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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
2017/02/08 02:33 PM
Nurses face endless delays in being sent their practice certificates after paying annual fees and must often travel far to get the certificate so they can keep their jobs. Though they are often said to be the health system’s frontline‚ nurses say the way the SA Nursing Council treats them shows the government does not respect them. The annual professional payment system is not yet online and the 220 000 nurses and 73 000 nursing assistants must pay via FNB and fax proof of payment to the office. Then certificates are posted to them, but many say they never arrive. Nurses‚ who do not get their licences‚ must travel to the only nursing council office in the country to get it. Using the number of nurses in the country recorded on the council website and the annual fees‚ it has been established the council rakes in at least R120-million in fees a year.

THE TIMES visited the council offices and found hundreds of nurses queuing for their documents in hot offices with a broken air-conditioner. A woman collapsed while waiting and was taken away by ambulance. One nurse asked where the nursing council money went. Council chairwoman Busisiwe Bhengu said nurses did not need to fax proof of payment to the offices. But THE TIMES has documentation from the council instructing nurses to do so. Bhengu said employees could check if nurses were registered using the electronic register‚ but many nurses said the state required hard documents. Bhengu said if they paid in time‚ the council would not have to post their annual practising certificates at the busiest time for the post office. She said the council held outreach days in all provinces making it easier to pay.
2017/02/08 02:34 PM
Treasury also said the proposed tax was not meant to be used as a tool to raise revenue, but was rather meant to ‘promote healthy’ living.

The so-called “sugar tax” is not meant to be a revenue-raising instrument, but was intended as a “health promotion tool”, MPs heard on Tuesday.

Treasury gave MPs sitting on parliament’s standing committee on finance and the health portfolio committee a presentation on the policy rationale for the proposed taxes on sugary beverages.

“Studies show that a 10 to 20 percent price increase of SSBs [sugar-sweetened beverages] may be required to translate into a meaningful impact on health outcomes,” the policy rationale document, tabled during public hearings on the tax proposal, said.

Treasury noted there were concerns that the proposed tax would be “regressive and cause harm to those most vulnerable in society”, but insisted obesity had mostly affected lower socio-economic groups making a sugar tax favourable to poor people.

Obesity being a global epidemic is a major risk factor for NCDs [non-communicable diseases] like diabetes and heart problems. In South Africa the number of overweight people has grown over the last 30 years, and the country now has the highest obesity rate in sub-Saharan Africa, with 42% of women and 13% of men being obese.

“Weight gain from excess sugar consumption mainly stems from sugar-sweetened beverages,” according to Treasury’s rationale.

The policy rationale mentions the World Health Organisations stance that “fiscal measures such as taxes are increasingly recognised as effective complementary tools to help tackle the NCDs and obesity epidemic at a population level”.

According to Statistics South Africa, in 2013 HIV and AIDS had been receiving the lion’s share of public health funding, despite 51.3% of all deaths being attributed to NCDs.

“The increased health care costs and increased utilisation rates will place a heavy burden on the health system,” the Treasury document said.

“The growing NCD burden will reduce productivity levels and GDP [Gross Domestic Product] (6.8% of GDP was lost due to NCD-related deaths, absenteeism, presenteeism, and early retirement in 2015).”

In July last year treasury published a draft policy paper for public comment. A total of 144 comments including from the Sugar Industry, NGO’s, Academia, and individuals were received.

In its consideration of the comments, Treasury said: “The proposed tax is in line with the Department of Health’s Strategic Plan for the prevention and Control of NCDs 2013 – 2017, and National Strategy for the Prevention and Control of Obesity 2015 – 2020.”

Treasury said the economic impact study by the sugar industry “appears an exaggeration”.

In August last year, the Beverages Association of South Africa cautioned taxes of SSBs would cost the economy R14 billion.

Treasury analysis differs, and estimates that the formal businesses selling sugar-sweetened drinks would suffer a loss of R1.4 bn, while the informal sector would lose around R165 million.


South African formal businesses selling carbonated sugar drinks is estimated to suffer a R1.4 billion loss in revenue, should a “sugar tax” be implemented, National Treasury said on Tuesday.

Treasury officials participated in public hearings on the proposed tax on sugar beverages before the standing committee on finance as well as the health portfolio committee, providing MPs with an analysis of the socioeconomic impact of the policy proposal.

The analysis document tabled during the hearings states: “Higher prices discourage consumption of soft drinks, with lower-income households most affected.”

“Overall, the impact of the tax is negative, but relatively small, real Gross Domestic Product (GDP) is 0.02 percent lower compared to the no-tax baseline,” said National Treasury.

2017/02/08 02:33 PM
Consumers who cannot afford medical aid often opt for hospital insurance plans thinking they have comprehensive emergency cover, only to find out that they don’t. When Jade Cherice Smith’s baby started bleeding after a “bout of gastro” last October, she called the providers of her R580-a-month hospital insurance policy to ask for authorisation for her daughter to be admitted to hospital. The insurer said it would authorise it only if the baby was critically ill or had been in a car crash. Smith, of Springs in Gauteng, said she was told her baby’s condition did not sound severe enough, “so keep an eye on her and if it gets worse go the nearest state hospital”. Fortunately, the bleeding stopped. Smith has switched to a medical aid, saying she feels safer with medical aid than with insurance because “there’s always fine print you happen to miss”.

