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SAPPFHEALTHVIEW:October2018

Content:FoodforThoughtViewonGovernmentFinancialViewViewonPharmaceuticals

SpecialNewsViewonMedicalSchemesSpecialNotices

Foodforthought

WillNHIbejustanotherstate-ownedenterprise?

AreportbyorganisationscollaboratingundertheumbrellaofthePeople’sHealthMovementSouthAfricawassubmittedtotheInternationalCommitteeonCultural,EconomicandSocialRights(ICESCR),interrogating-amongotherthings-theflawsandpitfallsofthecountry’sNationalHealthInsurance(NHI)proposal.

ProfessorLeslieLondonfromtheSchoolofPublicHealthandFamilyMedicineatUCT,andoneof

theauthorsofthereport,saidtheinternationalhumanrightssystemdoesnothavetheteethofalegal

process,butitisquitepowerfulifthecommitteerecommends,forexample,strongeroversightover

mentalhealthservices,orgreaterresources.

AboutathirdofthereportfocusedontheNationalHealthInsurance(NHI)proposal.Areasofconcern

includetheabsenceofanyreferencetopreventativehealth;capacityandresourceconstraints,and

governance.

TheNHI’sideaofseparatingtheproviderfromthepurchaserisaUK-basedinnovation,Londonsaid,

butintheUKtherearehighly-skilledpeople,whoarenotdirectlyinvolvedinclinicalcare,makingthe

systemwork.Hesaiditrequiresoverheadstomakeitwork,anditalsorequireslevelsofskillwhich

wearenotseeinginthepublicsectoratthemoment.

Londonsaidthereisarealdangerthatatlocallevel,peoplewhoarechargedwithpurchasing

servicesfortheirdistrict,willnotbeabletoactuallygetthatdone,norbeabletotranslatepopulation

needintothekindsofservicesthatarerequired.

Readmoreintheattachment:PHMSASubmission

NationalHealthInsurance:'goingnowhereslowly'

“FinanceMinisterTitoMboweni’smaiden

Medium-TermBudgetPolicyStatementlastweek

laidbarejusthowlittleprogressthegovernment

ismakingonNationalHealthInsurance(NHI).”-

EditorialComment:BusinessDay,30October2018.

“ThefactthattheTreasuryshavedmorethanhalf

abillionrandofftheR2.3-bnNHIgrantit

allocatedtotheDepartmentofHealth(DoH)in

theFebruarybudgetsignalshowlittlefaithithas

inthedepartment’scapacitytospendthemoney.

"Withgoodreason.Thedepartmenthasbeengoingnowhereslowlyforyears:itishalfwaythroughtheANC’sself-imposeddeadlineofimplementinguniversalhealthcareby2025

andhaspreciouslittletoshowforit.

"TheTreasuryhasdugintotheNHIindirectgrant

towardsmeetingPresidentCyrilRamaphosa’s

commitmenttofill2200

criticalpostsandbuyextrabedsandlinen,

becausesixmonthsintothefiscalyearthe

departmenthasspentjust10.4%oftheallocated

funds.

“Worsestill,notacenthadbeenspentonpriority

healthprogrammes,suchasthoseformental

andschoolhealth.

“Tohiscredit,Ramaphosahasrecognizedthe

crisis.HehasconvenedsummitsonNHIand

healthcareandappointedformerhealthdirector-

generalOliveShisanaashisspecialadviser.

"Buthenowneedstoact.Hecoulddofarworse

thanditchtherhetoriconNHIandfixwhatSA

alreadyhas:anenormouspublichealthsystem

ofdubiousqualityandapoorlyregulatedprivate

healthcaresystem.Ifbothpartsworkedasthey

should,withpropergovernmentstewardshipand

oversight,SAwouldindeedbewellonthewayto

universalhealthcare.”

Readmoreintheattachment:NHIlimpsalongtooslowly

ViewonGovernment

RegulatorprobesGEMSandDiscovery

TheCouncilforMedicalSchemes(CMS)isprobingSA’stwo

biggestmedicalschemes-DiscoveryHealthMedicalScheme

andtheGovernmentEmployees’MedicalScheme(GEMS)-

followingallegationsthattheyarenotpayingtheirmembers’

claimsinfullforprescribedminimumbenefits(PMBs).

