernstige sok-probleme ervaar wat groot inbreuk maak op hul werk en daaglikse lewe.” prof. Nando Ferreira

Probleme wat verband hou met sok-prostese is iets van die verlede met ’n osseo-integrasie-prostese aangesien dié prostetiese ledemaat direk aan die skelet geheg word. Ontvangers het ook beter propriosepsie (persepsie van die ledemaat se posisie en beweging) en kan die loop-oppervlak voel, wat hulle toelaat om met meer selfvertroue te loop.

Die osseo-integrasie-prostese herstel ook die normale anatomiese lynrigting van die dybeen (femoraal) (sien beeld hierby), wat algemene loop-afwykings verminder in mense met amputasies bo die knie. Die prosedure is egter nie sonder komplikasies nie.

Infeksie rondom die inplanting en frakture in die oorblywende been is die mees beduidende komplikasies wat ná osseo-integrasie kan voorkom. “Kandidate word versigtig gekeur vir geskiktheid en tans word slegs individue vir die operasie oorweeg wat ernstige sok-probleme ervaar wat groot inbreuk maak op hul werk en daaglikse lewe,” sê Ferreira. Die ontvanger van Suid-Afrika se eerste osseo-integrasie-prostese-inplanting is ’n 28-jarige vrou wat in 2009 ’n traumatiese amputasie bo haar knie gehad het. Sedertdien sukkel sy met haar sok-prostese, wat inbreuk maak op haar werk en alledaagse aktiwiteite. (Die pasiënt verkies om anoniem te bly.)

Só werk dit:
“Die OGAP-OPL se unieke ontwerp, materiaal en vervaardigingsproses laat toe dat daar been binne-in die oppervlak van die inplantasie groei en so “integreer” die prostese met die skelet.

’n Spesiaal ontwerpte stut wat dan deur ’n opening in die stompie steek, wat chirurgies gemaak is, vorm ’n koppelingspunt vir die eksterne komponente van die prostetiese ledemaat,” verduidelik Ferreira.

Al Muderis is die Australiese chirurg wat die baanbrekerswerk oor osseo-integrasie gedoen het en oor die afgelope dekade die OGAP-OPL-prostese ontwikkel het, asook die chirurgiese tegniek en die rehabilitasie-protokol.

Tot nou is die prosedure al ongeveer 750 keer uitgevoer, meestal in Australië.

“Prof. Al Muderis se entoesiasme om die lewe van mense met amputasies te verander, is sigbaar in sy onvermoeide werk en gewilligheid om ander chirurge op te lei in sy tegniek,” sê Ferreira.

Prof. Al Muderis se entoesiasme om die lewe van mense met amputasies te verander, is sigbaar in sy onvermoeide werk en gewilligheid om ander chirurge op te lei in sy tegniek. prof. Nando Ferreira Ferreira het na Sydney, Australië, gereis saam met die egpaar Eugene (prostetikus) en Fransien (fisioterapeut) Rossouw, om opleiding van Al Muderis te ontvang in die chirurgiese prosedure, prostetiese passing en rehabilitasie. Hierdie span is tans die enigste groep wat gesertifiseer is om die OGAP-OPL-prosedure in Suid-Afrika uit te voer.

Vir die chirurgie op die plaaslike pasiënt is Ferreira bygestaan deur dr. Gerhard Pienaar, ’n ortopediese chirurg van die Instituut vir Ortopedie en Rumatologie aan die Mediclinic Winelands, en Al Muderis, wat van Australië gereis het om toesig te hou oor die operasie. Die pasiënt sterk goed aan en het haar eerste prostese-passing twee weke gelede gehad. Sy het begin met die 12 week lange rehabilitasie-protokol wat progressiewe gewigslading vir ses weke met twee krukke behels, gevolg deur ses weke van bystand-mobilisasie met een kruk.

Die span is van plan om hierdie prosedure aan nog pasiënte te bied, in die openbare, sowel as die private gesondheidsektor, en hoop dat dit ’n goed aanvaarde opsie sal word vir Suid-Afrikaners met amputasies, volgens die verklaring.
  
2018/12/06
2018/12/10 04:36 PM
BIZCOMMUNITY
In a first for South Africa, a 28-year-old patient with a previous trans-femoral amputation has received a successful osseointegration prosthetic limb implant.

The surgery was performed by Professor Nando Ferreira, an orthopaedic surgeon at Stellenbosch University, as the lead surgeon. He was assisted by Dr Gerhard Pienaar, an orthopaedic surgeon at Mediclinic Stellenbosch. They were joined by Dr Munjed Al Muderis, an orthopaedic surgeon from Sydney, Australia, who has pioneered the technique and the device itself. Ferreira travelled to Sydney in 2018 to learn the procedure, and he is currently the only surgeon in South Africa who is certified to use the implant

Addresses limitations of traditional prosthesis

“This is a revolutionary technology,” says Muderis. “It changes the whole philosophy of how to treat and manage someone with an amputated limb. Before we would use a bucket prosthesis that encases the residual limb. With this procedure, we can directly attach the prosthetic limb to the skeleton. This reorganises the muscles and nerves to operate the limb.”

This procedure addresses a number of limitations of the traditional prosthesis approach, says Muderis. “The vast majority of amputee patients will at some stage have trouble fitting a bucket or socket prosthesis. They will struggle with skin issues, as the contact can cause friction, heat and chafing, and over time lead to blisters and infections, as well as mobility and fit. The human body changes as time goes by, and a bucket prosthesis that fitted perfectly in the morning will often not suffice by the afternoon or evening, as the residual limb swells in response to weather and pressure conditions.”

He says an osseointegration prosthetic limb implant can also help amputee patients regain their sense of confidence. “With a socket prosthesis, there is a lack of feedback from the ground. So when you walk, you walk as if you are on a hovermat. They do not feel the ground. So they will need to look at the floor all the time as they move, and are unable to walk in dark rooms. With this technology, they get 100% feedback from the ground.”

It also addresses a number of long-term issues. “In a traditional socket prosthesis, both the femur and hip joint are not loaded naturally, which results in degeneration and atrophy of the bone and can lead to osteoporosis," says Muderis.

