corona will change sa's economy foreverdocs.mymembership.co.za/docmanager/419ae5a4-f8c7... ·...
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PrivatePracticeReviewJanuary-June2020 Viewinwebbrowser
NOTICEPrivatePracticeReviewpresentsthereaderwithasummaryofthemostrelevantbreakingnewsinthelocaland
globalhealthcareindustry,asobtainedfrommediasources,includingthepublicbroadcaster,independenttelevisionbroadcasters,independentnewsagencies,newspapers,radioandnewssites.HealthManstrivestoquotethe
OriginalSource.HealthMancompilesthisinformationtoprovidethereaderwithabriefoverviewofthemostrecenteventsanddevelopmentsastheyarereportedinthemedia.TheviewsandopinionsexpressedinPrivatePractice
ReviewarethoseoftheauthorsofthemediasourcesanddonotnecessarilyreflecttheviewsoropinionsofHealthMan,itsdirectors,employeesandassociates.
InthisNewsletterAsummaryofnewshighlightsinthehealthcaresector:
January-June2020
FoodforThoughtNewsonGovernmentSpecialNews
NewsonMedicalSchemesCMSCircularsSpecialNotes
IntheJuneissueofSAPPF'sHealthView:AsummaryofFoodforThought,FinancialView,PharmaceuticalViewandGeneralHighlights:1January-30June
FOODFORTHOUGHT
CoronawillchangeSA'seconomyforever
“Whetherthepandemic,andthemassivejoblosseswillhelpfocusthemindsofcivilservantsamidgovernment’scrucialbidtoreduceitswagebill,remainstobeseen,”
wroteHelenaWasserman,News24(3April2020).
Abouthealthcare,Wassermanwrote:"LoftyplansforanewSouthAfricannationalhealthsystemwillprobablyfallvictimtonew
post-virusrealities.Therewon’tbeanymoneyleftforit.Butinitsplacecouldcomemuchtighterpublic-privatecooperationasgovernmentandcompaniesseemtowork
closelytogetherinthefightagainstthepandemic."
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NowistherighttimeforSAtoembracetelemedicine
“TheCOVID-19coronavirusoutbreakhasnecessitateda‘businessunusual’approachforhealthprofessionals,asmanyarenowdoingconsultationswithpatientsonlineorbytelephone,”wroteVuyoMkizeinCityPress(19April2020).Doctorsareturningtotelemedicine-alsoknownastelehealth-tohelplimitthefoottrafficintoconsultingrooms.
“Whilethegeneralresponsetotheguidelinesamendmentallowingfortelemedicinehasbeenpositiveamonglocalpractitioners,thecouncilisstillconductinganenvironmentalscantofindlastingsolutionsforSA,whichhasawidehealthcaredeliveryresourcegap,”saidPriscillaSekhonyanaHPCSAspokesperson.
Scrappingprivatehealthcoverisaviolationofrights
“Inthenext12months,hundredsofthousandsofSouthAfricansaretobestrippedoftheirprivateinsurancecover.NoprivateprimaryhealthinsuranceproductswillbeallowedbeyondMarch2021,”wroteJassonUrbach:directoroftheFreeMarketFoundation-BusinessDay,16Apr2020.
“Thisshockingmanifestationofgovernmentmeddlinghasforcedshort-terminsurerstocanceltheirclients’valuableaccidentandhealthpolicies,adverselyaffectingthelivesofthousandsofindividualswhoareinpossessionoflifeandillnesspolicies.Poorandmiddle-incomeSouthAfricanscannotaffordthisformofsocialengineering,wheretheyareforcedtosuffertheconsequencesofill-informedgovernmentdecisions."(UrbachhassubsequentlyresignedasdirectoroftheFreeMarketFoundationandhas
immigratedtotheUK(4June2020).HealthManwisheshimwell.)
Otherdiseasescannotbeputonhold"Hasthepandemictakenoverpatientpriorities,asthegreaterbattleistofightitatthispointandfortheforeseeablefuture?"askedThoneshanNaidoo,CEOofMedshieldinBusinessDay(3June2020).“Doctorsmightstartcounsellingagainsttreatmentsthey
wouldnormallyrecommend,andnodoubtseesomepatientsdiesooner;notbecauseofCOVID-19,butbecausetheyarenotabletotreattheirpatientsastheynormallywould.
"Whataboutpatientsneedingsurgery?Howmanybedswillbeavailableforsurgeryandintensivecarerecoveryduringthiscrisis?”