Research by the Competition Commission, titled “Market Inquiry for Health” and released in November, found that consumers did not understand the difference between medical aid hospital plans, hospital insurance and hospital cash plans. Hospital insurance usually pays a lump sum for each day spent in hospital to cover lost income. Medical aid hospital plans have a legislated set of basic benefits. Jill Larkin, head of healthcare consulting at GTC Financial Services, said insurance usually pays out on the third day in hospital and hospitals may even refuse one entry because they know they will not get paid for the first two days. A hospital insurance plan was not a substitute for medical aid, she said. In April, the law on hospital insurance plans will change to limit the amount such plans can pay a patient to R3 000 a day, with a cap of R20 000 a year. Casper de Vries, an actuary at Alexander Forbes, said it is hoped limiting hospital plans will increase medical aid membership by young people and bolster the industry.
2017/02/08 02:35 PM
If Johannesburg communications consultant Lianne Osterberger hadn’t downgraded her medical aid, her family of four would have been paying more than R10 000 a month in premiums. A steep, above-inflation increase in her premium forced her and her husband to change to a cheaper medical aid plan. It restricts which hospitals they can use, but it’s a compromise she can live with. Annual medical aid premium increases have been two percent above consumer inflation for the past 16 years, said Casper de Vries, senior actuarial specialist at Alexander Forbes. Most medical aid premiums increased this year by between nine percent and 10 percent, with Discovery’s Coastal Core plan up by 14.9 percent.

Experts say the trend is unsustainable in the long-term and even the regulator of medical aids admits the industry needs more young and healthy members. But people in their 20s cannot afford medical aid. Jill Larkin, head of healthcare consulting at GTC Financial Services, who advises on medical aids, said she noticed many clients downgrading to cheaper plans this year, as she did herself when she realised her premium equalled her car repayments. She said that at this rate premiums will eventually outstrip a person’s salary. But she warned that when consumers cut costs by getting a cheaper plan, they weren’t necessarily saving money. She said you carry the risk, you absolutely will pay for more in the end. You will have less money in your day-to-day spending accounts for GPs and dentists.

The Government Employees’ Medical Scheme (Gems) said 50 000 of its 694 262 principal members changed options this year - mostly downwards. The scheme expected this and designed a plan, Emerald Value Option, with cheaper benefits, restricting members to certain hospitals and forcing them to see GPs before a specialist, to keep the plan cheaper. Discovery Health Medical Scheme said it had a higher percentage of people buying more expensive plans (3.1 percent) than downgrading, but the percentage of members downgrading had increased from 2.6 percent last year to 2.9 percent this year. Last year, 1.2 percent of Bonitas Medical Fund members changed to cheaper plans. This rose to 1.8 percent this year, according to the scheme’s CEO Kenneth Marion. Most consumers stay put on their medical aid, research by the Competition Commission market inquiry last year showed.

Only 16 percent of those surveyed suggested any real commitment to changing the medical aid they were on. But Damian McHugh, head of health marketing at Momentum Health, warned that if people weren’t forced to downgrade this year, they would do so in future if these increases continue. The strain on medical aid schemes, which have increasing numbers of older and sicker members, is beginning to show. In 2015, the medical aid industry ran at a R1.2-billion loss, from R500-million the year before. Most medical aid options in 2015 paid out more than they earned in premiums.

But De Vries said that due to the relatively large reserves held by medical aid schemes, the industry remained financially stable. The increases in premiums are partly driven by increased visits to doctors and hospitals. Gems principal officer, Guni Goolab, said that five years ago, one in six people on the medical aid scheme were on chronic medication - it is now one in four. Elsabè Conradie, spokeswoman for the Council for Medical Schemes, said that rising prices were “definitely a concern. She said membership growth in the younger age group was needed to protect the risk pools of medical schemes. 
2017/01/30 03:53 PM
MEDICLINIC yesterday confirmed that it will acquire a majority stake in Life Path Health. Life Path Health is a mental health treatment provider operating seven facilities in the Western Cape, with a further three in the process of development in other regions of the country.

Mediclinic CEO Koert Pretorius said that there was a strong alignment between the two groups. "Life Path Health's healthcare offering and Mediclinic's vision of transforming into a more integrated healthcare service provider offer a broader range of services to our patients," Pretorius said.

Anton Rossouw, CEO and founder of Life Path Healthcare, said he saw this as the next phase in its growth path and valued the positive investment.
2017/01/30 03:32 PM
Why would a government seek to stop consenting adults from entering private contracts with insurers to minimise the risk of huge medical bills, asks Jasson Urbach

The final demarcation regulations drawing the line between medical insurance products and medical schemes was gazetted by the Treasury in December. When the first draft regulations were published for public comment four years ago, they were met with staunch opposition as the proposals would have all but banned health insurance products.

It was a classic case of "door-in-the-face technique". By diverting attention away from the real cause of the problem, the public would be lulled into agreeing to "more reasonable" future proposals.

The regulations gazetted in December still ban primary healthcare insurance policies but allow "gap cover" or "hospital cash plans", subject to the application of maximum limits and strict underwriting and marketing conditions. These watered-down regulations still do not address the dubious principles driving the perceived need for change.

The fundamental problem yet to be openly identified, let alone resolved, is the principle of so-called "social solidarity" contained in the Medical Schemes Act of 1998 (MSA). The Treasury states, "[Health insurance products] must operate within a framework whereby they complement medical schemes and support the social solidarity principle embodied in medical schemes".

The MSA of 1998 changed the regulations governing the operations of medical schemes and set in motion the determined process of crowding-out private medical schemes. Four changes that drastically increased the cost of providing medical scheme coverage were: open enrolment, community rating, statutory solvency requirements and the introduction of a comprehensive package of hospital and outpatient services that all schemes are compelled to provide — referred to as prescribed minimum benefits (PMBs).

Any "social solidarity" principle unavoidably raises the price of medical scheme coverage which prevents low-income people (mainly the youth and black people) from entering the private medical scheme market. Indeed, the average cost of providing PMBs alone amounts to R608 per beneficiary per month and necessarily precludes low-income earners from joining medical schemes.