Modelled on anatomy

The osseointegration prosthetic limb is modelled on the anatomy of the human body. “This prosthetic implant takes the load back to the femur and the hip joint when walking. This allows for direct contact to the ground, which provides greater stability and more control, and minimises energy exerted.”

During the procedure, surgeons refashion the muscles around the implant, says Muderis, using a technique known as myodesis. They will then implant the device into the bone, which over time will allow the bone to grow into the implant. This has the effect of allowing the muscles around the bone to operate the limb.

Only 750 cases of this surgery have been performed globally in the past 10 years. This procedure is still seen as revolutionary and only performed on a relatively regular basis in Sydney, Australia. Other centres in England, the Netherlands and Sweden are performing these procedures, albeit in limited numbers.
  
2018/12/06
2018/12/10 04:38 PM
BUSINESS REPORT
It is a fascinating time for healthcare globally. Shifting demographics, cost pressures, policy changes, consumer ism, and rapid advances in technology will change the face of healthcare as we know it.

South Africa has its own unique challenges and opportunities. The triple threats of poverty, inequality and unemployment mean many citizens are simply unable to access quality healthcare.

The introduction of National Health Insurance NHI in South Africa aims to address this issue, presenting real opportunities for public private partnerships and innovation.

Shifting global demographics and the demand for healthcare:
People are living longer, many with chronic conditions. We also see population growth, particularly in developing markets such as Africa expected to grow by 2.4 billion by 2050. Populations are becoming increasingly unhealthy, driven by sedentary life styles, high personal stress levels, and poor dietary habits.

The result is an increasing disease burden on health systems. In South Africa alone, 50 people die every day due to diabetes, while an additional 35 lives are lost daily due to respiratory diseases.

At Life Healthcare we are seeing increasingly complex cases, both in terms of diagnoses and treatment. We recognise that our patients require quality care, not only in acute facilities, but across the entire continuum of care.

For this reason, in addition to maintaining the highest quality of care in our hospitals, we are also focusing on building our non-acute offering from primary care services to mental health, rehabilitative care and diagnostic services.

Rising cost pressures:
Healthcare costs are rising globally, jeopardising affordability of healthcare for many. Most healthcare systems are looking at ways to cut costs, and improve disease prevention in society.

At Life Healthcare we pride ourselves on our operational efficiency. We continually work hard to ensure that we remain an effective, productive healthcare provider, without ever compromising on our commitment to quality patient care.

We are also strengthening our offering across the continuum of care to empower patients to take ownership of their health, and to support prevention as well as cure.

Changes in policy and regulatory environments:
Globally the healthcare regulatory environment is complex and evolving. In South Africa, the NHL Medical Schemes Amendments Bills, and outcomes of the Health Market Inquiry will change the healthcare landscape fundamentally.

The goal of universal health care will require strong partnerships between public and private players. If we look for creative solutions and leverage the best from the public and private sector, we have an opportunity to significantly improve healthcare access and affordability in the country.

While we at Life Healthcare appreciate the challenges of execution, we are excited to help deliver on new healthcare models to benefit population segments we don't currently serve.

Consumer centricity:
As people become accustomed to personalised, digital offerings in retail and banking, they will expect similar experiences when it comes to their healthcare. Connectivity and access to information mean healthcare consumers are becoming more knowledgeable and better able to compare quality and outcomes across clinicians and medical service providers.

Patients also demand convenience. In Europe, for example, home based care is gaining traction, while personalised care, walk in services and virtual queueing are also becoming popular.

Evaluation and measurement of patient experience has fast become international best practice and assists in ensuring patient centred care remains a priority for healthcare service providers globally. At Life Healthcare, we are commit ted to clinical excellence and patient centricity.

To this end, in South Africa we publish our patient experience scores in real time, giving insight into the hospital stay and the level of service.

Technology and healthcare access:
The World Health Organisation WHO predicts rapid advancements in technology will drive better quality of healthcare and enable greater access to services by providing more diverse treatment models while lowering costs.

Similarly, the 2018 Philips Future Healthcare Index FHI finds that technology and digital innovation, artificial intelligence, and connected care will be important enablers of healthcare access and ground-breaking treatments, despite the impact of rising costs on affordability.

At Life Healthcare we believe in the potential of technology to transform healthcare. We continuously seek ways to source cutting edge technology to improve patient quality, patient experience and efficiency.

One area already benefiting from technological advancements, and which will continue to grow is diagnostic imaging. Making use of smarter technology means healthcare providers can enhance the patient experience by lowering the risk of diagnostic errors while speeding up the provision of better, more affordable treatment.

We have seen the growing impact of diagnostics within integrated care and Life Healthcare has invested in these capabilities by acquiring the leading European provider of complex molecular and diagnostic imaging services, Alliance Medical Group, to strengthen our offering in this field and provide the best experience to patients across the whole continuum of care. Furthermore, advancements in surgical technology are making a positive impact on surgical outcomes for both the patient and the surgeon.

Life Healthcare's investment into robotics aligns to our strategy to invest in appropriate and proven technologies to remain technologically relevant and drive clinical quality and improved outcomes for our patients. Robotic assisted surgery, for example, allows minimally invasive procedures which reduces the need for blood transfusion and benefits patient outcomes in term of less postoperative pain, reduced risk of wound infection, as well as a shorter hospital stay and faster recovery. To this end, Life Healthcare has invested in a robotic assisted surgical system which will allow us to offer this technology at Life Kingsbury Hospital.

Setting up for future growth:
As healthcare providers, we must develop innovative healthcare models, while continuing to focus on efficiency, quality and patient centricity. We must also build strong partner ships to improve healthcare access and affordability. Despite its challenges, the future of healthcare in South Africa can be bright.

Dr Shrey Viranna is the chief executive of the Life Healthcare Group.
  
2018/12/05
2018/12/10 04:22 PM
BUSINESS DAY
A total 3,535 nurses qualified in 2018, of whom 3,470 have already been placed, MPs told.

Virtually all SA’s newly qualified nurses have been placed in public sector posts for 2019, a senior health department official assured MPs on Wednesday.