TheinspectionofDHMSanditsadministrator,DiscoveryHealth,

followsallegationsthatmembers’claimswerenotbeingpaidin

full.

Thecouncilhasalsoreceivedacomplaintfromapharmacy

allegingitwasforcedtosignanacknowledgementofdebtin

ordertohaveitsclaimspaid.

DHMSisSA’sbiggestopenmedicalschemewith2.75-m

beneficiariesin2017,accordingtothecouncil’s2017-2018

annualreport.

GEM’sadministrator,MetropolitanHealth,isalsounderthe

spotlight,duetoasharpincreaseinconsumers’complaintsin

2017andallegationsthatitwasnotpayingPMBclaimsinfull.

Governmenthasrecentlyproposedthatalltheschemesthat

currentlycaterforstateemployeesbemergedwithGEMSasit

implementstheNHI.

Investigationswerealsounderwayintotwosmalleropenschemes,ResolutionHealthandBonitasMedicalFund.

SARSonmedicalclaims

TheSouthAfricanRevenue

Service(SARS)saystherehas

beennopolicychangewith

regardstotherisktreatmentof

medicalexpenseclaims.Some

taxpractitionershaverecently

beencaughtoff-guardafter

medicalexpenseclaimsthat

werenotpaidbyataxpayer’s

medicalschemewere

disallowed.

Inthepast,SARSgenerally

allowedamedicaltaxcreditfor

legitimateout-of-pocket

expensesonsubmissionofthe

taxcertificate,butthisyear

sometaxpractitionershave

advisedthatthecreditwasonly

allowediftaxpayersalso

submittedtherelevantinvoices

andreceiptsrelatedtothe

amountreflectedontheir

medicaltaxcertificate.

Thisisofparticularconcernfor

somepensionersandtaxpayers

withdisabilities.

FinancialView

SA'sthreelargesthospitalgroupsbattleabroadStringentregulations,hubrisandanunderestimationofadifficultmarket,alongwithalanguage

barrierinonecase,havecombinedtomakeatoughyearforSA’sthreelargesthospitalgroups’

adventuresoutsidetheirhomemarketandinthedevelopedclimesofplacessuchasSwitzerland,

wrotePenelopeMashegoinBusinessTimes,28October2018.mitsLondonbasewasperhapsthebiggestexampleoffailure.TheresultsfromhospitalgroupsMediclinic,NetcareandLifeHealthcare

showthattheyarefacingsimilarpressuresintryingtoestablishthemselvesoutsideSA.

Thegroups“clearlyunderestimated”thepressuretheyfacedinthedevelopedmarketsthey

investedin,saidthedeputyCEOofinvestmentcompanySentioCapitalManagement,

RayhaanJoosub.

NesanNair,aseniorportfoliomanageratSasfin,saidthatinadditiontoregulatoryfactors,the

proliferationofdayclinicsmeantthatpatientswerespendinglesstimeinhospitalsand

procedureswerebecomingcheaper,thushurtingrevenuegrowthforthehospitalgroups.

Dis-Chemwantstoopenmorenewstores

PharmacychainDis-Chemplanstomaintainits

expansionpaceofmorethanonestoreamonth.

Duringthefirsthalfofits2019financialyear,the

chaingrewbysevenstores,whichaddedR155-

mtorevenue,helpingitsoverallinterimrevenue

grow9.4%toR10.5-bn.Dis-Chemended

Augustwith136stores;18morethanattheend

ofthefirsthalfofits2018financialyear.

Aspen'sR3.4-bnoutlaytopsSA’spharmaceuticals

AspenPharmacarewillmakeSA’s“single

biggestpharmaceuticalinvestment”whenit

poursanotherR3.4-bnintoitsfactoryinPort

Elizabeth.

Thefundswillbefortheproductionofsterile

anaesthetics-“aniche,high-techmanufacturing

capabilitythatpresentsbothdomesticandexport

opportunities”,saidAspenseniorexecutive,

StavrosNicolaou,atSA’sinauguralinvestment

conference.

PharmaceuticalView

Pharmacistslividat'irregular'election

Drugfirmsmustfight'superbugs'

Agroupofpharmacistsareclaimingthe

electionsoftheirregulatorycouncilwere

irregular.TheIndependentElectoral

Commission(IEC)approvedtheelectionsbut

disgruntledpharmacistssentalettertoHealth

MinisterAaronMotsoaleditocomplain.The

groupaskedtheMinistertoensuretheoutgoing

pharmacycouncildoesnotaccepttheelection

results.TheninewinnersnominatedtotheSA

PharmacyCouncilarewhite,but46ofthe72

nomineeswereIndian,black,orcoloured.Those

questioningtheelectionresultssaytheraceof

thewinnersisfurtherevidenceofanirregular

election.

