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2017/04/06 04:07 PM
The Competition Commission’s Health Market Inquiry has announced that it has not accepted a controversial report on private hospital prices commissioned by the World Health Organisation (WHO) because it failed to provide the underlying data. The move not only asserts the inquiry’s commitment to evidence-based analysis, but also deals a blow to Health Minister Aaron Motsoaledi, who has publicly promoted the report as it supports his conviction that private healthcare services are overpriced.

The inquiry was formed to establish whether there are barriers to competition and access to the private healthcare market. When it began public hearings, the WHO submitted a report that it had commissioned from the Organisation for Economic Co-operation and Development (OECD) that found South African private healthcare prices were similar to those in OECD countries, but were much less affordable. Private hospital groups subsequently challenged the report and made submissions to the inquiry.

The inquiry’s director, Clint Oellermann, said the WHO had said confidentiality agreements with the stakeholders who provided data prevented it from providing the information to the inquiry. Oellermann said that without the underlying data, the inquiry cannot place any significant weight or evidential value on the report in arriving at its provisional and final findings. He said the inquiry might conduct its own analysis of hospital prices based on the evidence it received. The WHO’s senior health policy adviser for Africa, Sarah Barber, said the inquiry could request the information from the participating countries directly. Lobby group Section 27 said the inquiry’s decision indicated the weight it attached to evidence-based decision-making.
2017/04/06 04:09 PM

Lifestyle diseases epidemic impacting medical schemes

Diseases related to unhealthy lifestyles and poor diet are an increasing health and economic burden that also impact negatively on medical schemes. It is an epidemic that requires urgent attention according to Dr Guni Goolab, principal officer of the Government Employees’ Medical Scheme (GEMS). Statistics South Africa analysis of mortality and causes of death found that non-communicable diseases (NCDs), such as type 2 diabetes, stroke and cardiovascular diseases, were responsible for 55.5 percent of all deaths in the country in 2015. This, said Goolab, highlights the challenge they pose. Millions of South Africans suffer from, and are being treated for NCDs. Aside from the immense suffering they cause, they represent a significant risk to the local healthcare sector, the successful implementation of National Health Insurance as well as the broader economy. Goolab said that if we are to mitigate the massive risk these diseases pose to the sustainability of our entire healthcare system, we need to work together in a determined and co-ordinated manner while there is still time to do so. It would, he adds, be misleading to suggest that all NCDs are related to poor lifestyle choices. Factors that can lead to their development include cancers, type 2 diabetes and heart diseases. They may include genetic predisposition and environment. However, the World Health Organisation (WHO) rates the prevalence of NCDs a growing global “epidemic” driven primarily by: physical inactivity, unhealthy diets, tobacco use, excessive use of alcohol and unhealthy diets. And the considerable socio-economic costs make their prevention and control a critical imperative for the 21st century. Goolab attributes the rise in NCDs in South Africa to: the increased consumption of fast and convenience foods high in sugar, carbohydrates, salt and saturated fats; the heavy use of tobacco and alcohol; as well as the increasingly sedentary lifestyles of people, particularly in urban areas. Poorer people also find it considerably more difficult to afford healthy foods.

He said that while government leads the way in addressing these problems through legislation aimed at reducing the content of unhealthy salt and sugars in our food, as well as tobacco use, a unified approach from all sectors of society is needed. Every South African must be more aware of the threats that the adoption of an unhealthy lifestyle poses, and be empowered to take greater responsibility for their own health. Medical schemes are particularly affected and GEMS has consequently re-aligned its products, services and benefits to emphasise preventative over curative interventions to reduce the risks to its members. Goolab said the scheme has adopted highly proactive measures in dealing with these healthcare conditions. These include innovative managed healthcare programmes, selective underwriting measures, public and member educational and awareness campaigns, as well as effective disease management programmes. He said more than 300 000 members are currently enrolled on at least one of the scheme’s disease management programmes. Back to top

Beneficiary registry will be in public interest

THE proposed beneficiary registry is in the public interest and will enable the Council for Medical Schemes (CMS) to optimally fulfil its mandate to protect medical scheme beneficiaries, according to Dr Elsabé Conradie, General Manager: Stakeholder Relations. It will, she added, allow the council to understand the geographical and demographical  distribution of all members and to share pertinent information. Conradie said this will ensure their rights and privileges in terms of the Medical Schemes Act are optimised and enhance the council’s mandate to effectively regulate the medical schemes industry. Presently medical schemes allow third party administrators to keep data without, in most cases, acquiring the required member consent. Several schemes have appointed the state as a designated service provider and, in the absence of any verifying mechanisms, schemes are rarely being billed for treatment. This, said Conradie, is not in the public interest as it adds to the burden of the already cash-strapped and overburdened state facilities. She said that if they are empowered to verify active membership and raise a fee for services rendered, the ratio of payments by private medical schemes to state would improve.

Conradie said the potential for fraud committed by patients purporting to be medical scheme members would also decrease and this would leave more money in the public coffers, allowing the state to procure better services for its citizens and is therefore directly in the public interest. Moreover, Conradie said, the collection of basic demographic member data at a more granular level will allow the CMS and the National Department of Health to base health insurance policy decisions on more precise business intelligence. This will benefit all members as well as the public at large and ensure that future healthcare interventions are better focused and scientifically based. Collecting individualised data will enable the CMS to verify aggregated figures submitted by medical schemes as part of the statutory return process, such as member movement between options as well as the worrying trend of buying down. The process, she emphasises, will be subjected to rigorous legal scrutiny before being finally implemented.

Information deficit is detrimental to members

THE information imbalance within the private healthcare market makes it difficult for consumers to make informed decisions, according to Dr Elsabe Conradie, General Manager: Stakeholder Relations at the Council for Medical Schemes (CMS). She said that in many instances, third party intermediaries are deployed to provide information on which medical scheme is the most suitable for a consumer’s particular needs and which benefit option to purchase. Conradie said it is a lack of sovereignty that worsens with the severity and complexity of condition or situation, but on the other hand, hospitals and other healthcare providers enjoy the advantage of having access to information. She said it is an asymmetry that causes increased prices for health services, because it gives market power to the holder of better information. Consumers are powerless to negotiate prices. The CMS regulates medical schemes, administrators and managed care organisations, as stipulated in the Medical Schemes Act. Its role is to protect beneficiaries, maximise access to coverage and protect the public interest. Conradie explain that without regulation, only private interests would prevail, reducing access and accountability. She said it is also important to bear in mind that the South African
healthcare system, with its strong private sector and a public sector with many challenges, differs from other countries. The latter have mostly only one healthcare system and various role players. Moreover, Conradie said, in this country of the current population of about 54-million only 8,8-million, (16 percent) are beneficiaries of medical schemes delivering private healthcare. There are currently 82 registered medical schemes, of which 22 are open. The remainder are restricted schemes. They all offer various benefit options tailored to particular needs and include hospital cover, optional day-to-day benefits and chronic benefits for prescribed minimum benefits (PMB) conditions. In turn, PMBs include 270 serious health conditions, any emergency condition, and 25 chronic diseases. Designed to offer maximum protection to members of schemes irrespective of which option they choose, they aim to ensure that when members face catastrophic healthcare events they are not financially ruined. PMBs are also geared to prevent individuals from losing their medical scheme cover in the event of serious illness.

This reduces the consequent risk of unfunded utilisation of public hospitals and encourages improved efficiency in the allocation of private and public healthcare resources. According to Regulation 8 of the Act, medical schemes must pay PMBs in full, without co-payment or the use of deductibles, the diagnosis, treatment and care costs of the PMB conditions. Although prescribed benefits must be funded in full, medical schemes are allowed to effectively manage the costs through the appointment of designated service providers who render services at a negotiated rate. They also use drug formularies and other tools such as managed care interventions, protocols and pre-authorisation. Members using designated networks are then protected against any additional costs, such as co-payments. In emergencies, members may not have a choice but to use providers out of network, but schemes may penalise members for voluntarily making use of non-designated service providers if it is not an emergency.

Industry can expect all current CMS initiatives to proceed

THE industry can expect all current Council for Medical Schemes initiatives to proceed according to its recently appointed acting chief executive, Dr Sipho Kabane. These include the prescribed minimum benefits definitions, review and code of conduct as well as development of the low-cost benefit option, supporting the NHI and the Health Market Inquiry. Dr Kabane joined the council as a senior strategist last year. Formerly a senior manager in the health sector, he also served as a medical practitioner in the Free State. Assuring that he is fully aware of the battles beneficiaries of medical schemes face to derive optimal benefits from their schemes in exchange of their contributions, he said allow the council to understand the geographical and demographical distribution of all members and to share pertinent information allow the council to understand the geographical and demographical distribution of all members and to share pertinent information, he said he is also a healthcare quality activist, who believes that the good health outcomes that we all aspire for, need to be driven by deliberately embedding clinical governance in our day-to-day contact with patients, irrespective of the sector we operate in.