In contrast to the last-minute scramble to find positions for new nurses in previous years, the process of placing nurses who qualified in 2018 has gone smoothly, according to the department’s chief operating officer, Gail Andrews.

A total of 3,535 nurses qualified in 2018, of whom 3,470 had already been placed, she told parliament’s portfolio committee on health. SA nurses have been given priority, and the handful of nurses who have not been offered posts in the public sector are foreigners who are studying in SA, she said.

All 248 bursary holders from Limpopo have been placed in posts in the province, she said. Bursary holders are required to work for a period in the province that funded their studies.

The department’s chief nursing officer, Nonhlanha Makhanya, briefed MPs on ongoing reforms to nursing qualifications, and the rationalisation of nursing colleges.

Nursing colleges fall under the jurisdiction of provincial health departments, which determine their five-year enrolment plans based on their needs and the available resources.

Following several years of reorganisation, each province now has a single nursing college with satellite campuses, and the nursing schools previously located in hospitals are being converted into clinical training units or sub-campuses, she said. The South African Military Health Services also runs a nursing college.

From 2020, a new three-year diploma in general nursing will be offered by nursing colleges. This will be the entry-level nursing qualification, and students can obtain advanced diplomas in skills such as midwifery or oncology. Studies that lead to qualifying as an enrolled nurse or staff nurse will not be offered after 2019.

Makhanya said general nurses will be more highly skilled than enrolled and staff nurses, and will not require supervision from more senior nursing staff.

In line with legislative requirements, health minister Aaron Motsoaledi has formally requested the higher education and training minister to declare the nursing colleges as public higher education colleges, she said.  All the provinces except Northern Cape have already submitted their programmes for accreditation with the Council for Higher Education, she said.

Makhanya said universities are also revising their nursing curriculums to meet the requirements of the new nursing qualifications.
  
2018/12/03
2018/12/10 04:32 PM
DAILY MAVERICK
On the eve of a quarter century of freedom and democracy, South Africa is engaged in yet another project of transformation that will bring us closer to the fulfilment of our constitutional objective to create a caring, inclusive and more equal society.

Cabinet is shortly expected to consider the National Health Insurance (NHI) Bill, which sets out to create, as Health Minister Aaron Motsoaledi has said, a funding system for healthcare that will guarantee that every individual living in South Africa has access to a free and good quality healthcare at the time of need.

At the core of this initiative is to ensure the widest possible pooling of resources – financial resources to pay for healthcare, and the effective and efficient use of available human and other resources to provide quality healthcare to all.

In pursuing this policy initiative, South Africa is by no means out on a limb. Indeed, South Africa is seeking to align itself with global best practice as experienced in a number of developed and developing economies. The country seeks to answer the call of the World Health Organisation (WHO), which asserts that good health is essential for sustained economic and social development and poverty reduction. The WHO maintains that access to much-needed health services is crucial for maintaining and improving health, and propounds that people need to be protected from being pushed into poverty because of the cost of healthcare.

The WHO defines universal health coverage as ensuring that all people have access to much-needed health services (including prevention, promotion, treatment, rehabilitation and palliative care) of sufficient quality to be effective while also ensuring that the use of these services does not expose the user to financial hardship. Universal health coverage has therefore become a major goal for health reform in many countries and a priority objective of the WHO.

For South Africa, the development and adoption of the NHI is an intervention that aims to end the inequality that is adversely affecting households and workplaces when people are denied certain levels and categories of healthcare, including access to certain technologies, purely because they cannot afford them.

Stories abound of patients being turned away from some health facilities because they cannot afford upfront payments running into tens of thousands of rand or of those critically injured being asked if they have medical aid before paramedics can decide where to take them for treatment. This is a sad violation of a basic human right to access medical treatment that our nation needs to deal with.

The status quo within the medical schemes industry and private healthcare system in general requires a complete overhaul in terms of pooling, purchasing and provisioning of care.

As demonstrated by the Council for Medical Schemes’ (CMS) annual reports and other publications, and to a large extent the Health Market Inquiry Provisional Findings over the past years, medical schemes’ membership growth has stagnated and has recently been declining. The medical schemes have either been amalgamating or liquidating.

Some schemes within this industry are also troubled by bad-risk profiles, and this often leads to increases in claims ratio and inevitably affects premium increases. All this occurs within the context of increased rates of supply-induced demand, excessive profiteering by third parties like administrators, dumping on the state (when beneficiaries run out of benefits), nomination of public healthcare facilities to provide healthcare without having service-level agreements with some medical schemes or the capacity to bill the medical scheme.

This industry is also plagued with issues related to fraud, waste and abuse across the entire healthcare value chain.

At an individual level, members are also experiencing increased rates of out-of-pocket payments and unaffordable premium increases are among other phenomena that leave millions of South Africans not just vulnerable to market forces but to worsening health status and mortality as well.

This has been demonstrated by a recent outcry from some medical schemes members like Zelda la Grange who have used social media to vent their frustration:

• “… I pay R5,000+ per month, and I was told last month that my chronic allowance is depleted, and I must now pay the last two months out-of-pocket. I haven’t been to the Dr once this year. The NHI starts looking attractive…”
• “… A family of 5, I pay R12,000 per month and my kids haven’t seen a doctor in the last 3 months, but our Medical Savings Account is depleted …”
• “… NHI has always been attractive. I pay R6,700 per month. Few months ago, I had to spend 3 days in a hospital and the medical scheme told me to pay R9,000…”
• “… I pay R4,000 with no dependants, I was told by my doctor that I need glasses and my medical scheme asked me to pay R800 over and above R4,000… Never thought I’d see the day when I say it, but NHI is looking attractive…”
• “… Utterly disgraceful, besides paying R12,000 every month, I must pay an extra R2,000 per month for chronic medicine… I ended up paying an additional R20,000 or so…”

Some of these principal members reduce the number of dependants covered, whilst others exit medical schemes due to different affordability challenges. Once these members exit the medical schemes environment, their financial protection against catastrophic healthcare costs diminishes and they now become beneficiaries of the public healthcare system.

All these issues occur within the context of excessive risk pool fragmentation (through multiple schemes and benefit options) and differences within medical schemes in respect of benefit option entitlements (or richness) and limited financial protection for the covered lives, especially the old and sick.