Eachyearabout700000peoplearoundthe

worlddiefromdrug-resistantstrainsofcommon

diseases.

Thisfigurecouldriseto10-mby2050ifthe

problemisnottackledhead-on,accordingtoa

reviewbyGoldmanSachschiefeconomistJim

O’Neill.

One-thirdofthosefuturedeathswouldbeduetotuberculosis(TB).

ThereislimiteddataonSA,butthestudies

conductedtodatehavefoundveryhighratesof

antibioticresistance.

SpecialNews

PresidentialHealthCompacttocommitallstakeholdersDescribedasapointofnoreturnforthecountry’shealthsystem,thetwo-dayPresidentialHealth

Summithasresolvedtocomeupwithasocialcompactthatwillcommitallstakeholdersinboththe

privateandpublicsectortosolvingthecountry’sdirehealthcrisisandimplementthesolutions

reachedatthehistoriceventasamatterofurgency.

Bringingtogethermorethan500representativesfromacrosstheboardofhealthcaredelivery,the

summitofferedforthefirsttimeaplatformforallstakeholderstodiscussopenlyandwithoutfearthe

problemsexperiencedinboththeprivateandpublicsector,andoffersolutionsinabidtobuildone

unifiedhealthsystemasthecountrymovestowardstheimplementationofuniversalhealthcoverage

throughtheimplementationofNHI.

Button

ViewonMedicalSchemes

Low-costmedicalplansnowlostinlegallimbo

"Discovery'sPrimaryCareplansandAgility

InsuranceAdministratorsareillegallydoingthe

businessofamedicalscheme"reportedSunday

Times,28October.

Discovery'splancovers30,000employeeswho

previouslydidnothavehealthcarecover.

Benefitsdiffergreatlybutsuchproductsstart

fromaboutR160amonth,withmanyaround

R400toR500amonth.

Primaryhealthcareplansnowneedtoregister

asschemeswithanexemptionfromproviding

theexpensiveprescribedminimumbenefits

(PMBs).Demarcationregulationsunderthe

insuranceactscameintoeffectinAprillastyear,

buttheCMSagreedthatinsurers'primaryplans

couldapplyforexemptionfromtheMedical

SchemesActwhileitdevelopedastandardised,

low-costmedicalschemeoptionfocusedon

primaryhealthcare.

Buttheactingregistrarformedicalschemes,Dr

SiphoKabane,toldarecentpressbriefingonthe

council'sannualreportthatthelow-costmedical

schemeoptionwouldnotbereadyfor

implementationbyMarchnextyear,asexpected.

Onlyadraftfordiscussionwouldbereadyby

thatdate.

Readmoreintheattachment:Medicalplansinlimbo

MedicalschemespaidoutR160,6-bnduring2017

AccordingtothelatestCMSreport,medical

schemeswereinarelativelystrongpositionat

theendof2017,withtheirclaimsratiodownto

88.7%from92.1%in2016.

OverallmedicalschemesspentR160.6-bnon

healthcarebenefitsin2017,up6.04%fromthe

R151.2-bnspentin2016.Hospitalexpenditure

amountedtoR59-bnor36.8%.Specialistssuch

asanaesthetists,medicalspecialists,pathology

services,radiologyandsurgicalspecialistswere

paid23.9%oftotalhealthcarebenefits

amountingtoR38.5-bn.

Membersofmedicalschemespaidanextra

R31.8-bninout-of-pocketexpensesforprivate

healthservices;up7%fromthepreviousyear.

Brokercostsincreasedby9.6%toR2.2-bnin

2017.

SpecctramedandResolutionHealthmergeSpectraMedicalSchemeandResolutionHealth

MedicalSchemehavemergedtoformHealth

SquaredMedicalScheme,asfrom1January

2019.

HealthSquaredwillbeadministeredbyAgility

Health,whichiscurrentlythemanagedcare

providerandadministratorforbothSpectramed

andResolutionHealth.

SpecialNotices

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withomnifusestandard0159-0001

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