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2016/12/20 03:34 PM
Johannesburg – The South African Medical Association (SAMA) has warned the public that the proposed amendments to allow for the medical use of dagga would be implemented along strict guidelines.

"On 23 November, Parliament's Portfolio Committee on Health announced that the Department of Health would soon regulate access to medical cannabis for prescribed health conditions," SAMA chairman Mzukisi Grootboom said on Wednesday.

"The public, and healthcare professionals, should note, however, that the Medical Innovation Bill seeks to allow cannabis for medical purposes only. The bill, and the regulatory framework to be introduced by the Health Department, do not apply to cannabis for recreational purposes, which remains illegal in South Africa."

Grootboom said the difference between recreational and medicinal dagga (cannabis) "created worldwide confusion".

A process by the World Medical Association (WMA) to develop a position on medical dagga, emphasised the need to make a clear distinction between recreational and therapeutic use, he said.

The range of conditions for which medical dagga was used varied from country to country and was informed by varying degrees of scientific evidence.

"As a professional medical body with prime concern for patient safety and protection, SAMA subscribes to the principle of evidence-based healthcare and maintains that policy decisions on medical cannabis should be based on high-quality scientific evidence," said Grootboom.

He added that regulations needed to adequately provide for the safe prescription and dispensing of dagga and that medical prescription of the drug should only be dispensed at a pharmacy.

"Even with careful regulation of medical cannabis, experience from other countries shows that the risk of counterfeit 'patients' abusing cannabis medication for recreation, or for profit, remains a problem."
2016/12/20 03:35 PM
Health News Daily Newsletter
Board of Healthcare Funders Media Release

According to Dr Anna van Poucke, Head of Healthcare at KPMG in The Netherlands, escalating private healthcare costs are a universal problem and therefore not unique to South Africa. Increases in costs are the result of high demand, the development of more treatment options - which cost more - and the ageing population. Dr van Poucke was the guest speaker at a workshop facilitated by the Board of Healthcare Funders (BHF) of Southern Africa. The aim of the workshop was to bring stakeholders together to discuss ways to curb increases in medical costs. Dr van Poucke said although escalating costs are a universal problem, the driving forces behind increases differ from region to region. In most developing countries, access to healthcare is the biggest challenge, while in more developed countries, the ageing population is the main driver. Dr Clarence Mini, managing director of the BHF, said recent announcements of double-digit increases in membership fees by several of the country’s biggest medical schemes came as a huge shock to consumers and it is therefore imperative that collaborative solutions are sought to prevent a similar scenario in 2017. Mini said escalating healthcare costs in South Africa are mainly due to an increase in hospital admissions, gaps in the current regulatory structure, as well as fraud, waste and abuse.

Some of the country’s biggest medical schemes have expressed concern about the rapidly expanding supply of private hospital beds. Since 2008, 23 new private hospitals were opened in South Africa and, while this has improved access to healthcare, it has also led to more hospital admissions which increased the number of medical scheme claims, and this in turn impacts member contributions. Detailed analysis by medical schemes shows that the availability of empty beds makes it easier to admit patients who could otherwise most likely be treated in an out-of-hospital setting. The availability of additional hospital beds not only led to more admissions, but also influenced the average length of stay in hospitals. Prescribed minimum benefits (PMBs) have been a bone of contention in the private healthcare sector for several years. Medical schemes claim that the current structure, as set out in the Medical Schemes Act, is open to potential exploitation. Under this structure, funders must pay for some 270 PMB conditions regardless of the plan that members are on. The BHF has welcomed the Council for Medical Schemes’ (CMS) recent announcement that it is reviewing the PMB structure. BHF has pledged its full support and resources for this initiative.

Another controversial issue, which contributes to increases in member fees, is broker commission, said Dr Debbie Pearmain, an independent legal consultant and extraordinary lecturer in the Department of Public Law at the University of Pretoria. This issue was addressed in the Demarcation Regulations tabled by Treasury in Parliament on 28 October. The aim of the regulations was to clearly separate the responsibility for medical scheme and health insurance products, and to ensure that the latter do not undermine the medical scheme environment. According to Dr Pearmain, brokers earn almost double the commission on the sale of cash back plans compared with medical scheme membership, which clearly undermines the business of funders. Dr van Poucke shared some of the lessons learned from reforms made to the Dutch healthcare sectors in 2006. Since the introduction of these reforms, the Netherlands has managed to substantially reduce healthcare costs and is currently rated as one of the countries with the best healthcare services in the world. Reforms to the Dutch healthcare sector were driven by escalating healthcare costs, said Dr van Poucke. As part of its healthcare reforms, the country introduced a private healthcare system. A very important characteristic of the Dutch healthcare system is that it is managed by foundations and non-profit organisations, she noted. All profits are used to improve the healthcare system and are not cashed-out. Other countries such as Israel and the US have also successfully introduced various measures to contain healthcare costs.

These include for example the introduction of well-managed competition between private providers, coordinated care (home-based care provided by trained professionals) and the effective use of data and analytics to spot trends. Workshop delegates identified five key areas that can potentially curb healthcare costs in South Africa. These include: integration of coordinated care; lobbying for regulatory changes and greater collaboration between the industry and the regulator; taking a strong stance against fraud, waste and abuse; restructuring benefits to draw new members (eg low cost benefit options); and, improved management of cost drivers (eg restructuring PMBs). Working groups have been established to pursue these areas further and to come up with workable solutions. Dr Mini concluded that consultation and collaboration between the different stakeholders will be key to the success of these efforts and the BHF is committed to work with the industry to bring some relief to the South African consumer.
2016/12/20 03:36 PM
South African patients are oblivious of the hidden hand of the pharmaceutical industry, which every year pays millions of rand in speakers’ fees, free meals and research grants to doctors and research institutions. There is no legal requirement for the companies to reveal the perks they give to medical professionals, nor are they willing to volunteer the information. In contrast, US law requires these same firms to publicly disclose their payments to doctors and teaching hospitals. They do so voluntarily in the UK as part of a Europe-wide move towards greater transparency, as well as in Japan and Australia. The lack of disclosure in this country leaves consumers in the dark about whether drug companies may be inappropriately influencing the prescribing habits of doctors. Nor do they know what conflicts of interest the experts may experience who advise the Medicines Control Council (MCC) whether or not to allow drugs onto the market, or those who draw up treatment guidelines for diseases such as hypertension and asthma or compile the government’s list of approved medicines for hospitals and clinics.

Medical Research Council senior scientist, Tamara Kredo, said there is global debate about the impact of this funding on the independence of those receiving the funds. Citing treatment guideline development as an example, she said poor reporting on conflicts of interest potentially erodes the trust that patients and the public place in clinicians. Recent analysis of the US Open Payments database found that doctors who received free meals from drug companies were more likely to prescribe their medicines than cheaper generic rivals, and that fancier meals were associated with the highest prescribing rates. The study, published earlier this year in the journal JAMA Internal
Medicine, examined 63 000 payments made to nearly 280 000 doctors over a five month period. Most received fairly cheap meals, ranging between $12 and $18. The database, which has been operating since 2014, shows that more than 618 000 physicians and 1 100 teaching hospitals collectively received more than $7.52-billion from drug and device makers last year. More than half that amount ($3.9-billion) funded research - the rest went to speaking and consulting fees, meals and gifts. Huge sums are paid out in other countries too: the top 10 pharmaceutical companies in Japan spent
$1.63-billion on healthcare professionals and researchers in 2013, while Medicines Australia recorded $A64-million in similar payments in the 12 months to April 2016.

BUSINESS DAY asked six multinational pharmaceutical companies to disclose the nature and size of the payments they made to doctors and researchers in SA in 2015. None were willing to do so. Abbott ignored several e-mailed requests for comment. Novo Nordisk and Eli Lilly said they could not disclose the information because it would breach confidentiality agreements and data privacy laws such as the Protection of Personal Information Act. Pfizer said there was no legal requirement to publish payments to researchers. However, this information was fully disclosed in clinical trial applications to the MCC and to the ethics committees that approve these projects.