This is the segment of the population that tends to require more protection against catastrophic healthcare costs.

In response to this volatile environment, some medical schemes use benefit design to recruit the young and healthy population whilst the old and sick members will experience entry barriers such as paying late joiner penalties.

It is therefore understood that underwriting is meant to protect the schemes against adverse selection; one needs not forget that it can be viewed as discriminatory as well, especially for the segment of the population that enters the labour market late in their lives due to unemployment.

Unless addressed efficiently through effective implementation of the NHI, where there will be a single pool offering one benefit package being accessed by different types of risk profiles, risk pool fragmentation will continue being a barrier preventing progressive achievement of universal coverage in South Africa.

It is within this background that the WHO recommends that health-financing reforms should consider policy options to encourage risk-pool consolidation, otherwise, implementing other measures (such as increasing the level of prepayment funding) without paying proper attention to changes in risk pooling can result in increased fragmentation, and compromised equity and efficiency goals.

The legislative provisions included within the published NHI Bill should therefore be read in context alongside the NHI Green Paper and NHI White Paper and Policy Document.

Since the publication of the NHI Green Paper in 2012, changes in the current pooling, financing and purchasing mechanisms within the national health system were mooted.

Paragraph 395 of the NHI White Paper states that “… the role that medical schemes will play within NHI must be considered within the current context of the existing two-tiered health system. The establishment of NHI will ensure that the State optimally uses available resources to benefit the national population, including post-retirement entitlements. This requires government’s strategic and decisive intervention to eliminate fragmentation in funding pools which has been shown to adversely impact the performance of the current health system…”

Paragraph 399 further states that “in line with international experience, individuals and households will have the opportunity to purchase voluntary private medical scheme membership to complement this universal entitlement if they choose to. Private health insurance coverage, such as that offered by medical schemes, can play various roles within South Africa’s universal health coverage system… Once NHI is fully implemented, medical schemes will offer complementary cover to fill gaps in the universal entitlements offered by the state…”

These provisions seek to optimise utilisation of available resources, including financial and human resources, and to ensure that people do not insure against the same healthcare costs twice.

It is therefore important to ensure that services provided by medical schemes are rolled out in tandem with the NHI Fund to secure value for money, address current pooling inefficiencies and eliminate duplicative cover or double-dipping.

The recently published Medical Schemes Amendment Bill envisions how the role of medical schemes in our national health system will change and outlines a new interplay between the NHI Fund and the CMS.

This re-organisation of the health system is designed to address long-standing shortcomings within the health system in the areas of human resources, financial management, procurement and supply chain management, and the maintenance of infrastructure and equipment.

This effort to level a critical playing field in our society should be welcomed by all South Africans who respect our Constitution and wish to be part of a healthy, productive and more equal South Africa. DM

Busani Ngcaweni is head of policy in the Presidency, writing in his personal capacity.
  
2018/12/02
2018/12/10 04:32 PM
CITY PRESS
It is a relationship marred by distrust and allegations of a lack of transparency but it's going to take two to tango and both the private and public healthcare sectors working together to achieve "one of the most pressing global priorities" universal healthcare coverage.

But if the latest report by the World Innovation Summit for Health Wish on the Role of Private Providers in Delivering Universal Health Coverage is anything to go by, private providers are not too keen for the changes this might entail.

The report was released at a recent Wish Summit held in Doha, Qatar. About 2 000 healthcare experts, innovators, entrepreneurs, policymakers and ministers from more than 100 countries attended the summit.

According to Sir David Nicholson from the Institute of Global Health Innovation, one of the authors of the report, for private providers universal healthcare coverage represents both an "opportunity and a threat".

"The opportunity comes from the chance to access a large number of patients under public contracts, often through new national health insurance schemes, such as those being rolled out by India, Indonesia, Kenya, South Africa and Egypt, among other countries.

"The threat comes from the shift in future spending trends for healthcare. In the coming decades public players will take an increasingly dominant position in low and middle income countries implementing universal health coverage," the report said.

In a survey for the report to find out whether established private providers were preparing to take up the opportunities for new business and service delivery models that could be offered, the responses showed that most were not.

The survey showed that, although they have an essential role to play in the realisation of universal healthcare coverage, it seems private healthcare providers are not keen on changing some of the ways they do business.

The researchers, chaired by Nicholson, surveyed 20 of the biggest private provider chains operating across 40 low to middle income countries representing the operators of more than 500 hospitals and 7 000 clinics or lab facilities.

"Only a quarter of providers expressed a clear intention to shift their business and service delivery models towards publicly financed universal care services. A quarter expressed a clear intention not to do this," the report noted.

The remaining half either expressed a desire to work with governments without significantly changing their mix of patients and reach of services, or planned to broaden their delivery model but without public partnerships.

"Government is not willing to pay the costs of world class medical care and we do not want to compromise quality," a private provider said.

"Doctors are in short supply and, even with salary incentives, it's hard to get them to move to areas in which the government would like us to work," another said.

Governments had negative perceptions about the private sector. "The private collects data to make money related decisions. They do little with that data to improve services," a public player said.

Another said: "Supplier induced demand is rife.

"The private sector has benefited from national health insurance participation as their occupancy rate has improved. But, at the same time, we see worrying rates of hospitalisation."

The report proposed setting up a global network of "investors for health" dedicated to developing "universal health coverage ready" approaches; a mediation service to improve the quality of dialogue between public and private sector organisations in countries that aspire to have universal healthcare coverage; and a sector collaboration charter to assess the readiness of both sectors to work together to achieve universal health coverage in countries that want it.
  
2018/12/01
2018/12/10 04:33 PM
MEDBRIEF AFRICA
The Health Market Inquiry’s (HMI) final report and recommendations on the private healthcare sector have been delayed to 31 March next year. Confirming the postponement of the report that was scheduled to be released today, Competition Commission spokesperson Lydia Molefe told MedBrief
Africa that the formal notice of the extended deadline will be published in the Government Gazette today.

According to the HMI Panel, the postponement will allow the inquiry sufficient time to review the 64 submissions received from stakeholders on its provisional findings and recommendations with the seriousness they deserve.