Cost-containment crucial

The healthcare industry continues to be impacted by macro-economic effects such as unemployment; rising cost of living and increased prevalence of chronic lifestyle diseases. There are also escalating healthcare treatment costs. Gerhard Van Emmenis, acting principal officer Bonitas Medical Fund, said that against this backdrop, the scheme has, over the past two years, implemented various initiatives to assist in managing future claims costs without impacting the quality of benefits that members access. Last year, for example, and in keeping with a commitment to strategic purchasing, Bonitas commenced negotiations with the three large hospital groups to create a network of designated service providers, a strategy projected to result in a saving of over R100-million this year and around R500-million over the next three years, in present value terms. This, he said, will directly impact future contribution increases and affordability.
2017/04/06 04:43 PM
Hospital group Netcare said its adjusted headline earnings per share (HEPS) for the first half of its 2017 financial year were expected to be between nine percent and 13 percent lower than the adjusted HEPS of 91c reported for the first half of 2016.

This was owing to, among other factors, the expected effect of currency conversion due to the stronger rand. In trading update, Netcare noted that the average rand exchange rate against the pound had been considerably stronger in the period under review, which would negatively affect the conversion of the UK results. Its South African hospitals and emergency services division had also experienced a very challenging period of trading for the period under review, characterised by low growth in the local economy and in total medical scheme beneficiaries.

The hospital group said the results for the period under review have also been adversely impacted within its emergency services division by the significant reduction in revenues from industrial sites in Mozambique, as prevailing economic difficulties are curtailing activity within the mining and resources sectors. The group also noted that in its previous guidance that it had indicated that it expected earnings before interest, taxation, depreciation and amortisation margins to decline due to the potential effect of sizeable new “efficiency options” being introduced by medical schemes. However, the take-up on these “efficiency options” had been lower than anticipated to date and the effect on margins in the first half of 2017 was expected to be minimal.
2017/04/06 04:11 PM
Teething problems at provincial health departments including a lack of co-ordination, poor planning and uncertainty in districts, remain stumbling blocks to the effective testing of how the National Health Insurance (NHI) will work at pilot sites. The dire state of affairs was detailed in a Financial and Fiscal Commission presentation to Parliament’s portfolio committee on health and the standing committee on appropriations. In 2015, Health Minister Aaron Motsoaledi introduced the NHI White Paper. In February, the government announced that it would set up an NHI fund even though the White Paper is considered a work in progress.

The commission’s Elliot Hadebe told MPs that challenges persisted at the NHI pilot sites when it came to “vertical and horizontal co-ordinated planning” between national government, provincial health departments and districts. He said co-ordination problems were evident at NHI pilots and in the implementation of grants. Provinces were unaware of what to use the grants for.

Hadebe said the NHI grants had to be accompanied by capacity building. Alex van der Heever, chairman of social security systems administration and management studies at the University of Witwatersrand, said the NHI grant-spending challenges were a microcosm of the larger problems that affected larger grants, such as the national tertiary services grant and the health professions training and development grant.
2017/03/08 04:24 PM
In finance Minister Pravin Gordhan’s budget speech in last week, he touted the type of inclusive economic growth and radical transformation that is long overdue in South Africa. Each year, the Minister’s speech outlines the broad brushstrokes of the country’s economic policy. From there, money flows from the national revenue fund into national, provincial and municipal departments. Who gets what is a matter of calculations based on various equitable share formulas. These equations are meant to ensure that money is allocated fairly across provinces and among South Africa’s 278 municipalities. The division of revenue is a powerful tool for redistributing wealth. In his speech, Gordhan announced that provinces that are largely rural will continue to receive a higher per capita proportion of equitable share allocations.

Data from the most recent census tells us that about 40 percent of South Africans call rural areas home - and it is here where much of the country’s poverty hides. A 2014 Statistics South Africa report found that six out of every 10 people in rural areas live below the poverty line. Former homelands, which are mostly rural in nature, are still plagued by pre-democracy levels of inequity, research by the Southern African Social Policy Research Institute shows. Giving rural provinces more money is an attempt to redistribute resources to areas of greatest need, but once money leaves the national coffers, there are serious flaws in how funds are allocated. Once provinces receive their share, they have full discretion over how that money is distributed - and this is largely done behind closed doors.

North West province, for instance, only allocates 26 percent of what it receives from the Treasury to healthcare - this is almost 10 percent less than the average spent on health in other provinces. Processes to divide resources within departments remain equally opaque. In recent years, this has seen the emergence of ad hoc and ill-considered cost cutting measures. Gauteng’s deadly decision to move almost 2 000 mental health patients out of state-sponsored care at Life Esidimeni facilities is but one example. In rural areas, we have seen facilities serving the most impoverished communities reduced to skeleton staffing levels. With so few employees, these clinics and hospitals have barely been able to continue providing basic health services, let alone the specialised outreach services needed by, for instance, people with disabilities in remote areas.

The Treasury confirms that there has been about a one percent reduction in health posts nationally. Although the Treasury’s directive to cut posts came with calls to protect the positions of frontline health workers, this “rationalisation” has definitely affected the delivery of healthcare to society’s most vulnerable citizens. Worse still, this has occurred outside the public domain with little or no consultation with those directly affected. We have seen the impoverished people lose faith in the health system after spending what little money they have to travel to a facility that may not have medicine in stock or a doctor on call. South Africa may be faced with an economic crisis, but radical transformation requires a change in the way we fund healthcare. We hope the proposed National Health Insurance will provide the answer, but it is still in its infancy and what the provinces’ role will be remains unclear. Whatever is decided, the goal of access and equity must be protected. There is no better time for radical transformation than now.

Rensburg is programme manager for health systems and policy at the Rural Health Advocacy Project and Versteeg-Mojanaga is the project’s director
2017/03/08 04:34 PM
International healthcare operator Mediclinic is lobbying the Abu Dhabi government to rethink a change in medical insurance rules that has damaged its business after it bet big on acquiring Al Noor Hospitals, its regional chief executive said.

At least two other healthcare companies operating in Abu Dhabi are also in talks with authorities, seeking a reversal or amendment to the reform Mediclinic frets over UAE reform Reuters that reduces state insurance coverage for citizens using private hospitals, according to two industry sources who declined to be named.

Abu Dhabi has cut insurance coverage under its Thiqa plan to 80 percent from 100 percent, meaning patients have to pay 20 percent of bills if they seek treatment at private hospitals. The rule started last July — at the worst possible time for Mediclinic as it had just bought Al Noor for about $1.7 billion. Go to www.busrep.co.za
2017/03/08 04:32 PM
International healthcare operator Mediclinic is lobbying the Abu Dhabi government to rethink a change in medical insurance rules that has damaged its business after it bet big on acquiring Al Noor Hospitals, its regional CEO told Reuters.

At least two other healthcare companies operating in Abu Dhabi are also in talks with authorities, seeking a reversal or amendment to the reform that reduces state insurance coverage for citizens using private hospitals, according to two industry sources who declined to be named due to the sensitivity of the matter.

Abu Dhabi has cut insurance coverage under its Thiqa plan to 80 percent from 100 percent, meaning patients have to pay 20 percent of bills if they seek treatment at private hospitals.

The rule, which does not apply to government hospitals, was introduced last July - at the worst possible time for Mediclinic as it had just bought Abu Dhabi private hospital group Al Noor for about $1.7 billion.

The London and Johannesburg-listed company's experience illustrates the business risks in the Gulf's oil-exporting countries as low crude prices dampen economies and strain state finances.

The firm has begun lobbying the state Health Authority of Abu Dhabi over the Thiqa change, David Hadley, chief executive of Mediclinic Middle East, told Reuters in an interview.

"Other providers have done the same," said Hadley, adding that the reform had channeled patients to government hospitals. "We don't have a problem with the policy on co-payments as long as it applies to the entire industry."

One of the industry sources said that although authorities did not want to be seen as giving in to pressure in any way, the policy might be adjusted again around the end of this year - partly because reduced Thiqa coverage had led to higher costs at state hospitals, hitting the government's budget.

The Health Authority of Abu Dhabi did not respond to requests for comment about the private sector's discontent with the Thiqa change or whether it planned to scrap the reform or extend it to all hospitals.

It has previously said that the rule change would contribute to its efforts to increase efficiency, standardize operations and increase the sector's financial viability for the benefit of patients and the healthcare system as a whole.


By many measures, the Gulf is an attractive destination for foreign healthcare providers; incomes are high and growing populations are burdened with some of the world's highest levels of lifestyle diseases, such as diabetes.

Encouraged by such trends, Mediclinic, which has 73 hospitals and 43 clinics across South Africa, Namibia, Switzerland and the UAE, bought Al Noor last year. But since the Thiqa change, Al Noor's in-patient volumes have dropped 38 percent and out-patient volumes by 43 percent, Hadley said.

To compound Mediclinic's problems, at around the same time as the reform, competition intensified in Abu Dhabi with three new players entering the sector, while thousands of expatriates and their families left because of job losses in a slowing economy. Also, 147 doctors out of 600 left Al Noor, many to join new hospitals in the area, and new doctors had to be hired.

"We were hit by a multitude of headwinds. I think it was the timing - we couldn't have predicted. It is going to be a challenging year," said Hadley.

Mediclinic's London-listed shares have dropped 8 percent since the company issued a profit warning for its Middle East business last week.

While timing played its part, other factors might also have contributed to the company's struggles in the region, however.

"In the long-term it will probably be clear that Mediclinic overpaid for the Al Noor acquisition," said Neil Brown, analyst at Electus, a South Africa-based fund manager.

"However, at these Mediclinic share price levels of 120 rand, which are now around 40 percent lower than mid-2016 when the above-mentioned rules changed in Abu Dhabi, we believe that Mediclinic is attractively priced for longer-term investors."


Mediclinic has not diversified across the region as broadly as some rivals to share out its risk.