Pfizer spokeswoman Charmaine Motloung recommended approaching the relevant ethics committees for the information. Sanofi-Aventis would need consent from all the healthcare professionals involved to publish the data, said its spokeswoman for SA, Prudence Selani. She declined a request to provide aggregate data that masked the identities of the healthcare professionals. GlaxoSmithKline, which discloses payments to doctors in the US, Japan, Australia and Europe, declined to provide data for SA. its GM for South and Southern Africa, Davies Gichuhi, said the company will work with the industry and government when they are ready. Eli Lilly’s MD for SA and sub-Saharan Africa, Ann-Marie Hosang, said in principle the company supported public disclosure of payments to healthcare professionals in SA, provided it was governed by an appropriate regulatory framework. She declined to provide information on its payments to healthcare professionals in SA. Local generic drug manufacturer Adcock Ingram was equally reticent. Spokeswoman Vicki St Quintin would not provide details of the payments the company made to doctors, but said the company complied with the guidelines drawn up by the Marketing Code Authority, a voluntary industry association. Aspen Pharmacare, another local generic manufacturer, was the most forthcoming. The company paid R883 000 in speakers’ fees to healthcare professionals last year, according to head of strategic trade Stavros Nicolaou. Some scientists, such as MCC chairwoman Helen Rees, have consistently refused to take funding from the pharmaceutical industry. She said she always thought good drugs must be used on the basis of their benefits to the patient, not on marketing ploys. Others regard it as a legitimate source of income.

David Marais, chairman of the Lipid and Artherosclerosis Society of SA, said there often is suspicion about the influence of the pharmaceutical companies on the profession.

However, his personal experience is that working together has ensured translation of therapeutics to patients with serious disease. He credits pharmaceutical companies with helping to provide state-of-the art treatment for patients with severe disorders and enabling university researchers to keep up to date with global scientific advances by paying for them to attend academic meetings. Marais said conflicts of interest should be declared at all academic presentations and publications to indicate potential bias, but amounts are not. He said his feeling is that this is enough and doing more, though superficially attractive, will not really be worthwhile: the profession is overburdened with administration and the system may not accurately reflect what is going on.

Southern African HIV Clinicians’ Society president Francesca Conradie is frank about the payments she receives from pharmaceutical companies. She said she participates in training events - such as panel discussions to debate the pros and cons of different HIV/AIDS medications - as well as advisory boards. Fees typically range between R5 000 and R15 000 a session. Conradie said her area of interest is narrow and the choice of drugs is usually determined by the funders. She said she can’t see how the payments would make a difference, adding that she has never been asked directly or indirectly to sell a product. Conradie said researchers have to declare their conflicts of interest when they attend conferences and when they provide expert advice to the MCC. The head of the University of Cape Town’s ethics committee, Marc Blockman, said pharmaceutical industry support for doctors is not necessarily wrong. However, the lack of transparency in the South African system is a problem.

He said no one does a lecture tour without being paid for it. Can we allow people to make extra money in a way that is not prejudicial to patient care? he asked. The Department of Health and the MCC are moving towards greater transparency. The MCC is exploring its options for making its members’ conflicts of interest available to their peers and to the public, said Rees. The department’s deputy director-general for regulation and compliance, Anban Pillay, said the experts who help draw up the Essential Drug List for hospitals are required to declare their conflicts of interest to the committee chair, who can ask people to recuse themselves from specific discussions. The information is not made public, but the Essential Drug List committee should consider making it so, he said. Pillay said it would be impractical to try to ban payments from drug makers to healthcare professionals, so the Department of Health supports the global move towards greater transparency. He said public disclosure should happen. It will temper the way the profession acts.

The Innovative Pharmaceutical Association of SA’s CEO, Konji Sebati, said she sees no harm in public disclosure of payments to doctors. She said there is nothing to hide.
IPASA is pushing the health department to legislate, she added. In the absence of legislation, the only strictures on the payments pharmaceutical companies make to healthcare professions are those imposed by the Marketing Code Authority. It has published a code that curtails some of the more egregious payments such as free overseas trips for spouses. Sebati said the authority regularly deals with complaints from its members. However, only a handful of cases are to be found in the complaints section of the authority’s website, and none related to payments to healthcare professionals. Despite the constraints imposed by the marketing code, industry sources say drug makers still pay hefty fees to individuals they identify as “key opinion leaders”.

These are people at the top of their profession who wield influence over their peers’ prescribing habits. They get paid for services such as participating in advisory board meetings, speaking at conferences, and providing training. Advisory board meetings are sometimes used to help guide research into medicines or launch new products. Some prescribers also make money by becoming involved in clinical trials and receive payment for meetings to plan, monitor and evaluate the research. Opinion is divided over the extent to which these payments are justified.
2016/12/20 01:52 PM
The Independent Community Pharmacy Association, which represents the interests of independent pharmacies, is taking Fedhealth to court for going ahead with plans to introduce a closed pharmacy network. This will force the medical aid scheme’s members to obtain their chronic medication from selected pharmacies, failing which they will have to pay a 40 percent penalty co-payment.

The appeal board of the Council for Medical Schemes (CMS) has already instructed the regulator to investigate the closed network principle. The association has been trying for five years to break what it regards as the power of medical aid schemes to set up closed network systems. Its first challenge to the council was dismissed, but the appeal board mandated the medical schemes council to probe the closed network and the penalty co-payment mechanisms.

The CMS promised to publish a discussion policy document to resolve the issue. However, Independent Community Pharmacy Association CEO Mark Payne said the CMS has not demonstrated that it is investigating the matter, or published the proposed legislative changes it promised. The association intends to go to the High Court to compel the CMS to make a ruling.
The law allows designated service providers for medical schemes and co-payments, but says nothing about closed networks and penalty co-payments. Payne said independent pharmacy groups were being marginalised because medical schemes implemented closed networks that restricted medical aid members to consulting with doctors and pharmacies selected by the scheme. He said a scheme like Fedhealth is saying that paying members cannot get medication from any pharmacy - they must get it from corporate pharmacies or incur a 40 percent extra payment on chronic medication.

The association argues that this practice removes customers’ choice and limits the standard of care. An open system allows any pharmacy to join a medical scheme’s network and provide services at particular prices. Payne said the association does not object to designated service providers being appointed but objects to them being closed to specific service providers. He said that with National Health Insurance coming, we need to have as many healthcare professionals on board to drive this process - not marginalise about 2 000 pharmacists in favour of 266 corporate pharmacies.

Payne said there were inconsistencies in Fedhealth’s proposal. Patients can receive chronic medication in the post and acute medication from their local pharmacies. These systems don’t speak to each other, he said. Medical aid schemes attempt to keep costs down by directing members to specific pharmacy chains. But the Independent Community Pharmacy Association argues that patient outcome is a more important issue than which professional helps them. Bonitas Medical Fund and Polmed, the police service medical aid, use the designated service provider system. Fedhealth spokeswoman Julie Keenan said the scheme was acting “within legal bounds” and was not aware of any planned court action against it.
2016/12/20 01:52 PM
Adcock Ingram Critical Care (AICC) has gained commercial rights to the Pharma-Q range of products in South Africa. The deal strengthens the offerings of the two companies, expanding their basket of products including the licensing of all Pharma-Q products to AICC, and marketing and distribution. Anthony Lesch, CEO of Pharma-Q, said the offering was much broader now, and more new products were entering SA because of the pipeline. AICC MD Colin Sheen said Pharma-Q, one of SA's few licensed sterile manufacturers, had “a product range that complements Adcock’s portfolio and commercial skills”.

Funds generated through the agreement would let Pharma-Q invest in upgrades at its plant said Vicki St Quintin, corporate affairs manager at Adcock Ingram. Pharma-Q would also have access to AICC’s comprehensive distribution network, she said. Through the deal, Pharma-Q hoped that it would receive more investments from the Department of Trade and Industry and the Industrial Development Corporation. The move would also see AICC expanding its business. Pharma-Q previously conducted its own in-house marketing of its products, but due to expansion, it has been forced to bring in the expertise of an experienced company. Lesch said they had been in business with each other since Pharma-Q bought the plant from Adcock in which they now operate.