Senior healthcare consultant at HealthMan, Dr Johann Serfontein says although the delay is disappointing, it is not unexpected.

“It does provide insight that the various submissions made by stakeholders following the interim report are being robustly engaged with by the HMI. This is an important engagement step, which cannot be rushed through in any project of this nature,” Serfontein said.

He however expressed concern that a similar robust consideration of stakeholder submissions is not being applied to submissions on the NHI. According to him, procedural issues, such as apparent non-consideration of stakeholder comments are likely to be raised in court at a later stage, as is currently happening in the land expropriation without compensation process.

It was hoped that the HIMI’s final report would be taken into account in the National Health Insurance (NHI) Bill that is expected to be presented to Cabinet next week.  However, this doesn’t seem to have happened with Health Minister Aaron Motsoaledi this week slamming media reports that changes were made to the version of the NHI Bill agreed on by him and former Finance Minister Nhlanhla Nene by a team led by presidential health advisor, Dr Olive Shisana.  He was reacting to statements civil societies, including the Treatment Action Campaign and SECTION27, that the hundreds of submissions on the draft Bill released in June this year were not taken into consideration and that he was adamant to rush it through Parliament before next year’s general elections.

Referring to a letter from Treasury to the Presidency that was leaked to the media earlier this month, expressing serious concerns about the alleged changes to the Bill, Motsoaledi blamed the criticism on “the enemies of the NHI that will do everything possible to cast serious aspersions on the credibility of the NHI process to stop it from becoming a reality”.

Section 27 deputy director Umunyana Rugege told Business Day that although they welcome the HMI’s decision to delay the report to ensure extensive consideration of stakeholders’ submissions, there was a need to conclude the deliberations of the panel as expeditiously as possible in light of the speed of the processing of the NHI Bill.

“As we have argued before, the two processes are linked and should influence each other in the interests of advancing access to healthcare in South Africa” she told Business Day.
  
2018/11/30
2018/12/05 09:23 AM
BUSINESS DAY
It is unsurprising that the latest National Health Insurance Bill is being rushed through the legislative process without adequate thought. The rush has little to do with meeting the healthcare needs of South Africans. Rather, the aim is to help the ANC win votes in the 2019 election through the false promise of free, quality healthcare for all.

The public submissions on the bill have generally been ignored. Even important points made by the Treasury were thrown into the rubbish bin, it seems.

The people in the government now arguing about the NHI Bill are united in supporting a particularly dangerous idea: that medical aid schemes should be confined to covering health services "complementary" to those offered by the NHI.

Since the NHI is intended to include a vast range of health services, there will be few "complementary" services that medical schemes can cover. Most medical schemes will thus cease to exist when this restriction takes effect.

But medical schemes are the main source of funding for SA’s excellent private healthcare system. Private healthcare will thus also largely come to an end under NHI. This will deprive South Africans of choice and force most to use the dysfunctional public healthcare system.

The government should aim at expanding access to private care. This can be done in various ways, including tax-funded health vouchers, permitting low-cost medical schemes, and making greater use of public-private partnerships.

In seeking to provide all South Africans with decent healthcare, the government should treat the private sector as an ally rather than an adversary.

Marius Roodt: Head of campaigns, Institute of Race Relations
  
2018/11/30
2018/12/10 04:34 PM
BUSINESS DAY
It is unsurprising that the latest National Health Insurance Bill is being rushed through the legislative process without adequate thought. The rush has little to do with meeting the healthcare needs of South Africans. Rather, the aim is to help the ANC win votes in the 2019 election through the false promise of free, quality healthcare for all.

The public submissions on the bill have generally been ignored. Even important points made by the Treasury were thrown into the rubbish bin, it seems.

The people in the government now arguing about the NHI Bill are united in supporting a particularly dangerous idea: that medical aid schemes should be confined to covering health services "complementary" to those offered by the NHI.

Since the NHI is intended to include a vast range of health services, there will be few "complementary" services that medical schemes can cover. Most medical schemes will thus cease to exist when this restriction takes effect.

But medical schemes are the main source of funding for SA’s excellent private healthcare system. Private healthcare will thus also largely come to an end under NHI. This will deprive South Africans of choice and force most to use the dysfunctional public healthcare system.

The government should aim at expanding access to private care. This can be done in various ways, including tax-funded health vouchers, permitting low-cost medical schemes, and making greater use of public-private partnerships.

In seeking to provide all South Africans with decent healthcare, the government should treat the private sector as an ally rather than an adversary.

Marius Roodt: Head of campaigns, Institute of Race Relations

  
2018/11/30
2018/12/10 04:34 PM
BUSINESS DAY
The Competition Commission's long running health market inquiry has delayed publishing its final report until March 29 2019, saying it needs more time to consider the extensive sub missions it has received from stakeholders since it published its interim findings in July.

It had hoped to publish its final report on Friday. The inquiry began in January 2014 and set out to investigate the barriers to effective competition in the private health care market and why annual health care inflation consistently out strips consumer price inflation by several percentage points.

The original deadline for the release of its final report was November 2015, but it has been repeatedly postponed partly due to legal challenges, but also because it has been at pains to show it is taking heed of concerns raised by stakeholders at every step of the way.

The inquiry has been conducted by a five member panel chaired by retired justice Sandile Ngcobo. The delay in the release of the final report will allow the inquiry sufficient time to review sub missions "with the seriousness they deserve", said panel member Sharon Form, professor of public health at the University of the Witwatersrand.

By September 7 the inquiry had received 47 written submissions from stakeholders in response to its provisional report Formal notice of the latest deadline extension, to March 29, is expected to be published in the Government Gazette on Fri day, said Fonn. Section 27 deputy director Umunyana Rugege said it is not surprising that the inquiry needs more time to consider comments, given the volume of sub missions it had received.

"This is a crucial process for the country and due consideration of all stakeholders comments is welcomed.

However, there have been many delays in the process since 2014 and we note the need to conclude the deliberations of the panel as expeditiously as possible in light of the speed of the processing of the NHI (National Health Insurance Bill).

As we have argued before, the two processes are linked and should influence each other in the interests of advancing access to health care in SA," she said.