Its stock performance stands in stark contrast to rival NMC Health, which has seen its shares rise almost 13 percent year-to-date, according to Thomson Reuters data.

NMC, one of the oldest healthcare players in Abu Dhabi, has operations in seven emirates of the UAE as well as Saudi Arabia and Qatar, while Mediclinic has operations in just Abu Dhabi and Dubai.

Also, some rival companies say they disagree that the Thiqa change is negative for the private sector.

"It is a measure to manage over-utilisation and over-diagnosis. When coverage is free, no one cares," said Prasanth Manghat, deputy CEO of NMC Health.

Shamsheer Vayalil, managing director of VPS Healthcare, said: "Unnecessary medical visits have stopped since the new policy took effect. There was a need for a correction."

Mediclinic aims to complete the Al Noor integration and rebranding by the end of this year. A total of 432 jobs at Al Noor were cut in 2016 with another 511 to go in the next few months, said Hadley. Of the planned lay-offs, 183 jobs relate to the closure of small facilities and clinics, including one in Oman which was uneconomic, he said.
2017/03/08 04:25 PM
SA’s medical schemes are prohibitively expensive, suitable only for high-income countries with low levels of unemployment, writes Michael Settas

Finance Minister Pravin Gordhan announced in his budget speech that the contentious National Health Insurance (NHI) fund is to be established this tax year, with an initial injection of R5bn.

Besides the legal and political hurdles the NHI faces in coming to fruition, it is entirely imprudent to even contemplate this gargantuan project without first undertaking an exhaustive technical assessment. There are four basic pillars to any healthcare system: how much it costs; who is going to pay; what the benefits are; and who is going to deliver them.

The white paper released in December 2015 contained precious little detail on these aspects, other than it will be expected of taxpayers to do the paying part.

The 10 NHI pilot sites operating since 2011 have been unable to contract even one-fifth of the providers needed to operate effectively. The reason? The tendered reimbursement rates were so low that private sector doctors considered them derisory! Yet Treasury’s chief director for health and social development, Mark Blecher, was quoted last week as saying that the NHI package would be offered through public and private sector providers.

SA has a private healthcare sector that currently operates in parallel to the public sector — perfectly capable of delivering basic healthcare services, right now, at a reasonable cost. Yet just prior to the budget speech, Gordhan gazetted the Demarcation Regulations that deny insurers the right to offer private healthcare insurance to anyone willing to purchase them. The reason quoted for this? NHI is coming — and it is important to protect the medical schemes industry from harm (that is, protect them from competition).

The average monthly contribution to a medical scheme is now more than R1,700 per beneficiary, costing a family of four nearly R7,000 a month. Medical schemes are prohibitively expensive, partly because they operate within an outdated social rights framework that is only suitable for high-income countries with low levels of poverty and unemployment.

Every progressive and rational government the world over does its best to enable the provision of healthcare within both its private and public sectors. Besides this being a constitutional responsibility, the rationale is simple: citizens of all means are willing to purchase private healthcare at a level they can afford. This is done voluntarily by such citizens and has the significant advantage of alleviating pressure on state healthcare resources, which will always be restricted by the level of taxes it can raise.

Gordhan is very much at the end of the line in terms of the amount he can tax the country’s citizens. The appropriate approach now would be to enable affordable private sector cover as much as possible, and from there it will be a whole lot easier to deliver NHI.
2017/03/08 04:26 PM
Cape Town - South Africa's biggest generic drug maker Aspen Pharmacare [JSE:APN] signed off on an agreement with GlaxoSmithKline to acquire a portfolio of anaesthetics, the company reported on Wednesday.

The company will pay an initial amount of £180m, paying an added £100m if certain goals are met in the three years following completion, according to a statement issued on Wednesday.

The transaction was completed on February 28 2017 on a global scale and on a national scale in Durban on March 1 2017. The deal adds to the anaesthetics Aspen bought in June from AstraZeneca of the UK for as much as $770m.

Aspen's shares declined 0.21% to R282.78 as of 16:32 on the Johannesburg Stock Exchange.
2017/03/08 04:36 PM
Mediclinic Pietermaritzburg made history recently when it opened the first private Emergency Centre in KwaZulu-Natal which will be run by two emergency medicine specialists, Dr Sandy Inglis and Dr Daniel Fiandeiro, from today, 1 March.

Speaking at the launch event, hospital manager Henk Laasky said that Mediclinic want to be the hospital of choice to people both in the city and beyond.

“We want to be the number one choice for the Pietermaritzburg community. We want them to have complete peace of mind and to know that they will get the best care in town with us,” he said.

Inglis, who has his roots in Pietermaritzburg but worked overseas for many years and has been heading the emergency unit at Edendale Hospital for the last four years, has moved to head the Mediclinic EC. “I am grateful to Mediclinic for having the faith in us to bring emergency care to Pietermaritzburg. Having emergency specialists heading an emergency centre should be the norm but sadly this is not the case.

“Our emergency centre will not only cater for injuries but will cater across the board from asthma to heart problems, diabetes and the like; it’s not solely focused on trauma. We want to raise the bar on emergency care in Pietermaritzburg, we want to be at the head of the change,” said Inglis.

Mediclinic has a long history of quality emergency care and with Inglis and Fiandeiro on board; the facility is further aligned with worldwide emergency care and standards. With 20 years Emergency Medicine specialist experience between them, the intention is to continue raising the bar on the quality of private emergency care provided, ensuring good value emergency medical and trauma care.

Fiandeiro, originally from Gauteng spent the last two years fine tuning his skills in the United Kingdom but completed his specialist training in Pietermaritzburg. He is familiar with the local community and is committed to giving them the best emergency care possible.

“I’m excited to see what we can do at Mediclinic. We want to provide world class care which is what emergency care is supposed to be like and how it’s supposed to be done,” he said.
2017/04/06 04:40 PM
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By Jasson Urbach, Economist at the Free Market Foundation of Southern Africa Medical aid [schemes] are a crime against humanity... [and] an atrocity", were the words used by Health Professions Council of SA (HPCSA) president, Dr Kgosi Letlape, last month.

If individuals using their own money to pay for their own and families' healthcare, while also paying taxes to fund the healthcare of others, is a crime against humanity, what would Letlape have made of the Nazi death camps, the Belgian rule of Congo, the Cambodia killing fields, or the Rwandan genocide?

It's worth reminding Letlape that if more people are enrolled in private medical schemes, the state would have more money available to care for the truly destitute. Rather, Letlape seems more concerned with removing the socalled "twotier system" than trying to design an affordable mechanism to provide high quality healthcare for the poor.

We have multitier systems at work when it comes to food, housing, clothing, and many other essentials. However, most people recognise that to drive private restaurants, real estate and clothing retailers out of existence and implement state-controlled delivery, will not provide food, housing and clothing to the poor.

Indeed, aside from healthcare, South Africans have other constitutional rights, such as for housing and education. Healthcare should be treated the same way as these other rights. Government should look after the poor and leave the private market alone to provide for those able to provide for themselves. More specifically, the state should simply finance healthcare for the poor and leave the rest of the population to decide for themselves how to spend their money.

The only question government should ask is: what is the best way for the poor to get highquality healthcare? It is neither necessary nor appropriate for the government to provide "free healthcare for all" because doing so would waste scarce taxpayer resources. Taxpayers could fund healthcare for those who cannot afford it, but where is the sense in interfering in the arrangements of those who can?

The proposed NHI would concentrate power in the hands of the government officials who would be acting as both a player and a referee, leaving no room for private medical schemes to operate. Whether directly or indirectly, the government would control the availability, financing and delivery of our health care — the choice will no longer be ours to make.  A compulsory NHI funding would serve the government's interests, not ours.

The proposed mandatory payments into the central NHI fund will crowd out private insurance as cash strapped individuals will no longer be able to afford to pay their voluntary private insurance premiums on top of the mandatory NHI payments. Those unable to pay the two premiums will be forced to resort to using the already overstretched public health service.

While the rich can hop on a plane and seek medical care anywhere they please, the poor and middleclass will be unable to escape the vagaries of the government controlled system. NHI would perversely increase the inequalities in healthcare and concentrate power in the hands of state officials, leaving no room for private medical schemes.

Letlape estimates that there are 'between 3000 and 4000 medical professionals working for medical schemes that could be redistributed to the health system if schemes were abolished".

That Letlape does not think medical schemes are part of the health system is revealing in and of itself. But his view that people can be "redistributed" harks back to a Soviet form of social engineering and has no place in a free democratic state.

Letlape should know better. According to Liz Still who compiles the annual "Health Care in South Africa" publication, the public sector does not have enough posts available to employ South Africa's health professionals. For example, over the period 20022010, approximately 11 700 doctors graduated but only 4403 posts were created in the public sector. In the field of dentistry, there were 2140 graduates but only 248 public posts were concurrently created. If the private sector was abolished, where would our medical graduates find work? The current chaos in finding funded intern and community service posts for doctors and pharmacists corroborate this state of affairs.

Dictating to people in the healthcare industry where they may or may not work raises the evil spectre of an apartheid-style form of social planning. This is not welcome — especially after so many South Africans fought so long and hard for their freedoms from an overbearing state.