The Adcock Ingram Critical Care factory in Aeroton, Johannesburg, is Africa’s only integrated medical-grade plastics and pharmaceutical manufacturing facility. Pharma-Q is one of only three licensed sterile manufacturers and the only dental cartridge manufacturer in SA.
2016/12/20 01:53 PM
Greater numbers of South Africans are dying from lung and cervical cancer, according to a study released by the Institute for Health Metrics and Evaluation (IHME). In 2015 alone, these cancers were responsible for the deaths of 19 160 South Africans. Professor Benn Sartorius, a co-author of the study based at the University of KwaZulu-Natal’s (UKZN’s) department of public health medicine, said the data suggests there is an increase in this global burden of incidence of cancer by about 33 percent in the last decade. In SA, there is also an increase in mortality rate of these cancers.

Last year, the country had 114 091 new cancer patients and 58 237 cancer-related deaths. Death rates per 100 000 people are increasing for the top 10 causes of cancer deaths in SA, apart from for oesophageal and stomach cancer. The most striking increases were in colorectal cancer, with a death rate that rose 31 percent between 1990 and 2015. The death rate for breast cancer grew 35 percent, ovarian cancer 41 percent and prostate cancer 45 percent. In the different stages of cancer, the probability of survival reduces radically depending on the stage in which it is detected. Cancer screening can be done through various tests, including pap smears and blood tests.

Sartorius said unfortunately, often cancers in Southern Africa are detected at a late stage so the prognosis is quite poor, in which case the therapy can’t be curative anymore, it’s more palliative. The high burden of HIV in SA has been supported by the national roll-out of antiretroviral drugs, leading to an increased life expectancy for HIV-positive people. Such individuals have shifted from needing acute care to more chronic care, and are now more likely to develop non-communicable diseases such as cancer. In some cases, the risk is greater because HIV leaves people more prone to developing certain types of cancer. Breast cancer is the most common kind of cancer affecting South

African women, along with lung and colorectal cancer. But cervical cancer is far more deadly, having caused the deaths of 5 406 women in 2015. South African men suffer mainly from prostate, oesophageal, colorectal and liver cancer. But lung cancer caused the most deaths, taking 5 726 lives in 2015.
2016/12/20 01:54 PM
South Africa’s 1.3-million public servants have until Thursday to consider whether to amend their healthcare plans, after it was agreed on yesterday that contributions to the Government Employees’ Medical Scheme (GEMS) will rise 15 percent from January 2017. The state subsidy to employees will increase 8.8 percent, meaning state employees will pay the additional 6.2 percent required to keep GEMS solvent. Public servants and the government agreed during collective bargaining in 2015, to retain 75 percent medical assistance for in-service employees, with state contributions capped at R925 per principal member and R565 per dependant. The parties further agreed to adjust the subsidy according to the medical price index on January 1 each year.

Public Servants’ Association (PSA) assistant GM Leon Gilbert confirmed the agreement on Tuesday, saying labour had previously raised questions about extending the period for choosing plan options. While not part of collective bargaining, GEMS had informed the Public Service Co-ordinating Bargaining Council that the option to change plans had already been extended to December 7, he said. It was reported in August that sources within GEMS said the scheme’s solvency ratio had dropped in the first eight months of 2016, reaching as low as five percent or six percent - almost 20 percentage points below regulatory levels.
2016/12/20 01:55 PM
Issues about choosing when to die were "engaging profound moral questions beyond the remit of judges to determine [and] should be decided by the representatives of the people of the country as a whole".

This was the view of the Supreme Court of Appeal when it upheld the government's appeal against a High Court judgment that gave euthanasia advocate Robert "Robin" Stransham-Ford the right to have a doctor-assisted suicide in April last year.

Stransham-Ford, who had terminal cancer, argued that his constitutional rights to dignity and bodily integrity were impaired because he was in pain and unable to look after himself.

Pretoria High Court Judge Hans Fabricius ordered that he had the right to die with a doctor's help and that the doctor would not face sanction.

The departments of Health and Justice and the Health Professions Council of SA appealed the ruling.

Yesterday the SCA upheld the state's appeal, saying it was not the High Court's job to make new laws, due to the separation of powers doctrine.

It said that duty rested with parliament, adding it would "welcome" a parliamentary hearing on the issue.

The court conceded that doctor-assisted suicide was an issue of constitutional importance.

If parliament got involved, "lobby groups could then make their voices heard and a proper debate and .reflection could occur".

In a majority judgment, penned by Judge Malcolm Wallis, the SCA found that:
• There were insufficient facts in the case to make a judgment;
• Stransham-Ford's affidavit "bore little resemblance to reality" - as his medical records showed he was not in much pain, on very low doses of morphine and he had expressed concern to his doctor about even going through with the assisted suicide; and
• That the Supreme Court of Appeal application was actually brought by NGO Dignity SA, which used Stransham-Ford to fight for the right to have doctor-assisted suicide.

Wallis slammed Dignity SA saying it was the real "litigant" but it had not been transparent about this.

The judges accused the NGO of using the legal argument prepared in November 2014 for a person who committed suicide in January 2015 and applied it to the Stransham-Ford application, rushing it through the courts.

"Such litigation is rarely urgent or warrants a court being hustled into a decision with inadequate time to .reflect on issues," Wallis said.

Stransham-Ford died two hours before the April court ruling allowing him doctor-assisted suicide.

The state won the appeal because the ruling was meaningless because he was already dead.
2016/12/20 01:56 PM
Medical aid consumers are facing premium increases of 10 percent or more next year, but the medical aid regulator may be finally doing something about rising costs. The Council for Medical Schemes announced last week that it is reviewing the Prescribed Minimum Benefits (PMBs) - the basic package of care consumers get when joining a medical aid. These benefits must be covered no matter their cost, according to the Medical Schemes Act.

But most medical aids have said it is the law that pushes up premiums. The benefits mean that medical aids must cover 26 chronic conditions and 270 diseases, ensuring consumers have a basic level of care in exchange for a premium. But many schemes have provided evidence to the Competition Commission’s independent inquiry into health costs, showing the benefits are increasing costs and repelling new members.

Mariné Erasmus, a health economist at Econex, said the Prescribed Minimum Benefits are accepted by the industry to be driving up costs." The council said its review needed to ensure that the basic benefits were “financially sustainable” and “viable”. It costs about R600 for a medical aid member to pay for these benefits, meaning all medical aids have to cost more than this.

Older people who use these benefits cost medical aids more than R1 000 per member in a month, according to the council’s latest annual report. Erasmus said that if there is a proper review, it could work towards decreasing prices. The review will also look at what diseases are covered as a basic package of care and if some needed to be removed or added. This means the review could also be bad news for consumers as it could remove certain benefits.

Medical lawyer, Neil Kirby, said if the focus of the review is on primary or preventative care, as the council’s review document suggests, it could result in fewer benefits for consumers. Healthman consultant, Johann Serfontein, said: the council’s motivation for the Prescribed Minimum Benefit review doesn’t make sense. He said they want to align medical aid benefits to the National Health Insurance scheme which is being implemented in 10 years’ time, where medical schemes will only provide supplementary cover. Discovery Health chief executive, Jonathan Broomberg, said the process outlined by the council for medical schemes appears to be carefully designed and rigorous and Discovery Health looks forward to working closely with the council to support this review.
2016/12/20 03:16 PM
The council for Medical Schemes is to review the prescribed minimum benefits that private medical schemes must pay.

That the council is doing this should prompt all medical aid members to sit up and take notice because it has ramifications for both their cover and their pocket.

Prescribed minimum benefits are benefits that all medical scheme members have access to, ensuring that they have access to certain minimum health services, regardless of the benefit option they have selected.

According to the Medical Schemes Act, medical schemes have to cover the full costs related to the diagnosis, treatment and care of any emergency medical condition, a limited set of 270 medical conditions and 25 chronic conditions.

The review is intended to ensure that these basic benefits are "financially sustainable" and "viable".

Providing cover for these benefits is one of the reasons premiums are increasing, according to the schemes. The schemes, in the absence of a cap on what the doctor or hospital can charge, have to cover the treatment no matter what the cost.

If the review results in the number of prescribed minimum benefits covered being reduced, or the amount payable for a particular treatment being capped, premiums would theoretically come down. Whether that saving would be passed on to medical aid members is debatable.