Many low-income earners have instead opted for hospital cash plans. Currently there are no limits in place for these payments but the new regulations will impose a limit of R3,000 per day and a maximum of R20,000 per year. "Gap cover" policies will be limited to a pay-out of R150,000 per year.

Why would a government step in to prevent mutually consenting, free adults from entering private contracts with insurers to minimise their risks of huge medical bills when catastrophe strikes? Especially when it would lessen the pressure on the government-run provision of services to have more people covered by private insurance.

The situation the demarcation regulations seek to remedy would never have arisen if "social solidarity" had not been adopted. They effectively stopped medical scheme actuaries from devising policies to suit low-income earners. The only real solution would be to eradicate the cause; to deregulate and scrap the dubious principle of social solidarity that applies to private medical scheme arrangements.

If the new limits are implemented, most wealthy people will be able to afford to continue their medical scheme membership and comply with the regulations. But poor people cannot afford this form of social engineering. They will be denied private cover.

The Department of Health has requested that the Council for Medical Schemes (CMS) grant a two-year exemption period for clients before existing primary healthcare insurance policies are banned, while the department conducts further research into the development of low-cost medical scheme benefit options.

Do not hold your breath: the government has been discussing the introduction of low-cost medical scheme benefit options for at least 10 years and we can expect further delays while the government continues to marginalise the private sector before the proposed National Health Insurance is introduced.

Government officials and their aides seem incapable or unwilling to appreciate the role of the private health insurance market in financing healthcare. Future healthcare reforms must recognise the positive role played by the private sector. Private healthcare financing increases access to high-quality care, improves consumer choice and leads to greater health system responsiveness.

• Urbach is an economist and director of the Free Market Foundation.
2017/01/30 03:34 PM
The Council for Medical Schemes (CMS) says in a statement today that it “noted with great concern the recent press statements and subsequent radio and television interviews regarding the beneficiary registry (BR).”

The CMS adds that it would like to clarify the position and any “misconceptions” created by these statements concerning the BR.

Current press releases and billboards are misleading in that they wrongly suggest that the CMS will be collecting medical data. It is not the CMS’ intention to collect any medical data and the directive received from the Minister of Health is clear in this regard, the statement says.

“The articles also mentioned a security threat to data, but the CMS has demonstrated to medical schemes and other stakeholders in the several engagement sessions that very adequate security measures are in place. Resulting from these meetings, an Industry Technical Advisory Group (ITAG) task team was established, consisting of representatives from medical schemes and administrators. One of the four work streams of the ITAG task team solely deals with the security issue.

“Statements suggesting that the CMS is contravening any legislation in requesting basic personal details such as name, surname, unique identification number and basic contact details of beneficiaries from medical schemes, are factually incorrect. Section 38 of the Public Protection of Information Act (POPI) makes provision for exceptions where information is processed for the purpose of a relevant function of a public body or conferred in terms of a law; and section 37 of POPI provides that the Information Regulator may grant an exemption if the privacy of a data subject is outweighed by the public interest of a public body or where it is in compliance with legal provisions.”

The CMS says the purpose of the BR is “in the public interest and will enable the CMS to optimally fulfil its mandate in protecting beneficiaries of medical schemes.”

The BR will allow the CMS to understand the geographical and demographical distribution of all members of medical schemes and will enable the CMS to share information pertinent to the members of schemes as the functioning of the Medical Schemes Act and their rights and privileges under the Act, the statement adds.

“The CMS thus finds it pertinent that in order to effectively regulate the medical schemes industry it is crucial that it has information on the beneficiaries whom it has a responsibility to protect. It is a notable concern that medical schemes allow third party administrators to keep data of members without in most cases acquiring the required consent of members whereas this information is asked by the regulator in order to protect the interests of these members.”

The CMS notes in the statement that several medical schemes have appointed the state a designated service provider and hence members are deferred to the state, in the absence of any mechanisms which allow state facilities to verify whether a patient belongs to a medical scheme or not, resulting in schemes rarely being billed for treatment.

“This is not in the public interest as it adds an additional burden on the already cash strapped and over-burdened state facilities. If these facilities are provided with a method to verify active membership and raise a fee for services rendered, the ratio of payments by private medical schemes to state would improve.

“Furthermore, the potential for fraud committed by patients purporting to be medical scheme members, would also decrease by the introduction of this much needed verification mechanism. This would leave more money in the public coffers, allowing the state to procure better services for our citizens and is therefore directly in the public interest.”

The CMS adds that the collection of basic demographic member data at a more granular level will allow it – and the National Department of Health (NDOH) – to base health insurance policy decisions on more precise business intelligence.

“This will benefit all members of medical schemes as well as the public at large and will also ensure that future healthcare interventions are better focused and scientifically based. Collecting individualised data will also 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 CMS concludes that it has consistently advised that the process will be subjected to rigorous legal scrutiny before being finally implemented.
2017/01/30 03:36 PM
Cape Town – The Health and Other Service Personnel Trade Union of SA (Hospersa) says Health Minister Aaron Motsoaledi has failed to sufficiently address the shortage of staff in public hospitals and clinics.

Hospersa also says more can be done to provide incentives to qualified but unemployed health professionals to work in rural areas.

Motsoaledi came under fire by health bodies after denying reports of a lack of posts available for doctors in the public sector last week.

The SA Medical Association (Sama) and the Junior Doctors Association of SA (Judasa) have called some of his comments an affront to all doctors in the country.

They have also said it was time that the medical profession re-examines its commitment to the principle of community service.

After reports emerged of numerous health practitioners who have completed internships and community service still seeking jobs, Motsoaledi said last week that there were 147 posts available for medical doctors in the public sector, and 45 internship positions available.