Given the country's bleak economic growth forecast, chronic unemployment situation, narrow tax base, and a ballooning budget deficit, South Africa simply cannot afford a system of nationalised health care. South Africans must be free to choose. The proposed NHI will destroy the private healthcare sector and South Africans will no longer have any choice when it comes to their healthcare. Private medical schemes are the opposite of a crime against humanity. They increase access to quality care and provide greater consumer choice, which leads to greater health system responsiveness.
2017/03/08 04:29 PM
The Council for Medical Schemes conducted a trend analysis study on chronic diseases in the private healthcare sector for the period 2010 - 2015. The main finding of the study is that there has been a sustained upward trend in diagnosis and treatment of many chronic conditions on the Chronic Disease List. The top 10 ranking of chronic conditions according to prevalence rates did not change significantly between 2014 and 2015.

Executive Summary

The Medical Schemes Act, 131 of 1998 makes it mandatory for medical schemes to cover costs for the diagnosis, treatment or care of a defined set of benefits or Prescribed Minimum Benefits (PMBs), regardless of the benefit option members have selected. PMBs include any medical condition which meets the definition of an emergency, a limited set of 270 medical conditions and 26 chronic conditions defined in the Chronic Disease List (CDL). The CDL specifies medication and treatment for the chronic conditions that are covered as PMBs. This law ensures that beneficiaries with chronic conditions are not risk-rated. The CMS conducted a retrospective study of the CMS Scheme Risk Measurement (SRM) database to establish changes in the frequency of chronic diseases among beneficiaries of medical schemes between 2010 and 2015. This study is an update of the “Prevalence of chronic diseases in the population covered by medical schemes in South Africa” published by CMS in December 2015.

For the first time in 2015, the CMS also analysed data on a more relaxed definition of prevalence as opposed to the SRM definition of prevalence. The findings of this study indicate that in 2015, the upward trend in diagnosis and treatment of many conditions on the chronic disease list continued. The top 10 ranking of chronic conditions according to prevalence rates did not change significantly between 2014 and 2015. The top 10 ranked CDL’s and HIV/AIDS (chronic conditions with the highest prevalence rates) are hypertension, hyperlipidaemia, diabetes mellitus 2, HIV/AIDS, asthma, hypothyroidism, coronary artery disease, cardiomyopathy, epilepsy, and bipolar mood disorder. The CDL’s listed as top 10 ranking CDL’s had prevalence rates of at least 3 per 1 000 beneficiaries in 2015.

Hypertension, hyperlipidaemia and diabetes mellitus 2 continued to be the highest prevalent CDL’s in medical schemes beneficiaries with the prevalence of more than 20 per 1 000 beneficiaries. HIV/AIDS moved one position down from being the fourth ranking CDL to being the fifth ranking condition in medical scheme beneficiaries.

Hypertension retained its rank as the highest prevalent CDL in medical schemes beneficiaries with an overall prevalence rate of 96.05 per 1 000 beneficiaries in 2015.

Hypertension prevalence increased by 7.8 percent in 2015 as compared with 2014. Over the period between 2010 and 2015, hypertension prevalence increased by 27.9 percent resulting in the average annual growth rate of five percent per year for the period. The growth in hypertension prevalence has been consistent in open and restricted schemes for the period under review.

Hyperlipidaemia continued to be the 2nd ranked CDL in terms of prevalence despite the prevalence rate decreasing by -1.4 percent between 2014 and 2015. Between 2010 and 2015, the prevalence of hyperlipidaemia increased by 12 percent resulting in an average growth rate of 2.3 percent per year for the period under review. Diabetes mellitus type 2 is still the 3rd ranked CDL in terms of prevalence. Between 2010 and 2015, prevalence of diabetes mellitus type 2 increased by 53.8 percent (from 20.29 to 31.21 per 1 000).

This represents an average growth rate of nine percent per year for the period between 2010 and 2015.

HIV/AIDS ranked the 5th chronic condition in terms of prevalence. Between 2010 and 2015, treated HIV/AIDS prevalence increased by about 82.4 percent. This resulted in the average growth rate of about 12.8 percent per year for the period under review. The treated HIV/AIDS prevalence declined from 20.96 per 1 000 beneficiaries in 2014 to 16.40 per 1 000 beneficiaries in 2015 (resulting in a year on year decrease of -21.8 percent). This is a worrying factor as the decrease was not expected. This decrease needs to be interpreted with caution as this may be a data quality issue. The number of medical scheme beneficiaries who were diagnosed and treated for multiple CDL conditions continued the upward trend in 2015. This might have a negative impact on the risk profiles of medical schemes.

The deterioration in risk profiles should be a concern for medical schemes. The upward trend in diagnosis and treatment of many chronic conditions on the CDL continued in 2015. This study is not yet in a position to isolate specific reasons for this increase in chronic diseases, the trend could still be generally attributed to improved data management systems of medical schemes and administrators, the deteriorating disease profile and increased beneficiary awareness of entitlements and changes in care-seeking behaviour.

A copy of the full report can be found at: http://www.medicalschemes.com/files/Research%20Briefs/researchBrieef.pdf
2017/02/27 04:52 PM
The National Health Insurance (NHI) fund is to be established this year, according to finance minister Pravin Gordhan.

The fund will initially focus on improving access to a common set of maternal health, ante-natal and family planning services; expanding integrated school health programmes, including spectacle and hearing aid provision; and improving services for people with disabilities, mentally ill patients and the elderly.

“The service package financed by the NHI Fund will be progressively expanded,” Gordhan said. “In setting up the fund, we will look at various funding options, including possible adjustments to the tax credit on medical scheme contributions. Further details will be provided in the adjustments budget in October this year, and in the course of the legislative process.”

According to the NHI White Paper published in December 2015 by the Department of Health, the fund will be capable of buying personal health services from accredited and contracted public and private providers at primary health care level and public hospitals. The fund is to be governed by the NHI Commission, which will include civil society representatives.

In due course, the NHI Commission as well as a management team and a stakeholder representative forum will be appointed.

Phase II

Government is now moving toward the next phase of implementing the NHI.

We are still in the first, preparatory phase which, according to Gordhan, involves “strengthening of the service delivery platform and the overall improvement of quality in the public health sector,” and extends from the 2012/2013 to the 2016/2017 financial years.

Phase II will extend from 2017/18 to 2019/21 and is to include the mobilisation of additional resources, a review of state subsidies to medical schemes (into GEMS, Polmed, Parmed and other private medical schemes to which the state makes contributions) which will be reallocated into the NHI, the establishment of the NHI Fund and governance structures as well as amendments to the Medical Scheme’s Act.

Phase three will extend from 2021/22 to 2024/25.

One-hundred-and-sixty submissions were received from the public on the NHI White Paper. As such, Gordhan said “National Treasury and the Department of Health are working together to revise and finalise the NHI White Paper and the longer-term financing arrangements. There will be consultations with stakeholders over the period ahead on reform of the medical scheme environment, including consolidation of public sector funds.”

Eleven pilot projects had “yielded valuable insights” on which government would build, including designing contracts with general practitioners, more effective dispensing of chronic medicine, strengthening district health services through clinical specialist teams, ward-based outreach teams and school health services, and supportive information systems.

In his 2016 speech, Gordhan said R4.5 billion had been budgeted over the medium term for “revitalising health facilities in the eleven NHI pilot districts, and related health system reforms”.

Industry comment on NHI

NHI has come under heavy criticism and been met with scepticism.

The Institute of Race Relations in an article entitled, NHI: Risking lives for no good reason, stated that the NHI would put an end to private healthcare. “The medical schemes that currently sustain private practice will mostly not survive once they are confined to providing cover ‘complementary’ to that supplied by the NHI. In addition, state controls will be so extensive that practitioners will have little autonomy in running their own practices.”

Commenting on SA’s questionable long-term fiscal sustainability, Arthur Kamp of Sanlam Investments said: “There is no room for a downturn in growth (indeed the budget relies on a sustained economic upswing) and there is no room for spending on NHI (although the minister indicated a review of medical tax credits to possibly help with funding down the line).

The Council for Medical Schemes however, is of the opinion that private healthcare will co-exist with the public sector, although it may be in a different format to how it is currently structured, according to general manager of stakeholder relations, Elsabe Conradie.
2017/02/27 04:54 PM
Fear of public hospitals, high medical bills and family responsibilities are often the underlying motives for those who become medical aid members. Furthermore, there is real need among consumers for easy, accessible information to compare healthcare providers. According to a report in The Citizen, these findings emerged from a Healthcare Consumer Survey that was conducted by the Health Market Inquiry (HMI) in 2016. The focus was on consumers’ experience in buying medical aid cover and using private healthcare services.

The report says players in the health industry should take note; consumers would value reliable and understandable information about how providers measure up to one another. At present, in the absence of any objective criteria or data, they rely on word-of-mouth information from providers, family and schemes on which services to use.
The general feeling among respondents was that information should be available in a simpler form – specifically regarding credentials and details of doctors, experiences at hospitals as well as costs of services.

According to the research, there is a sense that “any information relating to all of this should be readily available, for instance an app or online website like Hippo or TripAdvisor for private healthcare”.

The report says cost and the variety of medical scheme options are the primary factors that influence scheme choices. Cost was the determining factor for the younger group of respondents (age 18-34), while range of options were more important for older people (age 35-59).

Belonging to a scheme is also motivated by other factors. Participants in the survey’s focus groups stated that their choice of medical scheme was based on their fear of public hospitals, high medical bills and family responsibilities. Age-related factors, health scares like a stroke, and other heart-related diseases were also mentioned.