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SPECIALNEWS
RopingintheprivatesectortoassistincaringforCOVID-19patients:
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FollowingconfusionamongprivatehealthcareprofessionalsontheirroleinassistingtheDepartmentofHealth(DoH)incaringforCOVID-19patientsinprivatefacilities,
MedBriefAfricaco-editor,MarietjievandenBerg,askedtheDoH’sDrNicholasCrisptoaddresssomeoftheissues.Sheasledquestionsregarding:theDoH’splanstoutilisetheprivatehealthcaresector;scopeofpracticeissues;remunerationfordoctorstreating
statepatientsinprivateinstitutions;utilisationofretiredhealthcareprofessionals;assistancewiththeprovisionofPPEsforprivateinstitutions;andlimitationsonelective
surgery.
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NEWSONGOVERNMENT
Ramaphosabecomesa‘wartimepresident’“OnMondaynight(23March)PresidentCyrilRamaphosabecameawartimepresident.
AndheshowedSouthAfricansthattheonlywayhomeistounitearoundasinglepurpose,andthatistodefeattheCOVID-19disease,”
wrotePieterduToitinFin24(24March2020).“Ramaphosa'saddresswillrankasoneofthemostconsequentialbyanydemocratic
headofstate,andoneofthemosthistoricofanySouthAfricangovernmentleader.Itsetthetoneforanationaleffortwhicheverycitizenwillfeelcompelledtoheed."
Alothassincechanged...
COVID-19willpermanentlychangeSA’shealthcarelandscape
“TheCOVID-19outbreakhasalreadydonemoreintwoweekstoacquirepublicsectorpatientaccesstoprivate
facilitiesthan10yearsofNationalHealthInsurance(NHI)planningandpilotprojectshavedone,”wroteDrJohann
SerfonteininMedBriefAfrica(1April2020).Thisisaclearindicatorthatpoliticalwillwasthelacking
elementinmakingprogresswithNHI.
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"BetweentherecentcreditdowngradebyMoody’sandtheeconomicdecimationfollowinginthepathoftheworldwideCOVID-19epidemic,anyNHIplanshavenowprettymuchbeenscupperedforthenextdecade.TheSouthAfricangovernment’slendingcostsandinterestpaymentswillincreasebyasmuchas50%duetothedowngrade,leavingafiscalholethatleavesnohopeforataxfundedNHI,"wroteSerfontein.
“Iamsuretheprivatesystemwillpitchinwhereitcantotryandstemtheflood-tide.ThatiswhenourrealbattleagainstCOVID-19willbegin-thecommunalbattleforsurvivalofthemostvulnerableinoursociety.Foronce,IhopeIamwrongaboutthesituationandthatgovernmentwillmiraculouslymanagetoavertthisimpendingcatastrophe.”
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Covid-19responseispreparingcountryforNHI,saysPresCyril
Ramaphosa
“Thegovernment’sresponsetotheCOVID-19pandemicisabuildingblocktowardsSA’shealthcarefutureundertheNationalHealthInsuranceprogramme,”accordingtoPresCyrilRamaphosa.-News24(1June2020).
Thegovernment’srelianceonaprivate-publicpartnershiptodealwiththecoronavirusoutbreakadequatelypreparedthegroundfortheNHI,saidRamaphosaduringavirtualforummeeting,organisedbytheSANationalEditors’Forum(SANEF).
"HecalledtheNHIthesilverliningtothisunprecedentedhealthcarecrisis."
WhileRamaphosaremainsoptimisticabouttheNHI,tensionsbetweengovernmentandtheprivatesectoroverCOVID-19havebeensimmering.Privatehealthcareprovidershaverecentlyrefusedgovernment’sofferofaflatrateofR2493perdiemfortheirCOVID-19services(excludingextracostslikeintubation,iftheytreat“stateresponsibility”patientsinprivatefacilities).SomedoctorsareconcernedthattheagreementswillbeusedwhentheNHIbecomesareality.
SAinaNationalStateofDisaster
OnMarch15,PresCyrilRamaphosadeclaredaNationalDtateofDisasterandannouncedmeasurestocontainthespreadofCOVID-19,includingtravelrestrictionsonforeignersfromhard-hitcountries,abanonmassgatheringsofmorethan100people,andtheclosureofschools.OnMarch23,athree-weeknationalshutdownwasannouncedaspartofinterventionstocombatthespreadofCOVID-19.SouthAfricanswerenotallowedtoleavetheirhomes,unlessforessentialpurposesOnApril21,anextraheannouncedthatanextraR20-bnwillbeinjectedintothenationalhealthbudgettoshoreupitseffortstoslowtransmissionofCOVID-19andrampupitscapacitytocareforthesick.