The provisional report found a lack of competition in the medical scheme market and evidence of over servicing by providers and concluded that the private hospital sector is so highly concentrated it inhibits effective competition. It recommended interventions aimed at increasing.com petition, improving consumer protection and ensuring greater efficiency in the market.
  
2018/11/30
2018/12/10 04:35 PM
SAKE24
Daar is geen ongerymdhede in die proses van die wetsontwerp oor nasionale gesondheidsversekering (NGV) nie, se dr. Aaron Motsoaledi, minister van gesondheid.

Hy verwerp mediaberigte waarin bewerings van onreelmatighede uitgespreek is in 'n verklaring en meen dit is 'n poging om die geloofwaardigheid van die proses te "beswadder" en die openbare mening daaroor te verander.

Dit kom na berigte oor 'n brief van die nasionale tesourie aan dr. Olive Shisana, raadgewer van die president oor NGV, waarin kom mer uitgespreek is oor veranderinge aan die wetsontwerp wat nou op pad is na die kabinet.

Motsoaledi sit in sy verklaring die feite rakende die konsultasie proses uiteen:

Kommentaar is van belanghebbendes en van die publiek gekry. Dit is deur sy departement hersien en vir die hersiening van die NGV wetsontwerp oorweeg.

Verdere konsultasie met belang hebbendes is gedoen. Dit sluit in 'n beraadslagende vergadering waar op pres. Cyril Ramaphosa op 24 Augustus met meer as 300 partye geskakel het. Op die vergadering het Ramaphosa aangekondig hy sal die NGV proses as staatshoof lei.

Die media het vrae gehad waarop Motsoaledi se hy het Ramaphosa persoonlik gevra om die proses te lei omdat dit 'n "seismiese gebeur tenis" is wat die leiding van die staatshoof benodig.

"Daarom is daar niks sinisters vir die presidensie om in die NGV proses betrokke te wees nie. Dit is ontwerp om so te wees," sê hy. Motsoaledi se die NGV is 'n "vlagskipprogram van die staat wat ontwerp is om te verseker dat ons ons grondwetlike mandaat van ge sondheid kan lewer as 'n reg van elkeen in die land".

Sedert die Verenigde Nasies VN die beginsel van universele gesond heidsdekking aanvaar het as een van die 17 doelwitte vir volhoubare ontwikkeling, het "staatshoofde in die meeste groot demokratiese lan e die verantwoordelikheid aan vaar om dit te bereik".

Die NGV is Suid-Afrika se uni versele gesondheidsdekking. "Dit sal agterlosig wees van ons presidensie om afsydig te staan teenoor so 'n groot poging."

Na die beraadslagende vergade ring het Motsoaledi met burgerlike organisasies, akademiese instel lings, dekane van fakulteite van ge sondheidswetenskap, tradisionele leiers, vakbonde en professionele mediese verenigings gepraat.

Daar was wye konsultasie tussen die nasionale tesourie en die departement van gesondheid wat deur die presidensie gefasiliteer is.

"Soms was dit deur briefwisseling. Dus was daar niks onbetaamliks aan die brief wat die tesourie oor die kwessie geskryf het nie.

"Die soort gesprekke sal voort gaan tussen staatsdepartemente in die wetgewende en die beleidma kende proses." Hy ontken dat "enige wetgewing oortree is of dat daar enige onwet tigheid of onreelmatigheid" in die wyse is waarop die wetgewingspro ses tussen die departement, sy amp tenare, die tesourie, die presidensie en die res van die regering plaas vind.

Motsoaledi glo dit is sinister dat die brief aan die media uitgelek is. Hy se dit is deur gewetenlose amptenare gedoen wat voorgee hulle het iets "boos" in die gesprek tussen staatsdepartemente blootgele.
  
2018/11/29
2018/12/05 09:24 AM
BUSINESS DAY
The Competition Commission’s long-running health market inquiry has delayed publishing its final report until March 29 2019, saying it needs more time to consider the extensive submissions it has received from stakeholders since it published its interim findings in July.

It had hoped to publish its final report on Friday.

The inquiry began in January 2014 and set out to investigate the barriers to effective competition in the private healthcare market and why annual healthcare inflation consistently outstrips consumer price inflation by several percentage points.

The original deadline for the release of its final report was November 2015, but it has been repeatedly postponed — partly due to legal challenges, but also because it has been at pains to show it is taking heed of concerns raised by stakeholders at every step of the way.

The inquiry has been conducted by a five-member panel chaired by retired justice Sandile Ngcobo.

The delay in the release of the final report will allow the inquiry sufficient time to review submissions “with the seriousness they deserve”, said panel member Sharon Fonn, professor of public health at the University of the Witwatersrand.

The inquiry received 47 written submissions from stakeholders in response to its provisional report by September 7, the deadline it set for responses. It granted a further 17 stakeholders an extension to this deadline, which along with requests for access to the underlying data and information it had considered in compiling its provisional report, meant that it pushed out the deadline for its long-awaited deadline by two months until November 30.

Formal notice of the latest deadline extension, to March 29, is expected to be published in the Government Gazette on Friday, said Fonn.

Section 27 deputy director Umunyana Rugege said it is unsurprising that the inquiry needs more time to consider comments, given the breadth and volume of submissions it had received.

“This is a crucial process for the country and due consideration of all stakeholders comments is welcomed. However, there have been many delays in the process since 2014 and we note the need to conclude the deliberations of the panel as expeditiously as possible in light of the speed of the processing of the NHI [National Health Insurance] Bill. As we have argued before, the two processes are linked and should influence each other in the interests of advancing access to healthcare in South Africa” she said.

The provisional report found a lack of competition in the medical scheme market and evidence of over servicing by providers and concluded that the private hospital sector is so highly concentrated it inhibits effective competition.

It recommended interventions aimed at increasing competition, improving consumer protection and ensuring greater efficiency in the market.
  
2018/11/29
2018/12/05 09:25 AM
POLITY
Solidarity’s Occupational Guild for Health Practitioners today expressed their dissatisfaction with the irresponsible way the National Health Insurance Bill (NHI) is dealt with. This followed the Health Department’s attempt to get the proposed bill approved without proper public participation and consultation.