The report says, however, that choosing a specific benefit plan on the medical aid is not easy. Many respondents felt that the information made available by medical schemes was complicated. They also stated that they got confused at times because not only were the scheme plans complex, but the plans also kept changing. One participant said: “You always need to check if you are covered for something. It changes all the time.” Most respondents (50%) had selected their medical schemes through their employer. Only 18% had selected the scheme on their own and 12% used a broker.

Affordability seemed to be the main factor for members leaving schemes – 41% of respondents who were no longer members left because it became unaffordable. This was followed by 13% who were members through an employer, but contributions became unaffordable after changing employment.

Other reasons for leaving medical schemes included a change of job (11.6%), unemployment (11.2%), lack of value for money (5.6%), and exclusion due to health status (0.4%).

Interestingly enough, the report says the majority of respondents are very comfortable with their doctors having access to all their health records, including past treatments provided by other doctors, prescribed medicines and previous tests.

“There was a view that sharing of patient data between various providers that treat a patient would be beneficial. This is consistent with a sense that continuity of care is valued by patients and may also lead to better quality of care and lower costs,” the report states.

The study found that 65% strongly agreed that their doctors should have access to all their health records. This is followed by 22% who somewhat agreed and 74% also indicated that they would like to have access to their own health records.

The Citizen report
2017/02/27 04:55 PM
Pretoria – Treasury plans to prioritise finalising the National Health Insurance (NHI) Bill and it will establish an NHI Fund.

This is according to the National Budget which was delivered by Finance Minister Pravin Gordhan in Parliament on Wednesday.

"We are committed to achieving universal health coverage, in line with the National Development Plan (NDP)," said Gordhan.

The NHI is critical to this goal, and in his speech, Gordhan highlighted some of the focus areas of the fund.

These include improved access to maternal health, antenatal services and family planning services, as well as expanding integrated school health programmes, including the provision of spectacles and hearing aids, said Gordhan. Further, the fund would focus on improving services to people with disabilities, the elderly, and mentally ill patients.

"The service package financed by NHI Fund will be progressively expanded," said Gordhan.

R5.2bn allocated for NHI

To set up the fund, Treasury would consider possible adjustments to the tax credit on medical scheme contributions. More details regarding this would be revealed in the mini budget in October.

Gordhan also highlighted insights gathered from 11 NHI pilots. These are related to the design of contracts with general practitioners, more effective chronic medicine dispensing, strengthening of district health services through clinical specialist teams, ward-based outreach teams and school health services, and supportive information systems, he explained.

Treasury would allocate R5.2bn of the Department of Health’s budget to the NHI over the medium term. So far, R1bn was to be allocated for the recruitment of health care professionals. About 1.5 million chronic patients are set to benefit from the access to medication through centralised medicine dispensing and distribution. This would help alleviate pressure on public health facilities, according to the budget.

Spend on these interventions would increase by 21.2% per year over the medium term.

Other health expenses

Health has a budget of R187.5bn. District health services will be allocated R83.6bn, central hospital services will be allocated R35.9bn, and provincial hospital services will be allocated R32.3bn. Facilities management and maintenance are allocated R9.9bn and the remaining R25.8bn will go towards other health services.

Gordhan would also be working with other ministers to establish a new medical school in Limpopo, and would be involved in the planning of Limpopo Central Hospital.

Treasury has also allocated R885m for the universal test and treat policy for HIV, and R600m will be allocated to commission the new Nelson Mandela Children’s Hospital.

Expenditure estimates for 2017/18 come to R42.6bn. For the NHI, R735.1m is allocated and more than R18bn is allocated to HIV and Aids, tuberculosis, and maternal and child health.

About 88.3%, or R123.4bn, of the Department of Health’s budget will be transferred to provincial departments over the medium term through conditional grants.

R606bn on health

Compensation for employees will also be reduced by R9.7m as part of lowering the expenditure ceiling.

Refurbishment of hospitals will require R20.8bn investment in infrastructure over the medium term. 

Tertiary health services will be provided to 28 hospitals with a grant of R11.7bn in 2017/18.

"Government is committed to increasing investment towards health promotion, targeting non-communicable diseases alongside the implementation of the sugary drinks tax, such as diabetes screening and nutrition education," Gordhan said.

Government intends to spend R606bn on health over the next three years. R59.5bn will be in the form of an HIV and Aids conditional grant.

* Visit our Budget Special for all the budget news and in-depth analysis.
2017/02/27 04:56 PM
Maternal health services among the first benefits scheme will offer

The government plans to set up a National Health Insurance (NHI) fund this year that may be partially financed by a reduction in the tax subsidy currently given to medical scheme members, Finance Minister Pravin Gordhan has announced.

This is the first strong signal of progress on the NHI from Treasury since last year’s budget when Gordhan said it would soon issue a financing proposal for the policy, which promises sweeping reforms to SA’s healthcare system. That proposal has yet to materialise, partly because work is still under way to refine the NHI White Paper put out by Health Minister Aaron Motsoaledi in 2015.

The Treasury said the proposed NHI fund would start with maternal health services, improved psychiatric care and services for the elderly and disabled. It will also provide hearing aids and glasses through the school health programme.

These were priority areas identified by Motsoaledi, said Treasury chief director for health and social development Mark Blecher. "It reflects an agreement between the ministers (of health and finance) to move ahead with NHI, even if it’s relatively modest to begin with. It is likely a small amount of money, about R5bn per annum, will be taken from the medical scheme tax subsidy to begin with," he said.

The proposed NHI fund would require enabling legislation and a revised White Paper, Blecher said.

Further details would be provided in the October adjustment budget, Gordhan said in his budget speech on Wednesday.

Treasury said the package would be offered through public and private sector providers and would be gradually expanded.

Consolidated health expenditure is set to rise by 8.3% over the medium-term expenditure framework, making it the fastest growing category of government spending after debt servicing and post-school education.

Health expenditure will grow from R170.9bn in 2016-2017 to R187.5bn in 2017-2018, and then rise to R201.4bn in 2018-2019 and R217.1bn in the outer year.

Treasury said the increase in expenditure was mainly driven by the expansion of free anti-retroviral treatment for people living with HIV, highlighting the government’s commitment to tackling SA’s massive HIV/AIDS epidemic. An extra R885m has been added to the baseline for improving access to HIV treatment, which now reaches an estimated 3.5-million patients.

The comprehensive HIV/ AIDS grant is the fastest growing segment of health expenditure and is projected to increase by an average of 13% per year over the medium term. It is due to rise from R15.29bn in 2016-2017 to R22.04bn in 2019-2020.

Treasury emphasised the pressure facing the health budget as a result of increased personnel costs, higher spending on ARVs and currency depreciation. "Although centralised procurement of medicine has resulted in estimated savings of R1.6bn per year, these savings have largely been offset by the weaker rand which drives up the cost of imported medicines," the Treasury said in the budget review.

Blecher said R1bn had been added to the provincial equitable share in 2019-2020 to protect provincial health departments from future currency depreciation. Treasury has also added R600m to the baseline for the Nelson Mandela Children’s Hospital in Johannesburg.

The South African Health Products Regulatory Agency, which is due to replace the Medicines Control Council in the coming financial year, is allocated R397.6m over the medium term. It will be a public entity and will retain the revenue it collects from the pharmaceutical industry when it registers their products.
2017/02/27 05:02 PM
The Government is moving towards the next phase of the implementation of National Health Insurance (NHI).

Finance Minister Pray in Gordhan confirmed during his Budget speech yesterday that an NHI Fund would be established in the next phase of the NHI's implementation.

Gordhan said the initial focus of the NHI Fund would be to improve access to a common set of maternal health and antenatal services and family planning services; expand the integrated school health programmes, including the provision of spectacles and hearing aids; and improve services for people with disabilities, the elderly and the mentally ill, including the provision of wheelchairs and other assistive devices.

He added that the service package financed by the NHI Fund would be expanded progressively.

"In setting up the fund, we will look at various funding options, including possible adjustments to the tax credit on medical scheme contributions. Further details will be provided in the Adjustments Budget in October this year and in the course of the legislative process," he said.

Gordhan said the government was committed to achieving universal health coverage in line with the vision of the National Development Plan.

He said 11 NHI pilot projects had yielded valuable insights on which the government was now able to build. These included the design of contracts with general practitioners; more effective chronic medicine dispensing; strengthening district health services through clinical specialist teams, wardbased outreach teams and school health services; and supportive information systems.

Gordhan said 160 submissions had been received from the public related to NHI, and National Treasury and the Department of Health were working together to revise and finalise the NHI White Paper and longer term financing arrangements.

He said there would be consultations with stakeholders over the period ahead on the reform of the medical scheme environment, including the consolidation of public sector funds.

It was proposed in the Budget that the medical tax credit be increased for the first two beneficiaries to R303 a month from R286 and for the remaining beneficiaries to R204 a month from R192 to counter the effect of inflation.

However, the Budget Review said future adjustments would be balanced with the funding requirements of NHI.

Health R187.5bn
District health services R83.6bn
Central hospital services R35.9bn
Provincial hospital services R32.3bn
Other health services R25.8bn
Facilities management and maintenance R9.9bn
2017/02/27 05:03 PM
Minister of Finance Pravin Gordhan on Wednesday said a National Health Insurance (NHI) fund is set to be established in 2017.