OnApril23,asmartlockdownalertsystem(fromMay1)todeterminemovementrestrictions,basedonhowthevirusisspreading.ThecountrywasplacedunderLevel5,requiringanationwidelockdown.OnMay1,thecountrymovedtoLevel4,whereessentialservices,includingsomebusinesses,wereallowedtoresumeoperationsunderverystrictconditions.OnJune1,SAmovedtoLevel3withthegovernmentintroducingahostofnewregulations.Itimpliedtherelaxationofthecurrentlockdownrules,withmorethan8-mpeoplebacktowork.Meanwhile,governmenthasextendedtheNationalStateofDisasterwithanothermonthuntilJuly15.
'Just207criticalcarebedsand350ventilatorsaddedtopublichospitalsduringlockdown'
“SAhealthauthoritieshaveaddedanywherebetweenzeroand207newcriticalcarebedstoexistingpublichealthcarecapacityduringthenationallockdown,butthetruenumberremainsunclear,”reportedNews24(7June2020).
"Thedepartmentsaidthisweekthat2309criticalcarebedsallocatedtoCOVID-19patientsnationally,andmorethan13000fieldhospitalbedswereaddedtothetotalcapacityduringthelockdown.
AsofJune1,193Covid-19patientswereinICU,92wereonventilators,92wereincriticalcareand1531wereadmittedtogeneralwards,healthdepartmentspokespersonPopoMajatoldNews24.AsofJune3,therewere2719highcareandICU(criticalcare)bedsinthepublicsectornationally,and7676overall,ofwhich4957bedsareintheprivatesector.AccordingtoapresentationtoParliamentbythenactingdirector-generalatthedepartment,DrAnbanPillay,onApril10,therewere2512criticalcarebedsavailableinthepublicsector."Inotherwords,aftersubtractingthenumberofcriticalcarebedsavailablenearlytwomonthsagofromthenumberavailablenow,only207bedshavebeenadded."
HighCourtsdeclarelockdownrulesinvalidandunconstitutional
SouthAfrica’scourtshavedealtadouble-blowtothecountry’slockdownrulesthisweek,-reportedBusinessTech(3June2020).
OnJune1,theGautengHighCourtruledinfavourofbusinessgroupSakeligaafteritchallengedtheregulationsrequiringessentialservicestoregisterwiththeCommissionforIntellectualPropertyandCompanies(CIPC).OnJune2,thealertlevel3andalertlevel4lockdownregulationsweredeclaredinvalidandunconstitutionalbytheGautengHighCourt.TheCourtsuspendedthedeclarationofinvalidityoftheregulationsfor14days,meaningthatthelevel3regulationsremainineffectfornow.OnJune3,theHighCourtinPretoriaorderedthatanypersonwhohastestedpositiveforCOVID-19cannotbeforcedtoquarantine,be,orisolatedatastatefacilityifthatpersonisabletosuccessfullyself-quarantine.
Statelab'stestingbacklogcontinues
InApriltheNationalHealthLaboratoryService(NHLS)announcedthatitwillbeabletoprocess36000samplesadaybytheendofthemonth.Atthatstageitcouldonlydo5000testsaday.
BySunday(19April),114711testshadbeencompleted.Thisnumberincreasedto121510byMonday,ofwhich40698wereinthepublicsectorand80812wereintheprivatesector.
Accordingtohealtheconomist,ProfAlexvandenHeever,testingisthecheaperrouteforSA-provideditisdoneatasufficientscaletocontaintheepidemic.–BusinessDay(20April2020).ThecountrycouldlosearoundR13-bnperdayoflockdown,saidVandenHeever.
OnMay27,HealthministerDrZweliMkhizeadmittedthatSAwassufferingfromabacklogoftests.AsofMay27,634996testshadbeenconducted.Butofthose,“atotalof29948testsreflectsabacklogofunallocatedtests”.Thestatementclaimedthisiscausedbythelimitedavailabilityoftestkitsglobally(thatis,inadequatesupplyofextractionkitsandhighthroughputsofPCRkits).COVID-19resultsfromtheNHLSaretakingatleastaweektoreachpatients,whileprivatesectorteststakesabout72hours,reportedGroundup.