According to Morné Malan, senior researcher at the Solidarity Research Institute (SRI), the Health Department’s conduct indicates that this department is increasingly willing to push through harmful policies despite their negative impact on the fiscus and the health of South African citizens.

“Minister Motsoaledi reacts to criticism as if he believes he is at war with organisations that try to promote and protect citizens’ rights. Perhaps he should ask himself what is giving rise to this perception. The department has been acting in bad faith ever since the bill was released in June. They are cryptic about finances, practical matters, the nature and extent of the NHI fund, the impact on health practitioners and more. They clearly also do not pay attention to comments or suggestions to improve the current system. Furthermore, the estimated costs of the NHI are not yet known, but it will be an enormous amount,” Malan explained.

Solidarity emphasised its opposition to the NHI Bill and the nationalisation of health care by effectively expropriating the resources of private health care. “We refuse to accept the narrative that the department seeks to make South Africa a healthier country because this bill in particular has several shortcomings that will have countless conceivable – and probable – negative consequences – economically and especially with regard to the health of South Africans. When governments act in this way, they must be treated as ideologists or megalomaniacs, or both,” Malan said. 

In addition, Solidarity rejects the efforts of the department to classify the debate regarding the NHI as a struggle between different classes. “This issue is not about rich versus poor. It has to do with being sick versus being healthy. At present, our public health care is so sick, it is almost terminal, and no-one will benefit by transferring all health care to these bureaucrats. It will merely nationalise the service that has led to the Esidimeni tragedy and the countless public hospitals already falling apart, until nobody can escape the government’s incompetence any longer,” Malan emphasised. 

  
2018/11/29
2018/12/05 09:48 AM
CAPE TIMES
Health Minister Aaron Motsoaledi has slammed reports that he is "pushing" the National Health Insurance Bill NHI through Cabinet without proper consultation and public participation, saying that enemies of NHI will do everything possible to halt the bill.

This comes after reports emerged at the weekend suggesting that Treasury officials and President Cyril Ramaphosa's adviser, Olive Shisana, were at each other’s' throats over a number of changes introduced after the public comment period on the bill had closed.

The original draft bill was released on June 21, with a three month comment period that closed on September 21.

The bill intends to pave the way for a central fund that will purchase services on behalf of patients.

It will also realise the government's ambitions of providing universal health coverage. The Health Ministry's spokesperson, however, slammed the reports, saying there was no deviation from protocol, or irregularities, in the conclusion of the bill.

The department's Popo Maja said: "We have no doubt that enemies of NHI will do everything possible to try to stop NHI from becoming a reality, failing which they will try to cast doubt and aspersions on the integrity of the process. "We wish to reassure the nation that no law is being breached nor any illegality or irregularity committed in the manner in which the legislative process towards realisation of NHI is being conducted between the Department of Health, its officials, the Treasury, the Presidency and the rest of government," said Maja.

It is also claimed that Motsoaledi is trying to push the bill through Cabinet without consulting with Treasury and health Department officials.

Last week, Health director-general Precious Matsoso claimed that she was side-lined, and not involved in revising the bill after certain changes were made to it despite being the department’s accounting officer.

The minister, however, said no one had the sole power to decide on the bill, saying that various stakeholder are involved at all stages of negotiating the bill.

“It is unfortunate that some anti-NHI individuals or entities have decided to personalise, isolate and attack some hard-working and dedicated presidential support staff, particularly Professor Olive Shisana, employed to help drive government priorities in the social sector, health included,” said Maja.

However, the DA has called on the Portfolio Committee on Health and the Standing Committee on Finance to convene a joint meeting to discuss NHI in the wake of the reports.

DA MP Lindy Wilson said: “The revised national Health Insurance Draft Bill should be made public and the public participation process should be immediately reopened.

“The dodgy revised bill would put the needs of South Africans on the backburner yet again, and the DA will not allow this to happen.”
  
2018/11/29
2018/12/05 09:49 AM
BUSINESS DAY
President Cyril Ramaphosa's ambitions of getting a blueprint for fixing SA’s health system in the next two weeks have hit a stumbling block.

The Presidency has delayed the signing of this "health.com pact" until the end of January, spokesperson Khusela Diko confirmed. Healthcare professionals had complained that the deadline was unworkable.

The commitment to crafting this plan emerged from a two day health summit convened by the president in late October, which drew 600 delegates from the public and private healthcare sector as well as labour and civil society organisations.

The gathering was cast as a high level meeting to thrash out ideas for tackling the crisis confronting SA's public health system, which is grappling with corruption, staff shortages, and stock outs of even basic medicines such as contraceptives.

However, there is growing disquiet and suspicion that the government is seeking to spin the event to create the impression that participants endorsed its National Health Insurance (NHI) plans.

NHI is its flagship policy for achieving universal health coverage, and its first piece of enabling legislation is due to be tabled in cabinet next week.

Health minister Aaron Motsoaledi told Radio 702 earlier in November that the summit had given NHI the green light.

"Everybody endorsed NHI and said it must go ahead," he said at the time.

Fazel Randera, a member of the Progressive Health Forum, said focus should be rather spent on multiple crises facing the health service, rather than the NHI.

"At the end of the summit we were given a slide session summary of what had come back from the various commissions.

"One read that there should be one health service for one country and that NHI was no longer a debate.

"Now there was no discussion on those particular points," said Randera, who is a member of the summit task team chaired by presidential adviser Olive Shisana.

A power point presentation entitled "Way forward health summit", provided to Business Day after the summit, said participants were "committed to one country one health system", and that universal healthcare coverage" is not negotiable and NHI is a means to get there".

The SA Medical Association Sama was so concerned about the December 10 deadline that it convened a meeting of more than 60 associations representing healthcare professionals a fortnight ago, at which they resolved to seek a four month extension.

Sama chairperson Angelique Coetzee said the deadline had been unrealistic as the views of more than 100 healthcare associations and societies needed to be canvassed.

The health system had to be fixed before implementing NHI, she said. Separately, Motsoaledi issued a statement on Wednesday defending the government's handling of the NHI Bill, which has been mired in controversy after a leaked Treasury letter revealed it was butting heads with Shisana over a host of measures she and her team had changed after the public comment period closed in September.