But if the cover is reduced scheme members could find themselves running out of cover halfway through the year.

It is laudable that the council is trying to rein in costs but this should be done to the benefit of the consumer.

The council's review is in line with national health policy and the proposal for national health insurance. But it should not merely rubber-stamp the NHI planning.

Those handling the review need to be mindful that the NHI is nowhere near being able to provide adequate health cover for all South Africans.
2016/11/29 10:40 AM
Previously unpublished government records paint a grim picture of a failing public health system, a worrying lack of disclosure about its shortcomings, and an oversight mechanism that has done little to raise standards.

Data obtained from the Office of Health Standards Compliance (OHSC), based on inspections it conducted in the four years to March 31 2016, show that only 89 of the 1,427 public hospitals and clinics had met the office’s 70% pass mark.

And of the 320 facilities that were subjected to repeat inspections, the vast majority failed to improve in any significant way between visits.

The office used 13 metrics, ranging from the availability of medicines to operational management, to rank the facilities, and each of those comprised several components that were weighted according to the gravity of the threat they posed to patient safety.

Umhlanga Clinic in KwaZulu-Natal, which scored just 18% when it was inspected in 2014 and failed to meet the 70% compliance threshold for a single metric, fared worst in the rankings. Hundreds of other clinics fared little better.

While the data clearly highlights a crisis, it also contains a number of anomalies.

Only two of the 149 clinics evaluated by the OHSC in the Western Cape, generally considered to have a well-run health administration, scored 70% or more in the most recent inspection. In Tshwane, 16 of 47 clinics made the grade.

Steve Biko Hospital in Gauteng was the top-ranked facility, scoring 96%. However, the DA’s Jack Bloom recently highlighted complaints about the state of its casualty department and outstanding repairs.

The OHSC data also appear to be out of kilter with the provincial variations in maternal mortality rates — a proxy indicator for how well a health system is functioning and closely monitored by the government.

Business Day calculated a weighted average for the hospital scores in each province, using bed numbers. Gauteng, North West and KwaZulu-Natal get virtually the same weighted average quality scores for their hospitals (72.23, 73.57 and 71.25 respectively) as the Western Cape’s (74.52), yet their maternal mortality ratios are much higher at 141, 179 and 185 per 100,000 live births respectively than the Western Cape’s 77 per 100,000 live births.

Until now, details of the OHSC’s investigations have been kept under wraps, impeding efforts to hold facilities and provincial health departments to account. The lack of disclosure has also made it impossible to gauge whether the office is doing its job effectively, or ascertain whether patients are likely to get quality care.

The OHSC’s failure to publish its findings is perplexing given that it lacks the legal muscle to enforce standards: in March it complained to Parliament that it could not take action against hospitals and clinics because regulations giving it the power to do so were still in the pipeline.

Business Day accessed the OHSC’s high-level inspection data using the Promotion of Access to Information Act (PAIA) after the body repeatedly rebuffed requests for information. And then it relinquished the bare minimum — only the final scores — and declined to answer follow-up questions or respond to a request for more details.

A second PAIA application was filed to obtain the 13 composite scores. Despite agreeing to this second application, the OHSC provided an incomplete data set, omitting component scores for the 2015-16 fiscal year despite having given a written undertaking to do so.
2016/11/29 10:42 AM
Hospitals have steadily increased their admission rates over the past five years for overnight stays and day procedures, suggesting the private healthcare market has systematically shifted towards treating patients in hospitals instead of doctors’ rooms, a report released on Thursday by the Competition Commission’s health market inquiry has found.

The commission established the inquiry to investigate the dynamics of the private healthcare market, and establish whether there are barriers to effective competition and patient access. Its report is the first in a series it plans to release in the coming weeks.

It has scrutinised five years’ claims data submitted by 80 medical schemes representing almost 95% of the market.

The finding of increased hospital admissions helps explain why medical schemes’ claims expenditure has grown far faster than consumer price inflation. The inquiry found medical schemes’ claims costs per beneficiary rose 8.59%-10.16% per year from 2010 to 2014, while CPI rose at 5%-6.1% over the period. Out-of-hospital costs rose 5.25%-9.33% per beneficiary per year in the period under review, while in-hospital costs rose 10.27%-11.4% per beneficiary per year.
2016/11/29 10:42 AM
Insurance costs forcing doctors out

Medical negligence claims are forcing maternity doctors out of private practice — so much so that the gynaecologist society has warned there will not be any left in the private sector by 2020.

The SA Society of Obstetricians and Gynaecologists said about 50 obstetricians had quit this year, leaving about 450 in the private sector.

There are currently 140 000 babies delivered in private hospitals a year.

But the society is expecting between 50 to 100 obstetricians and gynaecologists to stop working in private practice next year because of the high insurance rates, which they say makes it impossible to stay in business.

"There are going to be about 200 to 350 obstetricians left next year," Johan van Waart, head of the society, said.

"If things continue as they are, by 2020 we will not have a private practice obstetrician in this country."

Already there are no paediatric neurosurgeons left in private practice as it is too specialised and expensive to insure, leaving them working in the overburdened state sector.
Unlike doctors working in the state sector, private practitioners have to cover their own medical insurance.

This year, each obstetrician paid R650 000 in medical insurance and this is expected to reach between R850 000 and R1million next year.

This is paid to the British nonprofit organisation, the Medical Protection Society.

Because of the high rates, South African doctors were looking at a model of insuring themselves at cheaper rates, gynaecologist and society member Chris Archer said. The insurance is used to cover any negligence claims against the doctor.

While no data on negligence cases in the private sector exists, the Department of Health owes at least R35billion in claims since 2010, many of which relate to maternity negligence.

Payouts can be between R10million and R21million a claim. Professor Ames Dhai, who is part of a team working on reducing medical negligence under instruction of Health Minister Aaron Motsoaledi, said the reason claims were so high was that the payouts covered the expected lifespan of the infant injured at birth into adulthood.

In addition, a child patient has 21 years in which to bring a claim against a doctor.

Another problem is the contingency law which sees lawyers take on cases for no charge but then claim 25% of the payout.

The society has approached Motsoaledi to intervene and asked him to:

• Cap the amount to be paid out;.

• Structure the payout so that it could be done monthly or annually;

• Make lawyers liable for the legal costs if doctors are found not to have been negligent; and

• Institute a mediation process before the claim goes to court.

Speaking to Times Media yesterday, Motsoaledi said medical litigation was out of control.

He said plans were under way to put a cap on the amount to be claimed. But Dhai said this would be difficult legally.
2016/11/29 10:43 AM
Questions linger over pilot project

Hospitals and clinics in the government's flagship National Health Insurance (NHI) pilot programme are failing to improve any faster than those in the rest of the country, according to inspection records obtained from the Office of Health Standards Compliance.

The records reveal a public health system in crisis.

Among the 1 427 facilities inspected in the four years to March, just 89 of them scored a pass mark of 70% or more.

Facilities fell short on matters ranging from the availability of medicines to infection control.

Improving the quality of the public health system is a vital part of the government's preparation for NHL and the data raise tough questions for the government about why its investments in its 11 NHI pilot districts were failing to translate into a better deal for patients.

The Treasury initially allocated R1billion for the pilot programme, but then slashed funding in the face of slow spending by the provinces.

The latest figures from the Department of Health, which oversees the grant, show the NHI pilot districts have collectively spent R145.7million of the R200.4million allocated via the NHI grant in the four years to March 31.

Analysis of previously unpublished data obtained from the watchdog, using the Promotion of Access to Information Act, show that it conducted repeat inspections in some cases up to three or four times in 110 public health facilities in the 11 NHI pilot districts between March 2012 and March 2016, yet most of them showed little or no improvement.

Only 25 (22.7%) of these facilities improved their scores by 20% or more.

Their performance is even more startling when seen against facilities outside the NHI pilot programme, which fared marginally better: 210 facilities were inspected more than once over the same period, and 67 (31.9%) improved by 20% or more.

The facilities' final scores are based on the results of 13 subscores, which are in turn made up of dozens of measures, riskrated so that those considered to be vital to life and limb such as the availability of adrenalin or operating theatre backup generators are weighted more heavily than less life threatening factors, such as the availability of paracetamol.