HealthcareworkersatriskwithoutPPEs
OnMarch29,SundayTimesreportedthathealthcareworkersareatriskofbeinginfectedbyCOVID-19withoutadequatepersonalprotectiveequipment(PPE).AccordingtoNatalieZimmelman,chiefexecutiveoftheSASocietyofAnaesthesiologists(SASA),oneinsixofthe500000COVID-19patientsgloballywasahealthcareworkerinfectedatwork.HealthMinisterZweliMkhizeassuredhealthcareprofessionalsthattheywouldhaveallthePPEstheyneedtoprotectthemselvesagainstCOVID-19.ThisfollowedtheNationalEducation,HealthandAlliedWorkers’Union(NEHAWU)decisiontoasktheLabourCourttoordertheHealthDepartmentto“meaningfullyengage”withitsmemberstoensuretheyhavetherightequipment.
OnApril7,thefirstconsignmentofprotectiveequipmentfromChinawasreceived.TheR69-morderwasfundedbytheSolidarityFund,billionairePatriceMotsepe’sphilanthropicorganisation,FirstRandandNaspers.AtotalofR750-mhasbeenmadeavailable.
OnJune1,BasicEducationMinisterAngieMotshekgarevealedthatafightabouttenderstoprovideschoolswithPPEshascauseddelays,preventingschoolsfromopeningafterathreemonthlockdown.
Alsoreadthefollowinghighlightsbyclickingonthebuttonbelow:
‘NHIunlikelytobeimplementedby2026’
Privatesectorcomplainsaboutfrostytreatment
StatelaboratoryfleecedofR93-m
Cubanhealthworkersregisterin3days
NegligenceclaimsagainstthestatesoartoR104-bn
Expertsrebelover'nonsensical'lockdown
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COVID-19:Thebigwaveiscoming“ItisonlyamatteroftimebeforetherestofSouthAfricareachesthesurgeinCOVID-19
coronaviruscasescurrentlybeingexperiencedintheWesternCape,expertswarn,”reportedCityPress(7June2020).
NEWSONMEDICALSCHEMES
CMSchangestackoncheaperoptions
InDecember2019theCMS,issuedCirculars80and82,prohibitingSAmedicalaidsfromofferingLow-CostBenefitOptions(LCBOs)tolow-incomemarketsegments,sayingitwouldunderminetheNHIscheme.Accordingtothecirculars,productsconsistingmainlyofprimaryhealthcareplansforbasicday-to-daycareweresettobecomeunlawfulbyMarch2021.(TheNHIisonlyduetobegindeliveringservicesin2026.)
InFebruary2020theCMSissuedacircular,invitingnominationsfortwo“stakeholder-based”advisorycommitteestodevelopaLCBOframeworkbyMarch2021.ThenominationdeadlinewasFebruary28.
RichardBlackman,chiefexecutiveofficerofDay1Health,aninsurerthatofferstheseproducts,saiditappearsthattheCMShadmadetheannouncementprematurely,beforeconsultingroleplayersintheindustry.IftheCMSdidnotwithdrawitscircular,itcouldexpectafloodofappealsintermsoftheMSA,hesaid.
AccordingtoMikeSettas(FreeMarketFoundation)theregistrarwasnowrequestingdiscussionswithroleplayerstofindapermanentsolutionforlow-incomeproducts.Butthisprocesscouldtakeyears,andtheinterimexemptionframeworkwillexpireattheendofMarch.
Doctorsgrumbleoverlowervirtualrates
InApriltheSAMedicalAssociation(SAMA)objectedstronglytothedecisionbyDiscoveryHealthandMedschemetopaylessfortelemedicineconsultations-coveredbytheirclientschemes-thantheydoforface-to-faceinteraction.
SAMAchair,AngeliqueCoetzee,saidmedicalschemeshavenotprovidedarationaleforthelowerrate,orindicatedawillingnesstonegotiate.
DiscoveryHealth,with19clientschemesincludingDiscoveryHealthMedicalScheme(DHMS),setvirtualconsultationratesat65%ofthoseusuallyprovidedforface-to-faceconsultations.CEO,RyanNoachsaidthelowerrateappliestoalldisciplines,includinggeneralpractitioners(GPs)andspecialists,sincevirtualconsultationsareshorter,havelowerinputcosts,anddonotrequireconsumablessuchastonguedepressors,swabs,andgloves.Discoveryisreviewingtheratesformentalhealthpractitionersandconsideringadjustingtothefullrate,asvirtualconsultationsareofasimilardurationtothosetheydofacetoface.TheratefordoctorsconsultingonDiscovery’sDrConnect(onlineplatform)hasbeenincreasedto75%ofthein-roomconsultationrates.