Motsoaledi said the 135 doctors quoted in the media, who are said to be without jobs, may contact the department.

According to him, 22 South African interns placed in jobs declined the posts.

Reasons ranged from marriage, family responsibility, medical conditions to religion and owning expensive property in a particular geographic location.

Hospersa general secretary Noel Desfontaines said: “On the one hand we have a confirmed shortage of staff, but on the other, we hear of qualified health- care professionals who remain unemployed. Hospersa is very concerned about this paradox."

“There is still a vast gap between public health-care facilities in the urban areas and what one finds in rural and far-flung communities. This needs to be addressed while implementing more effective incentives for health workers to apply their talents in rural areas.”

Desfontaines said Hospersa was appalled by the often dismal working conditions faced by its members in the public sector, especially in hospitals and clinics managed on skeleton staff.

“Nurses are at the front line of health care in South Africa, and one often finds that nurses are expected to operate clinics on their own, and with very little resources,” he said.

The department did not respond to requests for comment on Tuesday.
2017/01/30 03:55 PM
Mediclinic Southern Africa has announced that it will acquire a majority stake in Life Path Health, a mental health treatment provider which currently operates seven facilities in the Western Cape, with plans for more in other regions of South Africa.

Koert Pretorius, Mediclinic CEO, said in a statement:

“There is a strong alignment between Life Path Health’s current healthcare offering and Mediclinic’s vision of transforming into a more integrated healthcare service provider, offering a broader range of services to our patients.”

Mediclinic said it believes this acquisition will fulfill its strategic objective of expanding its offering of care services available to the South African market.

The acquisition is subject to conditions, including approval by the competition authorities.
2017/01/30 04:43 PM
Mediclinic Southern Africa has confirmed that it will acquire a majority stake in Life Path Health.

The Life Path Health Group is a network of hospitals providing mental health inpatient treatment and addiction treatment in private facilities in the country. The mental health treatment provider currently operates in seven facilities concentrated in the Western Cape, with a further three in the process of development in other regions of South Africa.

“There is a strong alignment between Life Path Health’s current healthcare offering and Mediclinic’s vision of transforming into a more integrated healthcare service provider, offering a broader range of services to our patients,” said CEO of Mediclinic Southern Africa, Koert Pretorius.

CEO and founder of Life Path Healthcare, Anton Rossouw, added: “We see this as the next phase in our growth path and we value the positive investment from a sound business partner of Mediclinic’s calibre.”

Life Path Health is a well-recognised role player in the mental health environment and Mediclinic believes that this acquisition will fulfil their strategic objective of expanding the basket of care services available to the South African market, while also leveraging off the experience and track record offered by Life Path Health.

Life Path Health specialises in addiction rehabilitation; adjustment disorders; anxiety disorder; dementia; electro convulsive therapy; mood disorders such as depression; bipolar; obsessive compulsive disorders; panic disorders; post-traumatic stress disorders; and psychotic conditions including schizophrenia and psychotic mood disorders.

While it will form part of the Mediclinic offering, business will remain as is for the mental health provider with no planned structural or operational changes in the immediate future.

The acquisition of the majority stake in Life Path Health is subject to the fulfilment of a number of suspensive conditions, including the approval of the transaction by the Competition Authorities.
2017/01/30 04:44 PM
Private hospital group, Mediclinic Southern Africa, has acquired a majority stake in Life Path Health, a mental health treatment provider operating seven facilities currently concentrated in the Western Cape, with a further three in the process of development in other regions of South Africa.

The acquisition aligns with Mediclinic’s strategic objective of expanding the basket of care services available to the South African market, while also leveraging off the experience and track record offered by Life Path Health.

While it will form part of the Mediclinic offering, business will remain as is for the mental health provider with no planned structural or operational changes in the immediate future.

The acquisition of the majority stake in Life Path Health is subject to the fulfilment of a number of suspensive conditions, including the approval of the transaction by the Competition Authorities.

“There is a strong alignment between Life Path Health’s current healthcare offering and Mediclinic’s vision of transforming into a more integrated healthcare service provider, offering a broader range of services to our patients,” says Koert Pretorius, CEO of Mediclinic Southern Africa,

Anton Rossouw, CEO and founder of Life Path Healthcare, supports the sentiment, “We see this as the next phase in our growth path and we value the positive investment from a sound business partner of Mediclinic’s calibre.”
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2017/01/30 04:45 PM
Cape Town - Mediclinic Southern Africa [JSE:MEI] confirmed on Tuesday that it will acquire a majority stake in Life Path Health. Life Path Health is a mental health treatment provider which operates seven facilities currently concentrated in the Western Cape, with a further three in the pipeline in other regions of South Africa.

Mediclinic said in a statement it believes this acquisition will fulfil its strategic objective of expanding the basket of care services available to the South African market, while also leveraging off the experience and track record offered by Life Path Health.

Mediclinic CEO Koert Pretorius said: “There is a strong alignment between Life Path Health’s current healthcare offering and Mediclinic’s vision of transforming into a more integrated healthcare service provider, offering a broader range of services to our patients.”

Life Path Healthcare CEO Anton Rossouw said the company sees the development as the next phase in its growth path. While it will form part of the Mediclinic offering, business will remain as is for the mental health provider, with no structural or operational changes on the cards in the immediate future.

Mediclinic advised that its acquisition of the majority stake in Life Path Health is subject to conditions, including approval by the competition authorities.

Mediclinic's share price on the JSE showed a 0.45% increase to R132.60 at 11.40.
2017/01/30 03:38 PM
The Department of Health has asked medical aids to pass on the names and addresses of all their members for use in a central government database.

The Democratic Alliance's spokesman on health‚ Wilmot James‚ said this request was a breach of the Constitutional right to privacy and the government had no right to each member's personal information.

