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MEDICAL CHRONICLE A little over four years after it was first started in 2014, the Health Market Inquiry finally released its provisional report. But, these remain recommendations and are not binding. As such the Minister of Health may accept all or none of them. "I feel like we're starting to get somewhere because in the last two to three years we were in a situation where we were all waiting for these things to happen," said Dr Johann Serfontein a member of the Free Market Foundation's Health Policy Unit and healthcare consultant at HealthMan. “And then in typical fashion they all happened at once. Which suddenly made things very interesting, especially for smaller organisations to respond to all the Legislation." HMI TIMELINE ENDLESS POSTPONEMENTS The Health Market Inquiry (HMI) process was initiated in May 2014 with a draft statement of issues. There was supposed to be a provisional report and recommendations in August 2016 which never transpired. "Along the way there were numerous legal challenges to aspects of it, which we actually had right until the very end," said Dr Serfontein. When the final report didn't come out in 2016 as promised, they gave us a new schedule in 2017 with a host of reports due, including provisional report dates and the HMI final report and recommendations. Of course, none of that landed up happening. We finally started getting some reports in December 2017," said Dr Serfontein. And, as things normally happen in the industry, the government tends to drop important information in December when everyone is on vacation and not around to comment." These included an Analytical Report on PMBs, Observation of Claims Data Analysis, then facilities, a practitioner, and a funder analysis report all of which were available as annexures to the recently released HMI report, adding another 300 400 pages. After the first scheduled date of 30 April 2018 for the provisional HMI report and conditional recommendations to come out was not met, the date was rescheduled another three times before it was finally released on 5 July. “The main HMI report is 484 pages, quite a thick document, and the comprehensive nature of it makes it very difficult to form a comprehensive answer when you respond to it," said Dr Serfontein, "So a Lot of people tend to focus on the sections that affect them and their organisations, Leaving the other sections to those affected by them. That said, as a consumer of healthcare, if you really care, you might find you need to respond to absolutely everything in the report. The indication is that some time in Nov Dec this year the final HMI report and recommendations will be published. It's important to remember these remain recommendations and are not binding to anyone. As such, the Minister of Health may accept all or none of them. As much as the HMI has done a Lot of good work to come to these findings, it still might come to naught in the end. And already we n have the Medical Schemes Amendment Bill MSA and the National Health Insurance NHI Bill actually Launched prior to the HMI report, and although one can see that some elements were included in those bills, it doesn't Look Like they were considered in total with the available bills. THE BOTTOMLINE When trying to figure out which parts to respond to, the rather cumbersome HMI report and annexures can make forming a comprehensive response daunting. Here's what you as a 'supplier of healthcare' should know: KEY HMI FINDINGS • Practitioners are key drivers of health expenditure overall and peer review mechanisms have limited effect • There is evidence of specialists acting in collective ways that have driven up costs • There has been a failure to properly explore multi-disciplinary models of care delivery and the fee for service model stimulates over servicing • There is a Lack of accountability in terms of reporting of outcomes • There is evidence of supplier induced demand including increases in the number of private hospital beds driving admission rates and inappropriately high rates of ICU admissions. It was also noted that facilities are competing to attract specialists with factors such as new technology • There is not an under supply of specialists but rather an inefficient use of their time • The private hospital market is highly concentrated with three dominant hospital groups. • They have exhibited sustained profitability and there has been a Low tendency to adopt alternative modes of delivering hospital care. The National Health Network (NHN) exemption appears to have been effective from a competition perspective • Provider networks are a promising tool for promoting an effective outcomes based approach • There has been inconsistent application of licensing processes across provinces which has Led to an oversupply of hospital beds • There is Lack of transparency in pricing and Lack of reporting on outcomes and the overall Lack of publicly available information affects decision making by consumers and practitioners. This data is also required to facilitate risk adjustment. HMI RECOMMENDATIONS: SUPPLIERS OF HEALTHCARE • There are detailed reporting requirements for facilities and a new Licensing framework under a Supply Side Regulator for Health (SSRH), which would be established under the National Health Act • The SSRH would be an independent public entity and would oversee proper healthcare resource planning and monitoring • A moratorium on new beds for the three large hospital groups should be considered • Practice code numbers for public and private facilities should be managed by the SSRH Practitioners must also register the facilities at which they operate to allow for inspections and prevent fraud. The OHSC would be incorporated into the SSRH • Economic value assessments should be published to stimulate competition, mitigate information asymmetry, and facilitate strategic purchasing by funders • The Outcomes Measurement and Reporting Organisation (OMRO) should be implemented in a phased way with the first phase being a voluntary measurement and reporting system Leading to the establishment of a statutory entity • The CMS should include metrics on supplier induced demand in its published reports and work with stakeholders to determine appropriate format and frequency • The public sector should be engaged in strategic purchasing from the private sector • The HPCSA must undertake a review of its ethical rules to encourage group practices and global fees, and to remove the ban on the employment of doctors by facilities. The rules should consider the competition perspective in general. Specific rule references have been provided and this includes full disclosure of the practitioners' interest in treatment provided including facility shareholding and financial interests in medicines and products used or dispensed.
Created at 2018/09/26 10:07 AM by Mediclinic
Last modified at 2018/09/26 10:07 AM by Mediclinic