Gordhan said the focus of the fund will “improve access to a common set of maternal health, ante-natal services, family planning services and expand the integrated school health programmes, including provision of spectacles and hearing aids. ”It will improve services for people with disabilities, the elderly and mentally ill patients, including provision of wheelchairs and other assertive devices,” he said.

In establishing the fund, the Minister said various funding options will be looked at. ”This includes possible adjustments to the tax credit on medical scheme contributions,” Gordhan said.

He added that further details will be provided in the adjustments of the budget in October this year. Gordhan also highlighted government’s commitment to increasing investment towards health promotion targeting non-communicable diseases.

“An additional R885 million has been added to support the implementation of the universal test-and-treat policy for HIV and R600 million for the commissioning of the new Nelson Mandela Children’s Hospital,” he said.
2017/02/27 05:04 PM
Health Minister Aaron Motsoaledi believes the government's radical economic transformation plan will speed up the full implementation of the National Health Insurance (NHI).

Motsoaledi told Independent Media at the weekend that while in other countries it had taken longer, in South Africa it would be implemented within 14 years.

South Africa has roped in France to help with the NHI.

Motsoaledi said he was with the French ministers on Thursday and they told him France and Britain were taking about 50 years to implement universal health coverage.

It was accelerated by World War II because many people needed medical care.

"In South Africa, people are still debating whether NHI will be expensive or not. Every country has gone through that. I suspect this radical economic transformation will spur us on," Motsoaledi said.

He said in many countries, corporates opposed universal health coverage. In the US, former president Barack Obama was taken to court by big corporates over Obamacare, and he won three times.

His successor, Donald Trump, wants to scrap Obamacare. There are 11 pilot sites for NHI across South Africa.

The government is also focusing on the health of schoolchildren as part of the pilot project.

Motsoaledi said NHI was key to the development of the country He said when Obama introduced Obamacare, he put 20 million Americans on it.

Many Americans use private health care, but Obamacare accommodated those who could not afford private health care. Motsoaledi said in the NHI pilot sites, they were integrating private health care with public health care.

They contracted 390 general practitioners when the project started, and it took off very slowly They now wanted to rope in specialists.
2017/02/16 03:11 PM
Eye Witness News
President Jacob Zuma says the NHI programme, which has three phases, is currently in its first phase.
President Jacob Zuma says the national health insurance (NHI) will only be implemented over a 14-year period, in three phases.

The president touched on the NHI in his State of the Nation Address (Sona) on Thursday night.

He says the programme is currently in its first phase.

But the National Health, Education and Allied Workers Union (Nehawu) says it’s disappointed by how long it’ll take to be fully implemented.

Nehawu’s Khaya Xaba says the process must be sped up.

“We want the NHI to be implemented a s soon as possible so that working class people and the poor can have access to quality healthcare. We can’t wait for 14 years for quality healthcare to reach those who cannot afford it.”
2017/02/16 03:15 PM
David Shapiro considers today’s market – commodities, mining shares, Mr Price, retailers, Cashbuild, Spar, Shoprite, Naspers, Mediclinic, Group Five and Royal Bafokeng Platinum

SIKI MGABADELI:  Good evening and welcome to the SAfm Market Update with Moneyweb. My name is Siki Mgabadeli.

There was no pomp and ceremony on the markets today because we ended up just 0.2% at 51 904 on the all-share. The Top 40 is up 0.2% as well. The rand is at R13.42/dollar, R16.78/pound and R14.31/euro.

It’s a mixed picture on commodities. The gold price is down about 0.5%, platinum is up a little bit; it’s sticking above $1 000/oz, and Brent crude is back above $55/barrel. Gold miners are down 2.7%, financials up 0.1% and industrials up 0.5%, with resources down 1%.

Watching those visuals from the National Assembly you’ve got the Economic Freedom Fighters now entering the parliamentary precinct, so we are set for an interesting day.

David, no pomp and ceremony here.

DAVID SHAPIRO:  No one on the screen at the moment is wearing Mr Price – not even the EFF. Those look like real designer overalls.

SIKI MGABADELI:  What does that mean for Mr Price’s own share price?

DAVID SHAPIRO:  Mr Price was up today, strangely enough. Up about 4%. Quite strong in retailers. It was a very good day in retailers. All the way up.

The one thing we have to watch – and I’m not sure what the story behind it is – is Cashbuild. It’s up 3 or 4%. This is Thursday. Over the last four days that share is up 14%. No story behind it. I’m not sure what’s driving it.

SIKI MGABADELI:  Why? Spar Build It did not give us a good picture of what’s happening in that sector.

DAVID SHAPIRO:  No. In fact Spar and Shoprite were down today as well. And if you look at Group Five’s trading update it just points to a lot of issues in the construction industry. So I’m not sure why there is a sudden rush. There might be a reason.

SIKI MGABADELI:  Maybe Cashbuild is buying Build It. [Chuckling]

DAVID SHAPIRO:  I’ve always liked Cashbuild. I like the way it’s run.


DAVID SHAPIRO:  When I say a low level, I don’t mean that in a disparaging way. It’s well placed in the country and it provides what you could call the bakkie builders and maybe small-time construction businesses, etc, those people who come and buy a few bags of cement or buy a few window frames. But, make no error, this is a big business. I think it’s well placed in this kind of economy where at the low end of the market you’ve got this very strong demand still to build houses – even to build houses room by room.

SIKI MGABADELI:  I mentioned the platinum price – it’s solidly above $1 000/oz.

DAVID SHAPIRO:  It’s above $1 000. Gold is up, oil was up, copper was also up because of strikes in Chile. And yet mining shares are all down. Even the heavyweights – Anglos, Billiton, Glencore, all of those were down. And what might be happening is that investors are just taking a step back, nervous that the run that we’ve seen in commodity prices might not last. In other words, we’ll start to see a pull-back. There are a lot of analysts that are coming out very cautious about the iron-ore price, which remains over $82/ton, saying that supply that’s going to come on, and perhaps a lower demand for China, could see this price retreat quite dramatically. So I can’t reconcile it with the fundamentals. But that’s been one of the features today. In fact, it’s been the second day in a row we’ve seen mining under a bit of pressure.

SIKI MGABADELI:  Naspers up again. Tencent was up this morning.

DAVID SHAPIRO:  Tencent up. Naspers is not keeping track with other IT companies like in the US, which has really led the S&P and the major indices up there. That’s differentiated US markets from other markets where there has been this very strong rise in tech shares. But for some reason it just seems to be flat-lining in China. We are not seeing much. The currency might have a bit to do with Naspers’s indifferent performance.

But what is happening is Mediclinic is strong. We are seeing a turnaround in Mediclinic. This is a company that was down dramatically last year, but we’ve started to see some buying coming in at these lower levels, believing maybe the worst is behind.

And also CapCo up for a second [day]. Hammerson also up. These are UK-based property companies also having a fairly good day.

SIKI MGABADELI:  And we watch them quite closely because of course of the Brexit effect.

DAVID SHAPIRO:  Group Five came out with a trading update that was a lot worse than the market had anticipated or that they’d led us to believe in December. Conditions have deteriorated and they extended their loss. They were down about 8 or 9%. There are a number of issues that are weighing on the group. But as well as the manufacturing and mining numbers that have come out, even though they are historic up to the end of December, it still shows what a tough year it was. And, if you look at those, if you translate the manufacturing numbers and you translate the mining numbers, it could mean that growth is perhaps even lower than everybody has expected, or certainly pushing it below 0.5% or those levels.

SIKI MGABADELI:  I was going to ask you about Royal Bafokeng Platinum. They are telling us that they are expecting to return to a profit.

DAVID SHAPIRO:  I don’t know why – maybe it’s lower than the market was expecting. The trouble is, when you look at trading updates, you have to measure them against what the market was expecting. So what on the face of it appears to be a very strong result might not be where perhaps analysts had marked in a turnaround. Much better results than last year out of platinum, but it still points to tough issues ahead.
2017/02/16 02:58 PM
Cape Town – There's a glaring shortage of nurses nationwide, nursing union Denosa (The Democratic Nursing Organisation of South Africa) has said, due to apparent technical failure of IT systems at the South African Nursing Council which is holding up the issuing of licences to new nurses.

Denosa is due to march on the council's offices on February 22 to demand action.

Vice-chairperson of the South African Medical Association (Sama) Dr Mark Sonderup said the shortage affected specialised departments in hospitals such as intensive care units (ICU) across the country.

The National Education, Health and Allied Workers Union (Nehawu) said the council had a failed e-register system which had been out of order for some time.

This was behind the delay in issuing new licences. But the council said the system had recently been upgraded, updating first weekly, and recently, daily.

But the unions and professional associations say there is still a backlog which is severely affecting hospitals and operations at clinics in rural areas, where nursing services are most needed.

“We are fully behind Denosa in their call for addressing the issues of licensing for nurses as the situation of staffing levels is one which needs to be addressed,” Sonderup said.

Denosa provincial secretary Danver Roman said the shortage of nurses was a result of internal and external immigration by caregivers in search of better employment; the National Health Department facing financial difficulties which in turn reduced the number of nursing vacancies; and the decline in the number of nurses being trained as compared to previous years.

“There are many factors impacting on the issue of the nurses and with the burden of diseases increasing, it is becoming more complex."

“We are faced with people coming in and out of the country to get treatment, and... the challenge of treating different illnesses, it puts more pressure on the available staff in health facilities, which also causes a battle for them to reach many patients,” he said.