The Office of Health Standards Compliance's own documents say facilities that fail to reach the compliance threshold of 70% should have been re-inspected within six months, yet the records show just 56 of the 936 facilities that scored below 70% between March 2012 and September 2015 have received a repeat inspection.

"We [initially] set a benchmark of 70% but we realised that was the majority of facilities, and with our current resources we were not able to go back and re-inspect them," deputy director for early warning systems Keketso Phetlhe said.

The watchdog had consequently lowered the threshold for re-inspection to 50%, and aimed to re-inspect 25% of those failing to meet this target in the current financial year, she said.

According to acting CEO Bafana Msibi, the watchdog has 17 inspection teams of five inspectors each, which make unannounced visits to hospitals and clinics. There are more than 4 000 public health facilities, of which almost 3 200 are clinics.

The office's aim is to inspect these facilities at least once every four years.

The Department of Health's deputy director general for primary healthcare, Jeanette Hunter, said the watchdog's sample of clinics and hospitals was biased and focused on underperforming facilities, and therefore no conclusions could be drawn about the NHI pilot districts from its data.
2016/11/29 10:44 AM
A new diagnostic tool allows doctors to detect prostate cancer early on and come up the appropriate treatment plan. The Biojet MRI Fusion is an advanced navigation platform that provides an accurate detection of suspicious lesions by combining MRI and real-time ultrasound.

According to Dr Werner Botha, a urologist at Mediclinic Cape Town, "The MRI prostate results are incorporated into the software programme where the lesions are mapped out. On the day of the biopsy, the MRI mapping is fused with the results from the transrectal ultrasound, providing an accurate target area.It is a safe and a more effective alternative to a standard ultrasound guided prostate biopsy, which can miss significant lesions and consequently lead to an underestimation of the patient’s clinical situation."

"Previously we were missing 50-80% of significant cancers and over diagnosing low risk cancers that did not require treatment. We are now identifying 40% more aggressive cancers earlier and detecting less of the insignificant lesions," explains Botha.

Similar systems are available but many are cumbersome and require biopsy via the rectum (with the additional potential for infection). This technology requires only a laptop with the Biojet software and a special electronic stepper that holds the transrectal ultrasound. A grid is placed over the patient's perineal area and coordinates are used to locate the cancer area. Almost like a GPS tracker. As a result, the urologist can perform this procedure on his own and does not require a technician in theatre.

Botha emphasises the benefits of this technology namely the improved diagnostic accuracy and enhanced detection of suspicious lesions. A further advantage is the reproducible nature of the biopsies for active surveillance of tumours or lesions, allowing doctors to monitor and track the progression of the cancer or success of the treatment. Back to top
2016/11/29 11:10 AM
Every patient can expect a bed with a view at the brand new Netcare Christiaan Barnard Memorial Hospital in Cape Town — the first phase of a nearly R1bn medical precinct.

The building is the latest addition to the city's foreshore. The building, will be officially unveiled on December 3.

This is probably the finest hospital we have constructed in SA or throughout the UK," said Netcare CEO Richard Friedland.
2016/11/29 11:06 AM
A new shock device implanted under the skin of a patient without a single wire touching the heart is a first in sub-Saharan Africa.

The new device to prevent sudden cardiac death was implanted on patient Jan Wiehman, 55, of Welgemoed, Bellville on Monday at Mediclinic Panorama.

He became the first patient in Africa to receive a subcutaneous shock device, also known as a subcutaneous cardioverter defibrillator (S-ICD).

The device is 83.1mm wide, 69.1mm high and 12.77mm thick, weighs 130g and is implanted in a space between two muscles on the left side of the patient’s body.

Dr Razeen Gopal, cardiac electrophysiologist at Mediclinic Panorama who completed the procedure, explained that sudden cardiac arrest was a serious, life-threatening medical emergency that occurred abruptly and without warning.

When this occurs the heart’s electrical system malfunctions and the heart is no longer able to pump blood effectively to the rest of the body.

When the brain is deprived of blood it causes the person to lose consciousness quickly and if the heart is not shocked back into normal rhythm in less than three minutes, brain damage and death can occur.

“The Emblem S-ICD system is the first and only FDA approved product with both the device and the leads inserted beneath the skin, with no leads inserted through any veins and thus with no leads placed inside or even touching the heart at all,” Gopal said.
“This leaves the heart and blood vessels untouched and so provides a safer alternative to conventional implantable defibrillators without the complications associated with cardiac wires.”

He said unlike traditional implantable defibrillators, it does not require leads in the venous system, eliminating potential sources of complications related to such leads or pockets, the most feared being infection.

Gopal said for those at risk of sudden cardiac arrest, one treatment option was an implantable cardioverter defibrillator (ICD), which may prevent sudden cardiac death.

The implanted device can sense arrhythmias (irregular heart beat) and deliver strong electrical shocks to the heart to restore a normal heart rhythm, also known as sinus rhythm.

“ICD therapy has been shown to effectively stop 95% or more of dangerously fast heart rhythms. With an ICD device, 19 out of 20 people will survive sudden cardiac arrest.”
2016/11/29 11:22 AM
If the world's economy has slowed, Netcare does not seem to be feeling it. In the Group’s 2016 annual financial results released on 21 November, it noted that group revenue was up 12.1%, to R37 796 million, group EBITDA was up 11.2% to R5 539 million, and normalised profit after taxation was up 19.1% to R2 906 million.

In its results statement, Dr Richard Friedland, CEO (pictured), described Netcare as having a strong group balance sheet with comfortable gearing and leverage, and said the South African operations posted solid results, with activity boosted by the prior year’s investment in 584 new beds.

South African revenue increased 9.7% to R18 958 million (R17 289 million in 2015). Hospital and Emergency Services grew revenue by 10.3% to R17 780 million, while in Primary Care revenue was up 0.7% to R1 178 million. EBITDA grew 5.0% to R4 147 million with margins of 21.9% (22.8% the previous year).
2016/11/29 11:07 AM
For patients at risk of sudden cardiac arrest (SCA), an implantable cardioverter defibrillator (ICD) is a viable treatment option. It has been shown to effectively stop 95% or more arrhythmias and has a survival rate of about 19 out of 20 people

The Emblem S-ICD system is the first and only FDA approved device of its type. “Unlike traditional implantable defibrillators, it does not require leads in the venous system, eliminating potential sources of complications related to such leads or pockets, the most feared being infection,” says Razeen Gopal, cardiac electrophysiologist at the Cape Town AF Centre located at Mediclinic Panorama, who completed the first series of subcutaneous ICDs in Africa this week.

“It provides a safer alternative to conventional implantable defibrillators, without the complications associated with cardiac wires," he says.

This is of particular importance in young patients, since the new, subcutaneous device can simply be pulled out and removed. A traditional transvenous system can only be removed during delicate surgery since the wires tend to become submerged and entwined in scar tissue.

The subcutaneous ICD is 83,1mm wide, 69,1mm high and 12,77mm thick, weighs 130g and is implanted in a space between two muscles on the left side of the patient’s body.

Research shows that the device has very low complication rates, and the cost to patients is almost the same as for the transvenous system.
2016/11/29 11:08 AM
A new device that can be placed under the skin without a single wire touching the heart is set to revolutionise the treatment of abnormal heart arrhythmia and sudden cardiac arrest.

Jan Wiehman, 55, of Welgemoed yesterday became the first patient in Africa to be implanted with a new generation, lifesaving shock device known as the emblem subcutaneous cardioverter defibrillator (S-ICD).

Unlike traditional implantable defibrillators which has up to three leads that are attached to the heart, the new device, which is widely used in First World countries, does not require leads in the venous system.

The device only has one lead that sits under the skin and on top of the breastbone, and is connected to veins or heart.

Dr Razeen Gopal, cardiac electrophysiologist, who implanted the device at Mediclinic Panorama, said while the traditional cardioverter defibrillator implantation was associated with complications such as adhesion to the veins and heart muscle, including the risk of systemic infection (septicemia), the new device was considered less risky as it didn't have the leads or tubes connected to the heart.

"This is an important step forward because the leads we use traditionally can be a pathway for bugs, which can end up in the heart.