The Council for Medical Schemes‚ which regulates medical aids‚ in July made a presentation explaining to schemes why it wanted this data. The Times has seen the presentation‚ which explains the data would help the government bill some medical aid members who currently use state hospitals and clinics for free.

The Department of Health also wants a single list of every patient in the country to be held on a central database as part of National Health Insurance‚ according to the presentation.

The Department of Health wants information on what medical aid option each person is on and what the relationship between the main member and their beneficiaries are. James said: "The state has no right to our personal information and the Council for Medical Schemes has no business in providing it. It cannot be that national government asks a national institution to break our own laws."

The DA has said it knows at least some medical aids have refused to provide it‚ but others have passed it on to the council.

Werksmans Attorney Neil Kirby said the department of health may have trouble enforcing this request as it contradicted a provision in the Medical Schemes Act.

"Section 60(2) of the Medical Schemes Act‚ 1998 prohibits any person from disclosing information about the affairs of a medical scheme unless it is done in terms of his or her duties in terms of the Act or as a witness before a court."

Spokesman for the Department of Health Joe Maila said: "Firstly‚ the registry is not to collect personal or private information as the DA claims‚ but to ensure that the public sector is able to identify medical scheme members so that their scheme can be billed for services rendered in the public sector. "

He said the information such as which options members are choosing and the ages and geographic distrubution of members was solely for research purposes and would be anonymised.

Maila hit back at medical schemes that wouldn’t provide the data.

"We are aware that some schemes do not want this information to be available neither to the department or the public. They have a lot to hide. They go around mobilising proxies to fight this battle for them. We are the last to act unethically in respect to patient confidentiality because we are the custodians of that."

The two largest medical aid schemes Government Employee Medical Aid Scheme and Discovery Health Medical Aid Scheme were unable to comment at time of going to print.
2017/01/30 03:39 PM
Zokufa died on Sunday after a short illness, after taking up his appointment as CEO at the CMS in November

Council for Medical Schemes (CMS) registrar and CEO Dr Humphrey Zokufa died on Sunday after a short illness, according to a CMS statement released on Monday.

A veteran administrator, Zokufa had taken up his appointment to the CMS November 1, following the quiet departure of Dr Monwabisi Gantsho, who left under a cloud.

Prior to his appointment to the CMS, Zokufa had been the MD of the Board of Healthcare Funders of Southern Africa (BHF) for almost 11 years.

"His energy and passion for an optimal and effective regulatory framework in the private healthcare industry was clear. He was firm in his belief that National Health Insurance (NHI) is not a pipe dream and his dedication, commitment and vision to lead the private healthcare sector into participating in the NHI was his priority," said Dr Elsabé Conradie, the CMS’s GM for stakeholder relations.

The CMS would continue with its organisational functioning under chief financial officer Daniel Lehutjo, who will be acting registrar in the interim.

Zokufa will be buried on Saturday in Pretoria.
2017/01/23 09:13 AM
A new molecule has given doctors fresh hope in the battle against a type of skin cancer particularly prevalent among white South Africans.

The man-made molecule‚ discovered in the US‚ is claimed to stop malignant melanoma — the deadliest skin cancer — spreading to other parts of the body‚ and is 90% effective.

“The majority of people die from melanoma because of the disease spreading‚” said Richard Neubig‚ head of pharmacology and toxicology at Michigan State University.

“Our compound can block cancer migration and potentially increase patient survival.” In lab experiments‚ the compound reduced the spread of melanoma cells by 85% to 90%. It also significantly reduced tumours in the lungs of mice that had been injected with human melanoma cells.

Whites in South Africa have one of the highest incidences of malignant melanoma in the world‚ at 19.2 cases per 100 000 people annually.

South Africans are particularly susceptible due to high ultraviolet radiation.

Certain provinces have higher rates; the Western Cape has the same malignant melanoma rate as Australia‚ where there are 49 cases per 100 000 people annually.

Caradee Wright‚ a specialist scientist at the South African Medical Research Council‚ said awareness of malignant melanoma was low. “When you talk to people in the Department of Health‚ in communicable diseases‚ they say it’s not an issue because there are bigger problems like TB and HIV/Aids.”

The World Health Organisation says the main causes of melanoma are exposure to sun and a history of sunburn. “If you get intense doses of sun‚ it is worse than a farmer who is out in the sun every day‚” said Wright.

While melanoma was more prevalent among whites‚ black people with symptoms were often overlooked due to the type of melanoma they were more susceptible to.

Whites developed melanomas on the lower legs‚ stomach and thighs‚ while black people generally showed signs on the palms of the hands and soles of the feet.

Neubig said more research was needed before the compound became a usable drug. The next step was to identify which melanoma patients it would work best on.
2017/01/23 09:06 AM
The Road Accident Fund faces huge claims as road death toll increased 5% over the 2016-17 festive season

Discovery Health Medical Scheme, SA’s largest medical aid provider, and the state’s Road Accident Fund (RAF) are paying dearly for SA’s high road death toll, which rose 5% over the 2016-17 festive season compared with a year ago.

Transport Minister Dipuo Peters said on Tuesday more than 1,700 people died on the roads during the period.

Many fatalities arose from cars overturning, or head-on collisions, which Peters blamed on unskilled drivers who had taken advantage of corruption at driving-licence testing centres.

Those injured in these accidents are costing the state and medical schemes millions.

"The RAF’s claims expenditure still remains unacceptably high at more than R32bn per annum, where each rand paid is a painful reminder of the extent to which lives are lost and people seriously injured on our roads," said Eugene Watson, the agency’s CE.

The agency is funded through the fuel levy determined by the Treasury. For the 2015-16 financial year, the agency collected R33.2bn in levies, barely covering claims lodged during the year.