Medschemeisalsopayinglessforvirtualconsultations.
SavingswillnotbeenoughtocoverCOVID-19costs
SavingsfromamassivedropinhospitalclaimsduringthenationallockdownwillnotbeenoughtooffsetasurgeincostsastheCOVID-19epidemic
deepens,accordingtoDiscoveryHealth.
InAprilhospitaladmissionsdroppedby50%comparedwithlastyearandweredownby40%yearonyearsincethecountrymovedtoLevel4LockdowninMay.
"TheCOVID-19pandemiccouldcostmedicalaidschemesbillionsatatimewhentheirincomeisexpectedtodeclineasanincreasingnumberoffinanciallydistressedmembersdowngradetheirmedicalaidplansorareunabletopayforthematall,”reportedSundayTimes(31May2020).Medicalschemesarerequiredbylawtokeep25%oftheirannualcontributionincomeinreservetobufferthemagainsthealthcrisessuchasCOVID-19,butnotallschemesmeetthissolvencythreshold.
AccordingtoDHMS,additionalclaimsofbetweenR7-bnandR31-bncanbeexpectedfrommedicalschemes.However,DHMSandFedhealthhaveseenamarkedreductionintypicalin-hospitalclaimsandmentalhealthclaims.Ontheotherhand,anincreaseinchronicmedicationcomplianceandtheutilisationoffluvaccines,havebeenexperienced.
A'SurgicalRecoveryPlan'willbeneededtocatchupwiththousandsofcancelledoperations,reportedDailyMaverick(31May2020)
Schemesmaybeallowedtobendrules
InApriltheCMSissuedacircularallowingmedicalschemestoapplyforexemptionstotheMedicalSchemesActtolaunchlifelinessuchascontributionholidays,oraccesstheirmedicalsavingsaccountstocoverpremiums.TheR160-bnmedicalschememarketcoversabout8.9-mmembers.
Paymentreliefoptionswillbeconsideredonacase-by-casebasis.Optionstosupportmembersincludelowermonthlycontributionsbydowngradingtheircurrentplan;freezingofcontributions;paymentholidaysforaperiod;orusingotherfundingmechanismstoassistincontributionrelief.
DoHoutlinescoverforCOVID-19
OnFriday,May8,theDepartmentofHealth(DoH)publishedchangestotheMedicalSchemesActwhichoutlinescoverforCOVID-19inSA.ItdetailsthediagnosisandtreatmentofCOVID-19asaPrescribedMinimumBenefit(PMB)bymedicalaids.
Thefollowingtreatmentswillbecovered:
Screening;Clinicallyappropriatediagnostictests;Medication;Medicalmanagement,hospitalisationandtreatmentofcomplications;andRehabilitationofCovid-19.
Alsoreadthefollowinghighlightsbyclickingonthebuttonbelow:
ParentsworryaboutmedicalcoverfornewbornsinICU
Schemesfightforlow-costbenefits
Medicalaidsgrilledoverracialprofiling
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CircularsfromtheCMS
ThefollowingCircularswerepublishedbytheCMSbetween
AprilandJune2020.
28of2020ClaimsinformationforbeneficiariestreatedforCOVID-19
29of2020ConfirmationofpurchaseoftheRAGilbertPharmaciesbyPlatinumHealth
30of2020PurchaseofRAGilbertPharmacies
31of2020SAICAAccountingGuide
32of2020SignaturesrequiredrelatingtotheAnnualStatutoryreturnelectronicsubmissionfor31December2019
33of2020Understandingmedicalschemereserves
34of2020UpdateddeadlinesforthesubmissionoftheHealthcareUtilisationAnnualStatutoryReturnfor31Dec.2019
35of2020MedicalSchemesActRegulations:Amendment
36of2020Virtualannualgeneralmeetings
37of2020EndofSAMWUMEDMedicalSchemesCuratorship
38of2020Self-administeredschemes-implementationofCircular77of2019
39of2020PaymentofCommissiontoBrokersandBrokerages
40of2020ProposedamalgamationbetweenSizweMedicalFundandHosmedMedicalAidSchemeeffective1August2020
SPECIALNOTES
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