"In the original system the leads can grow into the body and come part of the veins of the heart muscle.

"Treating infection or complication of the leads can be complex as we have to perform lead extraction to get the infected leads out. There is also no risk for heart perforation," he said.

Gopal said the new procedure was good news for cardiac patients, especially young patients who required shock therapy due to increased risk of cardiac arrest caused by congenital heart syndromes.

It is also useful for patients who experienced abnormal heart arrhythmia because of previous heart attacks.
2016/11/29 11:25 AM
Private hospital group Netcare has agreed to buy Akeso Clinics for R1.3bn, as it seeks to capitalise on growing demand for mental healthcare services, reports Business Day.  Akeso is a chain of 10 psychiatric health facilities, with two more under construction.

Like its biggest rivals, Life Healthcare and Mediclinic International, Netcare faces constraints in acquiring new hospital licences in South Africa and has tried to diversify its local business and expand offshore. In addition to its 53 hospitals in South Africa and Lesotho, it owns the UK’s biggest private hospital network, BMI Healthcare, which has 59 sites.

“The incidence and prevalence of mental health disorders is increasing at a rapid rate and Netcare is underrepresented in this space. This will provide us with a really good platform to grow and expand mental healthcare services,” said Netcare CEO Richard Friedland as the company released its annual results for the year to end-September.

The report says the acquisition, which was yet to be approved by the regulatory authorities, was expected to be earnings-neutral in the first year and accretive thereafter, he said.
2016/11/29 11:09 AM


Drie jaar gelede ontsnap hy uit die kloue van die dood toe sy hart tydens 'n fietstoer gaan staan; vandag is hy die eerste pasiënt in Suid-Afrika en Afrika suid van die Sahara op wie 'n nuwegenerasie onderhuidse hartskoktoestel ingeplant is.

Die pasient is Jan Wiehman (55) van Welgemoed, wat op 1 Desember 2013 tydens 'n fietstoer op Stellenbosch skielik ineengestort het toe hy in die voorste bondel gejaag het.

Sy lewe is gered toe paramedici baie vinnig by horn gekom het en vinnig met horn na 'n hospitaal in die Paarl gejaag het. Dokters kon daarin slaag om betyds sy hart weer aan die gang te skok.

Hy was twee en 'n half jaar sonder simptome en ry nog fiets, maar teen 'n matiger tempo en het die afgelope tyd hartkloppings ontwikkel. Die hartskoktoestel is onder sy vel ingeplant om sy lewe te red as sy hart skielik weer gaan staan.

Die rede vir sy skielike hartstilstand is nie bekend nie, maar sy hartvate (kroonare) is mooi oop en hy het waarskynlik nie 'n hartaanval gehad nie.

Hy het egter 'n groot risiko vir 'n tweede skielike hartstil stand. Gister is die lewensreddende hartskoktoestel, ook bekend as 'n subkutane hartdefibrillator, in die Mediclinic Panorama onder Wiehman se vel ingeplant sonder dat enige van die toestel se drade aan sy hart raak.

Dr. Razeen Gopal, kardiale elektrofisioloog van die Kaapstadse AF Sentrum, wat in die Mediclinic Panorama gelee is, het die nuwegenerasie hartskoktoestel ingeplant.

"Anders as die tradisionele inplantbare defibrillators, loop die nuwe toestel se drade glad nie deur enige bloedvate nie, en sodoende word potensiele komplikasies wat met sulke bloedvatbedradings gepaard gaan, waarvan infeksie die mees gevreesde komplikasie is, uitgeskakel," sê dr. Gopal.

Skielike hartstilstand is 'n lewensbedreigende mediese noodgeval wat skielik en sonder waarskuwing kan plaasvind.

Tydens skielike hartstilstand is die elektriese geleidingsweefsel van die hart defektief, kan die hart nie kragtig genoeg saamtrek nie en dus ook nie voldoende bloed na die liggaam pomp nie.

Dit lei tot 'n tekort aan bloed in die brein, wat op sy beurt tot bewusssynsverlies sal lei.
As die hart nie binne die bestek van drie minute geskok word sodat dit weer teen normale hartritme klop nie, kan breinskade en die dood intree.

Een van die behandelingsopsies vir mense met 'n hoe risiko vir skielike hartstilstand is die inplanting van 'n hartdefibrillator, wat dan skielike dood kan voorkom.

Inplantbare hartdefibrillators kan onreelmatige hartritmes "diagnoseer" en dan 'n kragtige elektriese skok aan die hart toedien sodat normale ritme (bekend as sinusritme) herstel word.

Navorsing het getoon dat hierdie inplantbare toestelle 95% van gevaarlike vinnige hartritmes doeltreffend kan omkeer tot normale ritmes.

Met 'n inplantbare defibrillator kan 19 uit 20 mense 'n skielike hartstilstand oorleef.

Nou kan die toestelle, danksy nuwe tegnologie, nog veiliger ingeplant word.
2016/11/29 11:24 AM
Johannesburg - South Africa's second-largest private hospital firm Netcare will buy Akeso Clinics, a chain of psychiatric health facilities, for R1.3 billion ($91 million), the firm said on Monday.

Netcare, which runs Britain's largest private hospital network, is seeking to increase its exposure to mental healthcare, which it sees as a fast-growing segment in its home market.

Akeso is a chain of 12 South African clinics and provides specialised treatment for eating disorders, post-natal depression, addiction and other psychiatric disorders.

“This will provide a national platform from which we can drive our mental health strategy,” said CFO Keith Gibson.

The acquisition will be earnings neutral in the first year but will contribute to profits thereafter, CEO Richard Friedland told investors at the firm's full-year results presentation.

Netcare reported a 31 percent drop in full-year profit as a once-off accounting charge in Britain weighed on earnings.

Diluted headline earnings per share (EPS) fell to 117.1 cents for the year to end-September, compared with 170 cents the previous year.

But when headline EPS is adjusted to separately disclose the exceptional nature of the swap instruments of the UK rent transaction, EPS totalled 199.5 cents, an increase of 5.6 percent, and better than analysts' expectations.

Shares in Netcare were up 2.6 percent at R34.89 by 1007 GMT, while the benchmark Top 40 index was flat.

Headline EPS is the main profit measure in South Africa and strips out certain one-off items.

Demand for private healthcare services in South Africa is expected to remain resilient and Britain's decision to leave the European Union has had no measurable impact on the business to date, Netcare said.
2016/11/29 11:25 AM
A R2bn write-down to account for changes in Netcare’s UK hospital rentals led the group’s after tax profit to dive 57% to R1bn for its financial year to end-September, it reported on Monday.

Netcare said its UK subsidiary, BMI Healthcare, took a "noncash fair value accounting charge" of £108m on swap instruments linked to the retail price index.

"BMI leases 35 of its hospital properties from various subsidiary entities of its major external landlord, Hospital Topco. The leases on these properties have annual rental uplifts linked to retail price index. BMI also holds certain retail price index swap instruments which, combined with the leases, achieve the economic effect of a fixed 2.5% rental uplift," the results statement.

Despite the sharp drop in after tax profit, Netcare raised its final dividend to 57c, taking the total for the year to 94c, a small growth on the prior year’s 92c.

The group’s overall revenue grew 12% to R37.8bn.

Its South African business grew revenue by 9.7% to R19bn.
2016/11/29 11:23 AM
Life Healthcare Group Holdings Ltd. agreed to buy diagnostics specialist Alliance Medical Group Ltd. for as much as 800 million pounds ($995 million) including debt as the South African company follows larger competitors by expanding into the U.K. market.
The Johannesburg-based owner of private hospitals agreed to pay 593 million pounds in cash and a performance-based additional payment, it said in a statement on Wednesday. The sellers are funds managed by M&G Investments, Talbot Hughes Mckillop LLP and senior management.

The deal comes after rivals Mediclinic International Plc and Netcare Ltd. also expanded in the U.K. to take advantage of growing demand for private health care in a country dominated by the state-owned National Health Service. Life Healthcare has also bought companies in India and Poland in the past four years, and the latest transaction will increase the portion of revenue generated outside South Africa to 24 percent from 4 percent, according to a presentation on the company’s website.