Nehawu’s Khaya Xaba said further action should be taken against the council for the shortage of nurses. “This issue has been happening for a long time. We do think maybe we should explore the legal route in order to put pressure on the council to issue licences. We have a huge backlog.”

But the council’s acting registrar, Sizeni Mchunu, refuted the charges of having a dysfunctional system: “The Sanc has identified the need to overhaul its IT system in order to ensure that it renders functions that are commensurate with today’s demands. It has already begun a system transformation service to improve services to nurses,” she said.

Xaba said the shortage mostly affected clinics and rural areas.

“As a country we are not producing enough nurses. We call for the closed nursing colleges to reopen because the institutes that do exist now are ‘fly by nights’ that do not equip students with the relevant knowledge and skills needed in the work market.”

Meanwhile, the Western Cape Health Department said the council’s alleged non-functional e-register system did not have an impact on health facilities in the province.

Zimkhita Mquteni, spokesperson for provincial health MEC Nomafrench Mbombo, said: “Sanc’s registration process has not impacted on the number of nurses practising within our health facilities as we only have a 4% vacancy rate.”
2017/02/16 02:59 PM
The South African Nursing Council has threatened to take legal action against the Democratic Nursing Organisation of South Africa (Denosa) for what it calls malicious and callous statements made by the organisation.

This after it claimed a nurse collapsed last month while queuing to renew her licence at the council’s only office in Pretoria. She later died in hospital, Denosa said.

Acting registrar of the SANC Sizeni Mchunu said the council took exception to statements made by the organisation’s spokesperson.

“The statement is devoid of fact. The SANC states no person has ever passed away within the boundaries of its premises and certainly not due to long queues and drawn out processes.

“The onus is on Denosa to produce documentary evidence supporting its allegation,” Mchunu said. The council has given Denosa 24 hours to issue a formal apology and to retract “false statements” against it.

Denosa said it’s awaiting feedback on its request for a meeting with SANC to discuss “pressing nursing issues”.

“Denosa owes SANC no apology or evidence and they are at liberty to exercise their legal right,” Denosa secretary general Oscar Phaka said.

Last year the Young Nurses Indaba marched to SANC demanding among other things that the council decentralise its office and establish offices in all nine provinces to allow nurses to register there.

The council said it has put in place short-term measures to ensure a smooth registration and has appealed for understanding from its members. Mchunu has also called on Denosa to produce evidence it has offered the council space at its offices for registration. 
2017/02/16 03:14 PM
In 'n operasie wat die eerste keer ter wereld gedoen is, het 'n span SuidAfrikaanse dokters aan die regterkantse basis van 'n vrou se skedel gewerk deur 'n piepklein gaatjie in die hoek van haar linkeroog te maak.

Die oorkruistegniek van regs na links met endoskopiese instrumente is gedoen omdat die pasient se vloeistof om die brein spontaan by haar neus begin uitloop het.

Prof. Darlene Lubbe, 'n oorneusenkeelspesialis van die Groote Schuurhospitaal, Mediclinic en die Universiteit van Kaapstad, dr. Hamzah Mustak, 'n oftalmoloog, en prof Patrick Semple, 'n neurochirurg, het die operasie onlangs uitgevoer.

Daar is net drie spanne in die wereld wat sulke dissiplines kombineer om unieke operasies te doen deur die hoek van 'n oog, neus, of soms deur albei. Benewens die SuidAfrikaanse span is daar ook spanne in Amerika en Italie.

Dit is die eerste keer dat die tegniek gebruik is om deur die hoek van een oog oorkruis na die ander kant van die brein te gaan. Die operasies is daarop gemik om minimaal indringend te wees.

Faieza Abdol (64) van Athlone, die pasient, se sy het minder pyn gehad as toe haar katarakte verwyder is.

Semple se die vloeistofdefek ontstaan op sy eie, maar dit is gevaarlik, omdat 'n mens meningitis kan kry en binne ses uur kan sterf. Die breinvloeistof loop fisiek by 'n mens se neus uit.

Die ander opsies is om die skedel oop te sny en so te opereer, maar dit het meervoudige risiko's en die pasient het nie net baie pyn nie, maar moet in die waakeenheid bly.

Die dokters het 'n dag voor die operasie op 'n ka dawer geoefen. Hoewel dit teoreties moontlik was om die operasie te doen, is dit nog nie voorheen gedoen nie. Lubbe en die span het al 40 ander operasies gedoen deur toegang te kry deur die hoek van die oog, maar dit was om aan dieselfde kant as die oog te werk.

Die operasie het vier uur geduur en Ina die tyd het ander dokters Abdol in die saal gesien en gedink die operasie is nog nie gedoen nie.

"'n Mens sien nie met die tegniek dat daar aan 'n pasient gesny is nie," se Lubbe. "Dit gee 'n mens regstreekse toegang. Ons het net 83 mm ingegaan en kon die lekplek regmaak. Indien daar 'n gewas was, sou ons dit ook so kon uithaal."

Semple se die lekplek was aan die basis van die regterkant van die skedel, en omdat die hoek moeilik was, was dit beter om van die linkerkant af in te kom.

Hulle wou ook nie senuwees wat aan die gesig sensasie gee, beskadig nie. Mustak het toegesien dat die oog en die senuwees nie beskadig word nie.

Die span gaan op 'n konferensie in New Orleans in Amerika hul werk voorle en die tegniek aan ander dokters verduidelik.

Hulle sal dit ook in 'n vakjoernaal publiseer. Abdol se dit voel glad nie of sy 'n operasie gehad het nie.
2017/02/16 03:02 PM
The chaotic and ultimately deadly transfer of the Esidimeni patients was a slow-motion accident that could have been stopped, writes Kerry Cullinan.

The deaths of 94 mentally ill patients transferred from Esidimeni centre is the biggest recorded mental health scandal in the history of South Africa.

The transfer of the 1 371 patients was “rapid” and “chaotic”, and the 27 “mysteriously and poorly selected” non-governmental organisations (NGOs) that they were transferred to had “invalid licences”, according to the Health Ombudsman Professor Malegapuru Makgoba’s report.

Some of these NGOs “rocked up in open bakkies” to fetch patients, while others selected them like “an auction cattle market”, according to the hard-hitting report.

Professor Makgoba has given the Gauteng health department 45 days to ensure that all remaining Esidimeni patients transferred to NGOs are “urgently removed and placed in appropriate health establishments”.

Former Gauteng MEC of Health Qedani Mahlangu resigned after being lambasted in the report. It is unlikely that Mahlangu resigned willingly, as she had stalled the release of the report for almost a month, asking for “more time to respond”.

More heads will roll in the coming days. Disciplinary proceedings against Head of Department Dr Tiego Selebano and Mental Health Director Dr Makgabo Manamela - for “gross misconduct”, including “tampering with evidence” during the investigation - has already begun.

Manamela is the one who issued the NGOs with licences despite lacking the authority to do so and without checking their premises. The report says both must also be reported to their professional bodies.

The report recommends action against a further nine officials.

Criminal charges are likely against Mahlangu in her personal capacity as well as the Gauteng government. The report details three-and-a-half pages of legal violations of the patients’ rights.

“Former MEC Mahlangu cannot simply resign and walk away from this. She, and other officials in the department, have to be held accountable,” said Dr Mzukisi Grootboom, chairperson of the SA Medical Association.

Meanwhile, human rights organisation Section 27, which has acted for the families in the past, is consulting its clients about possible legal action.

Section 27 also wants “an official inquest into the deaths of all patients”.

Some of the patients died of dehydration, hunger, septic bed sores and uncontrolled seizures, which indicates that they were not on their epilepsy medication, according to the report.

The worst offender was an NGO called Precious Angels, where almost one third of the patients transferred there died within a matter of months.

According to the report, the NGOs were only given R112 per patient per day and - worst of all - the department took three months to transfer the first payments. At Esidimeni, where patients were getting adequate care, the department was paying R320 a day.

Health-e News has covered the scandal over a number of months, and produced numerous articles and three TV documentaries - one of which, Dignity Denied, was used as evidence in the ombudsman’s report.

During our investigations, we witnessed poor conditions, overcrowding, a lack of basic care and no activities - not even radios or TVs to entertain the patients.

One of the patients we filmed, 23-year-old Sophia Molefe, who had moved back home, became violent towards her family although she had been stable at Esidimeni. Shortly after we filmed her, she overdosed on her medication and died.

Jabu Mackenzie, 34, was transferred to Siyabathanda in Braamfischerville, Soweto. “I am unhappy and hungry and can’t sleep. Please, please let me go home,” she begged.

Jenny Mbarati’s bipolar brother, David, was simply discharged with about 10 days’ worth of medication. It was a “very big shock” to his family.

Meanwhile, Caroline Ncube’s aunt ran away from the NGO she was moved to because there were no blankets and she was cold. Although she turned up at Ncube’s home, no one bothered to phone Ncube to find out whether her aunt was safe. The chaotic transfer of the patients was a slow-motion accident that could have been stopped. Section 27 brought legal action against the Gauteng health department in April last year on behalf of some of the patients’ families.

“In their current structured placement, patients with chronic mental illness are able to cope due to the 24-hour care and supervision they receive - but upon discharge without the same level of structured care and supervision there is a high probability of relapse and disintegration of the rudimentary coping skills, resulting in a need for more intensive mental health treatments than previously required.