Most of the claims expenditure – about R16bn – went to loss of earnings for people injured in road accidents. Medical costs accounted for its second-lowest expense at R1.2bn, with burial costs coming in lowest at R120m. It expects to collate data from the 2016-17 incidents in three months.

At Discovery Health Medical Scheme, administered by a subsidiary of listed insurer Discovery, claims related to motor vehicle accidents topped R432m for 2016, with most lodged in December.

Most claims — nearly R352.2m — were lodged for hospital costs related to accidents that occurred during the festive season, the scheme said. Injuries in Gauteng, Kwa-Zulu-Natal and the Western Cape accounted for more than 80% of the scheme's expenditure related to road accidents.

Recovering this money from the RAF under the scheme’s rules has proven difficult.

"[Discovery Health Medical Scheme] always pays out motor vehicle accident-related claims upfront, in accordance with a member’s benefits," Discovery Health CEO Jonathan Broomberg said.

Discovery Health administers the scheme.

The recovery of paid past medical expenses from the RAF, however, is limited to that which the legislation allows, taking into account fault, contributory negligence, the circumstances of the accident, as well as whether the member, in fact, elected to institute a claim.
2017/01/23 09:16 AM
Cape Town - South Africa’s pharmaceutical industry has continued to weather the storm amid tough economic conditions, said Erik Roos, CEO of generic medicine company Pharma Dynamics in a statement.

“Since 2012, originators have steadily lost market share due to fierce competition, while the generic market boasted double digit growth,” Roos said, adding that more growth in the generics market could be expected in 2017.

“Even though generic volume penetration will start to slow down, the 2 900 generic dossiers currently sitting at the Medical Control Council (MCC) awaiting registration will significantly boost generic growth in the next 12 to 18 months,” according to Roos.

The launch of the South African Health Products Regulatory Authority (SAHPRA) – the new regulatory authority set to take over from the MCC in April this year – will see products being fast-tracked and brought to market much sooner than before.

“Based on past industry figures, registering products with the MCC could take up to five years. Alleviating this backlog could see hundreds of new generic products flood the market, making newer generation molecules available to patients at a fraction of the cost,” Roos said.

SA's ageing population drives medicine demand

Since the introduction of generics in South Africa, medicine prices have been slashed by 80% - making medicines more affordable and accessible to the masses.

Roos’ confidence in the generic sector is further motivated by South Africa’s growing demand for medicines.

“The massive increase in demand is mainly driven by South Africa’s ageing population of 4,209 million people who are older than 65, who are most likely to require chronic healthcare interventions. From 2005 to 2015 the size of the aged population almost doubled from 4.1 % to 7.7 %,” Roos said citing the World Health Organisation’s World Report on Ageing and Health.

“According to the report, this figure will rise to 10.06 million people by 2050. This, along with the various cost containment measures that are being employed by government, should further increase generic prescription and substitution at pharmacy level,” said Roos.

OTC medicine sales surge

The fact that patients are also increasingly being empowered to take a proactive role in maintaining good health has also spurred a surge in over-the-counter (OTC) medicine sales, particularly among schedule 2 products that are primarily a generics- dominated category. Unscheduled medicines (those that don’t require a prescription) have experienced the fastest unit sales growth at 5% in the past year.

Among the top-selling generic medicines in this category are those aimed at pain- and fever relief, as well as OTC cold preparations.

Roos points out that a call to reschedule certain OTC drugs such as aspirin and codeine to prescription drugs could impact the size of the OTC market and particularly the price of the products, as they will be subject to Single Exit Pricing.

The single exit price (SEP) mechanism in South Africa lists the maximum price that a medicine can be charged at. Dispensers may charge an additional dispensing fee depending on the price of the medicine.

Roos suspects unit sales will continue to grow in the OTC category although tighter regulation in the pending Complementary and Alternative Medicines Act - which seeks to remove products with unsubstantiated medical claims from the market - could impact the size of the market upon enactment later this year.

The South African private pharmaceutical industry is expected to reach R47bn by 2020, increasing by 38% between 2016 and 2020.

Rand weakness drives up medicine costs

According to Roos, the strengthening of the currency in the first and second quarter of last year will go a long way in increasing the growth trajectory of the market, but he says the rand is likely to remain under pressure for some time.

“This means consumers would have to fork out a bit more for medicines since more than 70% of pharmaceutical products on the continent are imported.”

He continues that the pressure on the rand is making it increasingly challenging for local pharmaceutical companies to maintain medicine prices at the level expected by medical aid schemes.

“We are experiencing immense pressure to drop or maintain the price of medicines in order to remain listed on the respective prescribed minimum benefit (PMB) formularies, while the average annual medical aid increase in 2015 – 2016 of 8.8% (Council for Medical Schemes Annual Report) is almost double that of the medicine price increase allowed by the Department of Health (DoH) in the same period,” he said.

“This imbalance in regulation across the medical industry means that medicine providers are sometimes squeezed out of business or forced to remove products from the market, which ultimately decreases the variety of products available to consumers.”
2017/01/23 09:21 AM
Cape Town - How much do you really know about the inner workings of your medical scheme? Here are some quick facts on open medical schemes in SA.

Whereas each scheme will readily provide you with the facts on themselves, not everyone has the time or the patience to go and do a comparative study. Fortunately, Alexander Forbes Health has done it for you in their Diagnosis 2016/2017. Some additional information comes from the Council of Medical Schemes.

Find out here what the facts are on open medical schemes in South Africa:

• Since the year 2000 to the present, the number of open schemes in South Africa has decreased by 24 from 47. There are now 23 open medical schemes in SA, to which anyone can belong. Many smaller schemes have amalgamated, making them less prone to market volatility. The bigger the scheme, generally, the more financially stable. A small open scheme can be derailed by a couple of large claims, but that doesn’t happen so easily to a bigger scheme.