The shares reversed an earlier gain and dropped 1.2 percent to 32.99 rand as of 2:47 p.m. in Johannesburg, heading for the lowest close since Jan. 26. That values the company at 34.9 billion rand ($2.4 billion).
“What Life has spent in Poland and India has been mostly dilutive on earnings and I think there are concerns that this new deal comes before Poland has been integrated properly,” Sean Ungerer, a Johannesburg-based analyst at Arqaam Capital, said by phone. “There are probably also some questions about this deal’s funding structure with a rights issue likely to cover a part of the deal.”

The U.K. purchase enables Life Healthcare to take advantage of a 17 percent fall in the pound against the rand following the U.K.’s vote to leave the European Union.

Alliance Medical has a “long-term relationship with the National Health Service” and also owns the most out-of-hospital clinics in Italy, Life Healthcare said in the statement. The company has previously expanded into mental health, physical rehabilitation, dialysis and oncology and “sees the entry into diagnostics as a natural part of this growth and diversification strategy,” it said.

Life Healthcare has spent 2.5 billion rand building a stake in Max Healthcare Institute Ltd. of India starting in 2012 and has invested 2.2 billion rand in Scanmed Multimedis in Poland.
2016/11/09 04:26 PM
Cape Town - A crisis in the public health sector is inevitable, due to the Department of Health’s freezing of vacant posts, doctors and nurses’ unions said.

The move is meant to cut costs, but unions including the Cape Metro Health Forum say this could result in worsened service delivery in an already ailing public health sector.

The SA Medical Association (Sama), including Junior Doctors Association of SA (Judasa) and National Education Health and Allied Workers Union (Nehawu) said the policy by the department not to automatically fill vacated posts would, in the long term, “hurt the public sector” as many of the affected jobs were crucial clinical posts.

Such a move also added pressure on the existing health workers who often had to take time off and sick leave due to exhaustion and stress-related illnesses.

“We foresee a worrying trend developing in which our health system will be void of senior expertise needed to train and mentor doctors in developing their skills in order to best serve patients,” said Judasa chairman, Dr Zahid Badroodien.

Since last year, the department, as part of austerity measures following budget cuts by the national government, has not been filling some posts which became available due to retirements or resignations.

Department spokesman Mark van der Heever confirmed the department was currently reviewing every vacancy and only filled vacant posts “based on operational requirements”.

“It is a reality that reduced budget allocations put extra strain on the health system. The constrained economic environment is a challenge to the entire department and every vacancy is critically reviewed, as it has always been done as part of good governance,” he said.

According to the latest 2015/2016 annual report, there were 4 149 employees that left the department, with 1 777 resignations and another 1 710 leaving due to expired contracts. Four hundred and eighteen employees retired, while 82 staff members died and 71 were medically boarded.

Of those who resigned, 399 left for better remuneration, 816 resigned from their current positions, 202 started their own business and 104 left for other occupations. The majority - 1 286 - of those who resigned were aged between 25 and 49.

Van der Heever wouldn’t confirm how many posts had since been filled. “I cannot give you totals as these are institutional-based, but if a post is a critical one, it will be filled to ensure continued delivery of health service.”

But the irate unions and the health forum lashed out and cautioned the freezing of posts should not affect any clinical posts, including nursing and doctor positions, as all such posts were critical.

Dr Mark Sonderup, vice-chairman of Sama, demanded the department should cut the “unnecessary” administration and management jobs instead of clinical posts.

He said while freezing posts could benefit the department in the short term, long term it would have unintended consequences and could negatively affect the delivery of health services.

“We appreciate that there are budget constraints, but the non-filling of posts should never compromise service delivery,” he said.

Badroodien called on the department to prioritise the employment of health professionals “who add hands and skills to an already understaffed profession”.

“Taking the number of health professionals out of the system only places an unnecessary burden on all role-players, with the patients being the worst-affected. Needless to say, it will also have a direct effect in the short term on our ability to deliver a service to an overburdened patient population.”

Damaris Kiewiets of the Cape Metro Health Forum and Nehawu provincial secretary Eric Kweleta said the freeze not only took away much-needed skills, it also placed extra pressure on existing staff.

Kiewiets said Delft and Macassar community health centres were some of the facilities that were negatively affected by the freezing of posts, and for several months the facilities had no clinical nurses.
2016/11/09 04:27 PM
Cape Town - Private healthcare in South Africa is structured so that doctors work alone rather than in teams and are remunerated for the quantity of services they deliver rather than for quality of the outcome, according to Dr Brian Ruff, founder and CEO of healthcare management company PPO Serve.

“Rather than competing with individuals, teams should compete with teams, with the goal to avoid unnecessary hospitalisation,” said Ruff.

In his view, the primary driver is a growing excess of private hospital beds in South African metros.

“We are now approaching four private hospital beds per 1 000 medical scheme members. In some parts of the country we have as many as six beds per 1 000 people. This is twice or three times higher than the ratios seen in efficient systems with good community delivered healthcare services," said Ruff.

“Unlike other goods, where costs go down if there is an oversupply, in healthcare oversupply leads to cost increases. When an insurer pays, it is just too easy to spend money without worrying about the value."

Between 2005 and 2014, medical aid contributions in SA jumped at a pace 50% higher than the inflation rate. In 2016 and 2015, the average premium rate hike of South Africa's seven largest schemes ranged between 7.26% and 10.92%, exceeding the inflation rate of 6% over the two-year period.

“Schemes should embrace an integrated team-based healthcare model in which specialists, general practitioners, nurses, and other practitioners such as psychologists, proactively work together to look after a patient collectively,” said Ruff.

"We need to give medical practitioners the means to generate sufficient income, while providing patients with quality, multi-disciplinary care, free from over-servicing.”

Restructuring will lead to lower premiums, which will make private medical aid more accessible to more people, in turn re-invigorating an industry in crisis, in his view.

Ruff told Fin24 where there is a will there is a way.

"Most healthcare services in the world have organised better models. We must just decide how to create something more organised and more structured to produce the right outcome at the right price," said Ruff.

"If you end up every year coming to market with reduced benefits, making protocols tighter and making it harder for patients and medical practitioners, it increasingly discredits the health system. We rather want to make the market competitive in the right kind of way," said Ruff.

"The building block is to create teams within systems and create the right kind of competition. Creating teams will be the only way to produce the right outcome for patients. Patients are frustrated by our broken and fragmented system and the ridiculous expectation that they, the patients, can navigate IT."

In his view, the real problem is that at the level of the national Department of Health there is no policy framework for the SA private health sector, "so nobody is saying there is a terrible crisis".

"At a national plenary I said we are in a crisis and help is not coming. Being brave means embracing innovation and embracing pilot projects and putting money behind team care and paying for value and not for services," said Ruff.

"We have been talking about value-based contracting for ages, but not doing anything about it. I am hoping people will wake up and see there is a crisis. We know what the solutions are, so let's jump in and get cracking at it."
2016/11/09 04:28 PM
The sustainable improvement of South Africa's healthcare system including the implementation of the National Health Insurance (NHI), is being stalled by competing challenges including an increase in medical litigation.

Opening the International Hospital Federation's World Hospital Congress in Durban yesterday, Health Minister Dr Aaron Motsoaledi said it was appropriate that the conference was held under the theme "addressing the challenge of patient centred care and safety" as patient safety was a worldwide priority.

He said in South Africa medicolegal litigation was not only draining resources away from clinical care, but driving specialists, such as obstetricians, away from certain specialist fields.

"In Canada 23% of doctors have identified medicolegal litigation as their most stressful life experience and medicolegal concerns have been cited as the commonest reason to early retirement by obstetricians and anaesthetists."

Motsoaledi said a ministerial advisory committee and a declaration signed after the recent MedicoLegal Summit will hopefully address the problem.

"This declaration addresses the main areas of patient safety, administration and legal front to improve medicolegal litigation in South Africa," he said.

Last year the KwaZuluNatal department of health coughed up more than R105m to settle claims brought against doctors and nurses around the province.

"Colleagues and doctors get irritated and tempted to attack lawyers. I will strongly advise that we'd rather be inward looking and expend all our energies in fine tuning our systems so that the lawyers find nothing to scavenge on," he said.