“Ultimately, the cost of care will be higher,” warned Professor Anthony Pillay, president of the Psychological Society of SA (PsySSA), in a letter to Mahlangu before the mass transfer.

Meanwhile, Section 27 has called for a review of mental health-care service provision, “in all its forms, not only in Gauteng but the entire country. Those institutions that are found to be illegal must be shut down”.

May this never happen again anywhere in South Africa.
2017/02/16 03:02 PM
Medical aid schemes are a “crime against humanity” and should be abolished because they cannot co-exist with the government’s proposed National Health Insurance (NHI) scheme, according to Dr Kgosi Letlape. The president of the Health Professions’ Council of SA (HPCSA) was addressing academics and medical professionals at a discussion on whether the NHI White Paper met constitutional and human rights muster. He suggested private medical aids and the Medical Schemes Act should be abolished if the NHI is to provide universal healthcare access for all citizens. Letlape said there can be no national health if it is not for all of us. He said when you try and engage about NHI with the privileged they say: “Don’t touch my medical aid.”

Letlape said Health Minister Aaron Motsoaledi did not seem to have much support for the NHI and members of Parliament and judges also had an attitude of “don’t touch my medical aid”. However, he said, it was possible to provide universal healthcare, which was not a new concept, as the country had previously had one of the best healthcare systems in the world under apartheid. He said South African whites had health for all.

By 1967 they had a system that could give somebody a heart transplant for no payment. At the point of service, there were no deductibles, the doctor was on a salary and everyone could access healthcare. But, Letlape said, when the Medical Schemes Act was created 50 years ago, the exodus of medical professionals from the public to the private sector began. He said there were between 3 000 and 4 000 medical professionals working for medical schemes who could be redistributed into the health system if schemes were abolished.

Dr Mfowethu Zungu, deputy director general for macro policy, planning and NHI at the KwaZulu-Natal health department, said only 48 percent of expenditure on health was spent in the public sector, which serviced 87 percent of the population, while the balance was spent in the private sector which serviced medical aid members, who comprised about 13 percent of the population.
2017/02/16 03:09 PM
Durban – Medical Aid Schemes are a “crime against humanity” and should be abolished because they cannot co-exist with the government’s proposed National Health Insurance (NHI) scheme.

SA Health Professions Council president Dr Kgosi Letlape told academics and medical professionals at a discussion on whether the NHI white paper meets human rights objectives of the constitution, that private medical aids and the Medical Schemes Act should be abolished if the NHI was to provide universal health care access for all citizens.

Letlape was speaking at a public discussion at the University of KwaZulu-Natal in Durban on Friday.

“There can be no national health if it is not for all of us. You try to engage about NHI with the privileged, and they say ‘don’t touch my medical aid’. Medical aid is a crime against humanity. It is an atrocity.”

Letlape said Health Minister Aaron Motsoaledi did not seem to have much support for NHI, and people such as parliamentarians and judges also had an attitude of “don’t touch my medical aid”.

However, he said it was possible to provide universal health care, which was not a new concept, as the country previously had one of the best health-care systems in the world under apartheid.

“South African whites had health for all. By 1967 they had a system that could give somebody a heart transplant for no payment. At the point of service, there were no deductibles, the doctor was on a salary and everyone could access health care.”

But when the Medical Schemes Act was created 50 years ago, the exodus of medical professionals from the public to the private sector began, Letlape said.

He estimated there were between 3000 and 4000 medical professionals working for medical schemes that could be redistributed to the health system if schemes were abolished.

Dr Mfowethu Zungu, deputy director-general for Macro Policy, Planning and NHI at the KZN Health Department said only 48% of expenditure on health in South Africa was spent in the public sector, which served 87% of the population.

The balance was spent in the private sector, which served medical aid members, who comprised around 17% of the population.

Dr Hanif Vally, deputy director of the Foundation for Human Rights SA, said medical aid created a divide, as 50% of the country’s doctors and an even greater number of specialists served around 18% of the country’s citizens, who had access to the private sector.

“Medical professionals are going into private practice, inequalities are being worsened and people are not realising their constitutional rights."

Heath Department deputy director-general for Health Regulation and Compliance Management, Dr Anban Pillay, said the provision of universal health care for all citizens was critical.

“We currently have a system where people access care based on what they can afford. Clearly, there are a number of barriers to access, particularly in the lower socio-economic groups. NHI is a massive reorganisation of the public and private health-care system.”

Pillay said the poor were often most in need of health care, and funding for NHI would come from taxpayers based on a principal of social solidarity.

“Social solidarity means we all contribute to a fund, so that when I am sick I will have access to health care. But maybe I may never need to (access), but somebody else will.

“It’s not a concept South Africans are particularly used to in the current context. If you look at your medical scheme environment, which an individual contributes to as an insurance, you have a particular entitlement – it’s your money. This is very different to how the NHI works.”

In younger, healthier years, South Africans would contribute to the fund and were likely to derive benefits from that contribution only later in life.

“The young and healthy should subsidise the sick and old. This is not about investing in something where you are going to derive some profit. It’s investing in society so you can build society,” Pillay added.
2017/02/08 02:29 PM
An Acting Chief Executive and Registrar for medical schemes has been appointed by Health Minister Dr Aaron Motsoaledi‚ after the sudden death of the Council for Medical Schemes' respected registrar Dr Humphrey Zokufa in January.

He has been with the CMS for seven months as the Senior Strategist and has several years’ experience in the public health sector.

Dr Kabane said in a statement announcing his appointment he was "committed to take the CMS and the private healthcare sector forward in my acting capacity‚ whilst the process of appointing a permanent Registrar is continuing".
2017/02/08 02:30 PM
Some 80 000 nurses may soon stop paying their practising fees if the South African Nursing Council (SANC) does not create better ways to collect this cash. The Democratic Nursing Organisation of South Africa (Denosa) said its members will march on the offices of SANC and the Department of Health in Pretoria next month‚ demanding a solution. Nurses from across the country have been travelling to SANC’s lone office in Pretoria for the annual renewal of their practicing licences‚ where they wait for service in long queues. Last week a KwaZulu-Natal woman collapsed in the queue as she waited to renew her license and the licences of some of her colleagues.

Denosa said she died on arrival at the hospital but could not say what she died of. Those who elect to pay their fees through FNB may wait up to six months for their papers to be delivered‚ during which their employers may dismiss them for being unlicensed‚ Denosa said. If a solution for the poor servicing of nurses is not found urgently‚ Denosa will urge its 80 000 members to withhold payment of their 2018 fees. It said its members are spending so much money‚ energy and time traveling to SANC from all provinces if they are to get their receipt on time‚ which should not be the case in this day and age of technological advancement. Nurses face losing their jobs because of delays in receiving certificates after paying their annual fees.

Denosa suggested SANC deduct its fees directly from the salaries of government employees‚ with permission‚ and demanded the council opens provincial offices. Lastly‚ it said, online payments should at least be created as soon as possible. The council rakes in at least R120-million in fees a year from 220 000 nurses and 73 000 nursing assistants. Denosa is also taking SANC on for failing to appoint a permanent registrar since the departure of Tendani Mabuda more than a year ago, and for its poor communication channels. A year ago, SANC presented its plan for a feasibility study for the establishment of regional offices at the South African Nurses’ Conference. Denosa said it has made use of its regional offices available to SANC. It is appealing to Health Minister Aaron Motsoaledi to help SANC get its act in order.
2017/02/16 03:10 PM
The Health Market Inquiry into the Private Healthcare Sector (HMI) is about to enter the final public hearings phase of the investigative process.

The Chairperson of the HMI, Justice Sandile Ngcobo, provided progress on the HMI at a media and stakeholder session held on 14 January in Pretoria.

First launched in May 2014, Justice Ngcobo said that although the information assessment and analytical phase is ongoing, the panel is ready to commence with public hearings.

The HMI had received a total of 60 registrations from stakeholders to participate in the public hearings, following two registration periods.

The HMI intends to conduct six sets of public hearings over the period, 16 February to 9 June 2016.

The first set of hearings will commence on 16 February and conclude on 10 March 2016.

These will be held in four provinces:
Pretoria (16 - 18 Feb)
Durban (23 - 25 Feb)
East London (1 - 3 March)
Cape Town (8 - 10 March)

These hearings were preceded by prehearing consultations with stakeholders, which took place from 26 - 29 January 2016.

"The public hearings will commence with a general session, which is intended to set the scene for the hearings. During this session and the following sessions making up the first set of hearings, we would like to hear from all stakeholders in the private healthcare sector, which includes consumers and consumer groups; service providers comprising hospital groups and practitioners; funders and financiers, which include brokers, schemes, administrators and managed care organisations; regulators and policy makers," said Justice Ngcobo in a statement.

The chairperson said the purpose of the session is to gain an understanding of how these groups interact with one another as well as their experience in interacting with one another.

He also emphasised that the inquiry is not Litigation, but rather an inquisitorial process to Look into the state of competition in the private healthcare sector, identify any impediments and make recommendations to remedy them.

The further five sets of sessions will be conducted 29 March to 9 June.

These sessions will focus on specific aspects of competition issues, such as availability of information about private healthcare services; competitive dynamics among funders and service providers and the impact regulatory framework on competition among sector stakeholders.

All non-confidential transcripts of the HMI public hearings is available to the public. A detailed schedule of public hearings is be available on the websites: www.compcom.com
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