• During 2016, Bonitas Medical Fund merged with Liberty Medical Scheme – the only amalgamation recorded during that year.

• Almost 59% of principal members covered on medical schemes, belong to open schemes. The other 41% are on restricted schemes. The numbers of dependants on medical schemes in general have decreased, pointing to financial pressure being experienced by principal members. This also indicates that members are most likely to add only family members who need medical attention – this could increase the financial pressure on all schemes.

• Discovery Health is the biggest open scheme in the country and had just over 1.2 million principal members and just over 1.4 million dependants.

• The top ten medical schemes, according to membership figures, are (in order): Discovery Health, Bonitas, Bestmed, Medihelp, Medshield, Fedhealth, Liberty (now merged with Bonitas), Sizwe and Keyhealth. Hosmed and Topmed come in at numbers 11 and 12 respectively.
• Six open schemes had a positive growth in membership numbers during 2015.

• The average annual increase in medical scheme contributions over the last 16 years has been 7.6%. Average CPI inflation has been 5.7%. Medical care and health expenses have gone up by average 7.7% per year during the last 16 years. Medical scheme contribution exceeds CPI by at least 1.9% on an annual basis.

• During 2015, open schemes had an overall risk claims ratio of 88.7%. This is proportion of contributions used to fund claims. The generally accepted benchmark for a claims ration is 85%. Excess funds are used to build reserves and pay for non-healthcare expenses, such as administration.

• The open scheme that had the highest claims ration in 2015, was Keyhealth (90%), followed by Fedhealth (86%). Discovery Health had a claims ratio of 77%.
• Open schemes spent an average of 10.4% of their contribution income on non-healthcare expenditure. Cost increases of non-healthcare expenditure increases with CPI. Non-healthcare expenditure includes administration expenses, broker commission and marketing fees, and bad debts.

• The open scheme with the highest non-healthcare expenditure was Sizwe (just over 16%), followed by Medihelp (just over 15%). The open scheme with the lowest non-healthcare expenditure was Medshield with just over 11%. Discovery Health spent just over 13% of its contribution income on non-healthcare expenses. On average (both open and restricted schemes) the industry spent 11% on average on these expenses – about R275 per member per month.

• Open schemes recorded an operating deficit of R565.63m in 2015. This was down from an operating surplus achieved in 2013 of  R626.54m. In 2015 only 8 of the 23 open schemes achieved an operating  surplus. When there is an operating deficit, schemes have to rely on investment income to break even.

• Open schemes have 45.8% of their assets held in cash. Schemes may not hold more than 40% in equities (stocks and shares) and the limit on property-related investments is 10%. There is a preference for cash investment, often driven by a need to have access to liquid assets.

• Schemes are required by law to have 25% of their assets in a reserve fund. By the end of 2015, open schemes had just under 30% of their contributions in reserve, as opposed to just under 40% held by restricted schemes.

• Of the open schemes, Medshield has a solvency level of just over 50%, Sizwe of just under 50%, Fedhealth about 35%, Keyhealth just over 30%, and Discovery and Bonitas very close to the legal requirement of 25%.

(Sources: Alexander Forbes Health Diagnosis 2016/2017; The Council for Medical Schemes)
2017/01/23 10:03 AM
Roshan Bhana, head of Alexander Forbes Health discusses the findings of the its health diagnosis for 2016 and 2017, as the healthcare industry faces a fair amount of change in the year ahead.

BUSINESS DAY TV: As South Africans brace themselves for medical aid tariff increases well above inflation, the healthcare industry itself faces a fair amount of change in the year ahead. The Competition Commission is expected to wind up its inquiry into the industry while schemes also face proposed new risk-based solvency measures.

Is this likely to change the face of medical schemes and will consumers ultimately pay even more for health insurance? Alexander Forbes Health recently published its Health Diagnosis for 2016 and 2017 and Roshan Bhana joins us with some of the reports insights.

Roshan ... so a year of change ahead perhaps for the medical schemes industry, a year of challenges though as well, it looks like.

ROSHAN BHANA: Yes, certainly the challenges have been well documented in the past two years. It’s just the nature of the industry and there’s very little appetite in terms of reforms that need to happen from the minister of health ... the focus from the Department of Health is mainly around National Health Insurance (NHI) more so than fixing up what’s wrong with the medical schemes industry.

Having said that, the medical schemes industry is still doing quite well given the circumstances under which it needs to operate and the Competition Commission inquiry together with some of the changes that are expected in the coming year can disrupt the industry, but that is probably still going to take a while before those changes take effect.

BDTV: Before we get to those disruptive forces, let’s take a look at what’s wrong with the industry because when it comes to the top 10 open schemes and top 10 restricted schemes during 2015, 16 of the 20 schemes did not maintain a surplus on an operating level in 2015 and therefore had to rely on investment income to subsidise claims and that (has put) the industry on very treacherous territory.

RB: Yes, there are a range of factors that have contributed to that. Firstly, the ageing profile of medical schemes, so like typical insurance products, medical schemes also operate on the basis where the young and healthy need to subsidise the old and sick. So if I explain it by means of a simple example, if the three of us are in a plan, then we contribute R3,000 for a year ... then that pot is only R3,000 so if one of us claims R3,000 or if we claim R1,000 back, that’s the bit that doesn’t get understood by the average consumer because the consumer thinks they’re contributing R2,000 or R3,000 a month and they’re getting nothing back in return.

That ageing profile is actually making medical schemes unaffordable so as the average age increases there are fewer people at the younger age at the healthy end of the spectrum to subsidise those older people. So that’s one where the industry is ageing and ageing at quite a quick rate.