Motsoaledi said the increased life expectancy from 57 years in 2009 to 62 years in 2013, was an indication that the country had the capacity to implement NHI.

The NHI is being piloted in 11 districts and it is hoped to improve service standards and administrative processes.

"Public sector hospitals are still perceived to be disproportionately inefficient and slow in responding to national health priorities," he said.

Motsoaledi said the NHI will ensure effective governance and performance of public hospitals is enhanced by increasing local decision-making and accountability.

Cosatu has accused the minster of outsourcing NHI to "private interests". "The federation is angered to discover 170 doctors who are employed in the NHI programme will be unemployed by January because of retrenchments. These retrenchments are a clear sign the NHI is being sabotaged by the department of health," the federation said.
2016/11/09 04:30 PM
Tygerburger (Brackenfell)
Tygerburger (De Grendel)
Tygerburger (Durbanville)
Tygerburger (Goodwood)
Tygerburger (Parow)
Tygerburger (Kuilsrivier)
Tygerburger (Table View)
Ahistoric operation at Mediclinic Panorama lasted just 20 minutes, but Brackenfell's Joan van Niekerk (74) will reap the benefits of the world's smallest pacemaker for a good 10 years.

Says the innovative surgeon, Dr Razeen Gopal, during surgery: "We're going to come back just a little now to free the housing from the device."

To the untrained eye something remarkable is happening on the fluoroscopic view (Xray) screen.
In shades of purple one can see a capsule, which moves rhythmically with a beating heart, slowly detaching from a tube.

This "capsule" is the new technological marvel, and has recently been implanted by Gopal in the operation that is a first for Africa post FDA approval.

He looks at another screen and says: "OK, we've got capture at 100 — nice and still ... Nice and still ..."

The historic operation on Van Niekerk made her want to clean beforehand, she says laughingly.

"I didn't even know I was going to get this device before I went to hospital! Before I went, I Googled the old procedure and saw it was a big operation, so I thought I'd better mop the floors because I wouldn't be able to do it for a while afterwards," she laughs.

When she was told by Gopal she will be the first to get this operation, she responded: "Gee, wow! Why me?"

"He just told me it's because I'm special and always do what he says!"

This is the first time Van Niekerk has had a pacemaker to help her. She used to get heart palpitations every now and again if she worked in the house or the garden, but so far, so good.

"I worked in the garden the very next day. I have to give all the accolades to Gopal, who is a fantastic cardiac electrophysiologist. I put my faith and my trust in him," she says.

Gopal continues: "The device underwent trials in the United States and received FDA (Food and Drug Administration) approval. It is now being actively used in a few countries."

The tiny pacemaker is entirely wireless, and at 6.7 mm in diameter and 25.9 mm in length, it is only one tenth the size of an ordinary pacemaker.

"It is small enough to be delivered through a catheter via the femoral vein in the groin and implanted directly into the right ventricle of the heart, providing a safe alternative to conventional pacemakers without the complications associated with cardiac wires," explains Gopal.

The average battery life of the device is about 10 years, and a second or even a third device can be placed in the right ventricle if necessary in future.
2016/11/09 04:28 PM
The benefits you can enjoy on medical gap cover and hospital cash plans are likely to be limited and top-up cover banned on new insurance policies from April next year and on existing policies from January 2018, if draft regulations published this week are implemented.

Insurers will be allowed to continue to sell policies that provide basic healthcare benefits, known as primary healthcare plans, to employee groups and bargaining councils for the next two years. The Council for Medical Schemes will use this period to draw up a low-cost medical scheme option covering these benefits, a statement released yesterday by National Treasury and the Department of Health, says.

The statement announcing that Finance Minister Pravin Gordhan and Health Minister Aaron Motsoaledi have tabled the third draft of the demarcation regulations outlining that health insurance policies insurers will be allowed to sell, says that once the low-cost medical scheme benefit option is in place, providers of these primary healthcare plans will be expected to register as medical schemes.

The latest draft regulations, which will fall under the Short Term and Long Term Insurance Acts, propose that insurance policies that pay a predetermined sum of money per day spent in hospital, known as hospital cash plans (not to be confused with medical scheme hospital plans), be allowed to continue, but limited to offering a benefit of R3 000 a day or a lump sum of R20 000 a year.

The draft regulations provide for gap-cover policies with annual benefits up to R150 000 – up from the R50 000 in the second draft regulations. The first draft regulations, published in 2012, proposed banning gap-cover policies altogether, but Treasury received many objections to the proposed ban.

Gap-cover policies cover you when there is a shortfall between what your scheme pays and what your doctor charges for a procedure, typically in hospital.

The uptake of this cover has increased dramatically since 2010 when the Department of Health’s guideline tariffs for medical services were struck down after a court challenge and the gap between what doctors charge and what schemes pay has broadened.

Insurers also offer top-up cover that pays out when you exhaust your medical scheme benefit or annual limits, but these policies will not be able to continue if the draft regulations are promulgated.

The Treasury/Department of Health statement says the regulations are being tabled in Parliament for comment.

The intention is to finalise the regulations and make them effective from April 1 next year for all new policies. On existing policies, insurers will have until January 1, 2018 to comply.

This means that if you have gap cover or a hospital cash plan in place now, or take out a policy before April next year, there will be no limits on the benefits until January 2018. But from April next year, any new policy you buy will have to comply with the limits in line with the final regulations.

The aim of the regulations under the Insurance Acts is to ensure that healthcare policies offered by short-term insurers and life assurers do not undermine the cross-subsidisation medical schemes require to be sustainable. Insurance can be cheaper for younger, healthier people, but schemes need young and healthy lives to subsidise the healthcare costs of the old and sick.

Medical schemes are able to offer you better protection against financially catastrophic medical bills, because while the benefits may be subject to some limits, certain minimum benefits for emergencies and other life threatening conditions are unlimited.
Insurance products can pay out only the benefit amount defined in the policy. The draft regulations specifically prohibit insurers from offering benefits that cover actual medical costs.

In 2013, the definition of a medical scheme in the Medical Schemes Act was amended to ban healthcare policies, with only regulated exceptions. This will take effect when the regulations become effective, making it possible for insurers to offer some limited healthcare policies subject to strict conditions.

The draft regulations name the policies that will be allowed: gap-cover policies and hospital cash plans, as well as policies covering frail care expenses, benefits for the testing and treatment of HIV/Aids, tuberculosis and malaria, evacuation or transport in a medical emergency, and health events while travelling internationally.

Existing primary healthcare plans, which serve some 200 000 people, provide cover for general practitioner visits, acute and chronic medication, emergency medical care, dentistry and optometry. These plans do not cover hospital expenses and are often sold to lower earners in conjunction with hospital cash plans. Hospital cash plans are intended to provide for other expenses that arise from your hospitalisation, such as loss of income or transport costs.

Although there is nothing stopping you from using these plans to pay your hospital bills, they can fall horribly short of covering, for example, a day in an intensive- or high-care unit in a private hospital or even in a government hospital (if you earn above a certain threshold – about R6 000 a month).

These plans are sold to working people who want to see private doctors rather than use government clinics for their day-to-day healthcare needs but who will use state facilities for costly hospital procedures and chronic conditions.

In an attempt to ensure that you are not unfairly discriminated against if you have health problems, the draft regulations also state that:

• Hospital cash plans, cover for HIV/Aids, TB and malaria, and gap cover must be sold on a group basis – that is the insurer may not make you pay a premium that is based on your individual health status, age, gender or any similar grounds, but is priced according to the group that is likely to take up the insurance.

However, your insurer can charge you a higher premium for gap cover, hospital plans and plans covering HIV, Aids, TB and malaria if you take out a policy after a certain age, as long as this condition applies to everyone over that age.

• Hospital cash plans must pay benefits from the first day you are hospitalised.

• Commissions payable to a broker who sells you a health insurance policy is limited to between five and 20 percent, depending on your premium. The commission limit is aimed at preventing brokers from selling you insurance because the commission is higher, when it would be in your best interests to join a medical scheme. Medical scheme brokers earn only three percent on your contributions up to R80 a month plus VAT.

The regulations are the outcome of a consultative process between the Ministers of Finance and Health as well as the Council for Medical Schemes and the Financial Services Board.
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