Motsoaledi said he rejected "with contempt" reports of alleged irregularities in the manner in which the legislation was being processed.
  
2018/11/29
2018/12/05 09:50 AM
SOLIDARITY
Movement says dept. has been acting in bad faith ever since the bill was released in June.

Solidarity’s Occupational Guild for Health Practitioners today expressed their dissatisfaction with the irresponsible way the National Health Insurance Bill (NHI) is dealt with. This followed the Health Department’s attempt to get the proposed bill approved without proper public participation and consultation.

According to Morné Malan, senior researcher at the Solidarity Research Institute (SRI), the Health Department’s conduct indicates that this department is increasingly willing to push through harmful policies despite their negative impact on the fiscus and the health of South African citizens.

“Minister Motsoaledi reacts to criticism as if he believes he is at war with organisations that try to promote and protect citizens’ rights. Perhaps he should ask himself what is giving rise to this perception. The department has been acting in bad faith ever since the bill was released in June. They are cryptic about finances, practical matters, the nature and extent of the NHI fund, the impact on health practitioners and more. They clearly also do not pay attention to comments or suggestions to improve the current system. Furthermore, the estimated costs of the NHI are not yet known, but it will be an enormous amount,” Malan explained.

Solidarity emphasised its opposition to the NHI Bill and the nationalisation of health care by effectively expropriating the resources of private health care. “We refuse to accept the narrative that the department seeks to make South Africa a healthier country because this bill in particular has several shortcomings that will have countless conceivable – and probable – negative consequences – economically and especially with regard to the health of South Africans. When governments act in this way, they must be treated as ideologists or megalomaniacs, or both,” Malan said. 

In addition, Solidarity rejects the efforts of the department to classify the debate regarding the NHI as a struggle between different classes. “This issue is not about rich versus poor. It has to do with being sick versus being healthy. At present, our public health care is so sick, it is almost terminal, and no-one will benefit by transferring all health care to these bureaucrats. It will merely nationalise the service that has led to the Esidimeni tragedy and the countless public hospitals already falling apart, until nobody can escape the government’s incompetence any longer,” Malan emphasised. 

Issued by Morné Malan, Senior Researcher, Solidarity Research Institute, 29 November 2018

  
2018/11/28
2018/12/05 09:50 AM
BUSINESS DAY
The hotly contested bill paves the way for the establishment of a central fund that will purchase services on behalf of patients.

The DA plans to seek legal advice on the National Health Insurance (NHI) Bill, which is due to be tabled before the cabinet on December 5. The hotly contested bill paves the way for the establishment of a central fund that will purchase services on behalf of patients, and is a vital step towards the government’s ambitions of providing universal health coverage.

The bill is now mired in controversy, after it emerged in early November that Treasury officials were butting heads with the president’s adviser, Olive Shisana, over a host of measures she and her team had introduced or changed after the public comment period on the bill had closed.

The Treasury also raised concerns over the extent to which public submissions were considered. The extent to which the Treasury’s concerns have been addressed is not clear at this stage, as cabinet documents are classified and rarely leaked.

The controversy was heightened last week after health director-general Precious Matsoso revealed that she had been side-lined and had played no role in revising the bill after it had been released for public comment in June, despite being the department's accounting officer. 

“If the ANC government continues to push through the NHI Bill without proper public participation and consultation, the DA will seek legal advice regarding the highly irregular process followed in revising the NHI Bill,” DA deputy health spokesperson Lindy Wilson said.

“The minister’s backdoor dealings subsequent to the closure of public comment period, effectively mutes any input from the public, as the proposed changes are substantive, and the public and other stakeholders have not had an opportunity to raise their concern.”  Wilson said the revised NHI Bill should be made public, and the public participation process reopened. 
  
2018/11/28
2018/12/05 09:51 AM
BUSINESS DAY
The health minister has rejected recent media articles alleging irregularities in the way the bill is being processed.

Health Minister Aaron Motsoaledi has defended the government’s approach to crafting the contentious National Health Insurance (NHI) Bill, which is to be tabled in the cabinet next week.

The bill is a vital step in achieving the government’s ambitions of providing universal health coverage, as it paves the way for a central fund that will be used to purchase services on behalf of patients. The government has promised that NHI services will be free at the point of delivery, but exactly what benefits will be covered and how they will be funded has yet to be spelt out.

The bill is now mired in controversy, after a leaked Treasury letter revealed that its officials were butting heads with the president’s adviser, Olive Shisana, over a host of measures she and her team had changed after the public comment period on the bill closed on September 21.

Political tension over the bill rose last week after health director-general Precious Matsoso disclosed that she had been side-lined and had not had sight of the bill since it was released for public comment in June, despite being the department's accounting officer. At the time, Shisana confirmed that Matsoso had not been involved, saying Motsoaledi had assigned that task to deputy director-general Anban Pillay and his adviser, Aquina Thulare.

In a three-page statement released by his spokesperson, Popo Maja, on Wednesday afternoon, Motsoaledi said he rejected “with contempt” recent media articles alleging irregularities in the manner in which the NHI Bill was being processed by the government.

He said there was nothing sinister in the presidency’s involvement in the NHI process. There had been extensive consultation between Treasury and his department, facilitated by the presidency, he said.

“Sometimes these consultations took place through exchange of letters. There was hence nothing untoward with the letter written by the National Treasury on this matter. What is sinister, however, is the leaking of such letters to the media by some unscrupulous officials pretending that they uncovered some hidden evil lurking in governmental departmental exchanges,” he said in the statement.

He did not offer an explanation for why the director-general had not been included in revising the NHI bill.

Motsoaledi said the presidency had the right to “facilitate, direct and unblock obstacles in the process of legislation and policy making.

“We have no doubt that the enemies of NHI will do everything possible to try to stop NHI from becoming a reality, failing which, they will try to cast doubt and aspersions on the integrity of the process. We wish to assure the nation that no law is being breached nor any illegality or irregularity committed in the manner in which the legislative process towards realisation of NHI is being conducted between the department of health, its officials, the Treasury, the presidency and the rest of government,” he said.
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