The second component is the utilisation of healthcare benefits where, for example, you’ve got new technologies, new drugs that come onto the market and people wanting to access those and medical schemes having to fund those treatments whereas previously they didn’t need to. So it’s that component and it’s the component of people becoming unhealthier. Where people over the years have become unhealthy mainly through lifestyle diseases, lifestyle choices such as alcohol, tobacco, lack of exercise, poor diet.

The third component is one of the financial management of the schemes themselves ... on an annual basis medical schemes need to cost their products for the next year. In order for them to remain sustainable some of them do from time to time choose not to fully price their offerings, just to remain competitive. So that would be the case for some of those 16 schemes. Some of them may have actually deliberately chosen that path.

BDTV: The report tracks medical inflation over the 16 years to the end of 2015 and while CPI has averaged 5.7% over that period, medical aid inflation has averaged 7.6% and this year members are facing increases of between 10% and 15%, depending on which scheme they belong to. Are we going to have to continue paying more for less?

RB: Going back to my initial example of the R3,000, if there are three of us and next year claims are R3,500, then the three of us need to pick that up unless a fourth person enters our pot and that’s the challenge. So medical schemes contributions continue to be CPI plus 3%-4%, the consumer, on the other hand, what they tend to do is they tend to buy down to lower options or they remove dependents and that’s how they manage the annual increase from one year to the next.

That’s also a trend that we’ve observed over the last five years or so and it is just indicative of the affordability constraints of the individual, on the one hand, and the constraints faced by medical schemes, on the other hand. Medical schemes also need to remain solvent and they also need to price on an annual basis where they’re sustainable for the long term. And some of the high increases may also have been corrections from previous years where they didn’t price adequately in previous years and they corrected in the current year.

BDTV: When it comes to the regulatory ground that these schemes operate in, the current regulation requires all medical schemes to hold reserves amounting to 25% of annual gross contribution income, with many missing the target on that front. The Council for Medical Schemes has proposed a move to risk-based solvency framework. How do you see this shifting the landscape?

RB: I believe that the industry would welcome a risk-based approach. The current 25% doesn’t have any basis on which it has been determined. So someone just decided that 25% was the number and that’s the requirement for all schemes irrespective of size and the risks they face and all of that. The industry would welcome the Council for Medical Schemes embarking on this risk-based solvency measure.

My views are that it’s still three to five years away. So in order for that to happen there needs to be a change to the Medical Schemes Act because the act basically specifies a 25% level and that obviously depends on the minister’s appetite for regulatory reform for medical schemes.

BDTV: Do you see that reform happening, do you see it starting to happen this year, particularly as we move further into that NHI era?

RB: Yes ... it’s anybody’s guess whether that would happen or not but I believe the Council for Medical Schemes may relax their monitoring of schemes if they have an alternative measure which they themselves have developed. So they could run a parallel process where they have a 25% solvency for statutory purposes, but in terms of their monitoring of financial soundness of schemes, they use a risk-based measure.

For example, a government employee’s medical scheme might not be at a 25% level but a risk-based measure might say they need 15% or some other number and in that instance they wouldn’t worry too much if they’re not at 25%. But, on the other hand, it might be a scheme that is 40% that might need 50%, so the risk-based measure might make it easier for them to monitor financial soundness and sustainability.

But I also do believe that might destabilise the whole industry because you could have a scheme sitting at 100% solvency and requiring 50% and all of a sudden they have these access funds and the only way they could use these access funds is through giving members higher benefits or to use the investment income or the reserves to subsidise contributions. Back to top

9 January 2017
Times Live
Katharine Child

There is a lack of state posts for pharmacists to complete their year of community service‚ forcing them into unemployment‚ according to the Pharmaceutical Society of South Africa.

The society said on Monday that if the government couldn't afford to offer pharmacists community service posts‚ then it had no legal or moral basis to enforce community service and it should end the practice. Pharmacists cannot work in either the private or state sector until they have completed a legally required year of community service‚ usually in understaffed state hospitals or rural parts of the country.

Of the 984 who were supposed to start work at the beginning of the year‚ at least 78 don't have jobs. There may be as many 129 newly qualified pharmacists who were supposed to start work this year and are without jobs‚ said Lorraine Osman‚ a member of the Pharmaceutical Society of South Africa.

"Although the National Department of Health was notified of the number of interns who would need placement‚ provinces found that there was insufficient funding for them to offer the necessary posts."

President of the society‚ Professor Sarel Malan said‚ "If there are insufficient posts in the public service‚ then the only tenable option is to remove the obligation for community service immediately‚ and to allow all completing interns to be registered without limitation and to practise in any setting".

Osman said while there were problems placing staff every year in community service posts‚ far more were out of work this year forcing the society to publicise the issue.

In the year 2000‚ the number of pharmacists needing to do community service was about half of what it is now‚ she said.

She said it appeared as if there had been an increase in the number of professionals trained‚ but not an increase in state-funded posts to absorb them.

Osman said: "One of the other problems is that the new software that automated the community service placement process for all health workers was rushed into use last year and there were many technical glitches."

The faulty software allocated 17 pharmacists to posts in Limpopo‚ but these posts were already filled with bursary holders who had received provincial funding and needed to repay their bursaries by working in the province Osman said one pharmacist moved to Limpopo where the software had allocated him.

He spent money on renting an apartment and when he arrived at work last week‚ he was sent home as his job had been filled already.

"The Department of Health has tried to help us and been cooperative‚" said Osman‚ "but the whole system is not working". It appears provinces don’t have funding to employ staff.

"The society feels very strongly that young pharmacists should not be precluded from practising their profession because of dysfunctional systems‚" said Malan.

The Department of Health did not respond immediately for comment.
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