HEALTHMANPRIVATEPRACTICEREVIEW:August2018
August2018Asummaryofbreakingnewsandgeneralinformationregarding
healthcareinthepublicandprivatesector,publishedinthemedia.
1.FoodforThought2.NewsonGovernment3.SpecialNews4.FinancialNews5.PharmaceuticalNews6.GeneralNews7.NewsonMedicalSchemes&Circulars8.SpecialNotices
FoodforThought
RockystartforNationalHealthInsuranceTenderProgrammeThefirsttendersfortheNationalHealthInsuranceScheme(NHI)havebeenissued,butonlythreemedicalschemeadministratorspitchedforthecompulsoryinformationsession.AccordingtotheSundaynewspaperRapport,expertsarecriticalofthetenderspecificationsforfivepriorityprogrammesannouncedbyHealthMinisterAaronMotsoalediwhenhepublishedtheNHIBillforpubliccomment.
Inonetender,thegovernmentwantsaprivatecompanytocontractoncologyradiationservicesformorethan9,000prioritybacklogpatientsatfourstatehospitalsinKZNandGauteng.Inanother,thesuccessfulcompanywilltakeoverthegovernment’sschoolhealthprogrammeforwhichthegovernmenthasidentifiedchildreninneedofmedicalservicessuchasoptometryanddentistry.HealtheconomistAlexvandenHeeversaystheaimof theNHIistodotheprocurement,butthegovernmentisnowcontractingprocuremententitiestosub-contractservices.“Whycan’tthegovernmentsimplyimplementand
managetheprogrammes?WhydowethenhavetocreateaNHI?”
ReadtheSummariesofNationalHealthInsuranceBill,MedicalSchemeAmendmentBill,HealthMarketInquiryfindingsand
recommendationsintheattacheddocument.
Internationalexpertshighlight‘significantweakness’inSATobaccoBillInalast-minutesubmissionontheSATobaccoBill,internationalacademicsarguethattheBilldoesnotsufficientlydifferentiatebetweennicotineproductsofwidelydifferingrisktohealth.A'signif icantweakness'isthatit
alsodoesnotembracethedef initionof ‘tobaccocontrol’usedbytheWorldHealthOrganization(WHO),including‘harmreduction’.
Thesubmission,titledCommentsontheDraftControlofTobaccoandElectronicDeliverySystemsBill2018,isbyProfessorsDavidBAbramsandRaymondSNiaura(NYUCollegeofGlobalPublicHealth,NewYorkUniversity);CliveDBates,directorofCounterfactual,aconsultingandadvocacypractice;
andDavidTSweanor,adjunctprofessoroflawandchairoftheadvisoryboardoftheCentreforHealthLaw,PolicyandEthicsattheUniversityofOttawa.
AgriSA,theFoodandAlliedWorkersUnionandtheSouthAfricanSpazaandTuckshopAssociationsaythenewtobaccobillwould‘devastateSA’sagricultureandtownshipbusinesses'.HealthMinisterAaronMotsoaledireleasedtheControlofTobaccoProductsandElectronicDeliverySystemsBillforpubliccommenton9May,2018.Thethree-monthperiodforsubmissionsclosedon9August.
NewsonGovernment
Morethan20000Gautengpatientsharmedatstatehospitalssince2016
GautengHealthMECGwenRamokgopahasconfirmedthatmorethan20000patientshavebeenharmedduetonegligenceinthespaceoftwo-and-a-halfyearsatstatehospitalsinGauteng.
Therehavebeen20417oftheseincidentsintheprovincefrom2016todate.ChrisHaniBaragwanathHospitalisthemostdangeroushospitalforpatientsinGauteng,with4320recordedincidents.
Casesweremostlyrelatedto'allegationsofnegligence,incompetenceofstaffmembers,humanerror,secondmentofpatientsandsystemfailure'.
Incidentsrecordedatotheracademichospitalsincluded:SteveBikoHospital(1789),GeorgeMukhariHospital(1574)andCharlotteMaxekeJohannesburgHospital(1262).
HeidelbergHospitalhadthelowestnumberofincidentsat42.
Ramokgopasaidthatactiontakenaftersuchincidentsinvolveddiscipliningstaff,referraltothepolice,andreferralstotheHealthProfessionsCouncilandtheSANursingCouncil.
Howmanydoctorsandnurseswilllosetheirlicensesover#LifeEsidimeni?
HalfofthetopofficialsresponsiblefortheLifeEsidimenitragedystillhavenotbeenreportedtotheirprofessionalassociations,accordingtoinformationfromtheSouthAfricanNursingCouncil(SANC).HealthombudMalegapuruMakgobaandformerdeputychiefjusticeDikgangMoseneke—whopresidedoverthearbitration—recommendedthatthetopnursesanddoctorsembroiledinthedeadlyscandalbebroughtbeforeeitherSANCortheHPCSA.TheGautengDoHonlyreportedBarneySelebano,theformerheadofthedepartmentandalsoamedicaldoctor,totheHPCSAinDecember2017—morethan10monthsafterMakgoba’sinitialrecommendation.Hehasyettositinfrontofapreliminarycommitteeofinquiry,whichinvestigatescasesofallegedmisconductandisstillabletopracticependingtheoutcomeofhiscase.
MeanwhiletheSouthAfricanSocietyofPsychiatrists(SASOP)hasundertakenacampaigntoencouragehealthprofessionalstoexposeabuse.SASOPhaspartneredwiththeruralhealthactionprojecttoassistinthetrainingofitsmembers,whoincludepsychiatrists,occupationaltherapists,nursesandpsychologists.
ClinicscloseandmedicinerunsoutintheNorthWest
MafikengProvincialHospitalisrunningonskeletonstaffandtwoclinicsintheNorthWestprovincehaveclosedtheirdoorsbecauseofalackofsecurity,reportedMail&Guardianon10August.Moreover,afailuretopayserviceprovidershasleftmanyotherhealthfacilitieswithoutsecurityandinshortsupplyofdrugs.Somehealthworkersarerefusingtoworkintheabsenceofsecurityguardsaftercontractedsecuritycompaniesrecentlywithdrewtheirservices.TheNorthWestDoHadmitsthatsuppliershavestoppedtoprovideitwithmedicineandequipmentuntiltheyhavebeenpaid.
PrivateBillforterminallyill
COPEMPDeidreCarterandDignitySAhavelaunchedacampaigntohelpdoctorsrealisethetreatmentdirectivesoftheirterminallyillpatientswithoutfearofprosecution.TheNationalHealthAmendmentBill2018willsetoutthescopeofadvancedhealthcaredirectives,provideamechanismforresolvingdisputesrelatedtotheselegalinstruments,andclarifywhethertheymaybeoverriddenbyamedicalpractitionerorfamilymember.Thebillalsoseekstoclarifywhetherpeopleactingonthesedirectivesareimmunefromcriminalandcivilprosecution.
YoungdoctorsgetnohelpTheJuniorDoctors’AssociationofSA’s(JUDASA)TelegramchatgroupforyoungdoctorshopingtoapplyforplacementnextyearhasbeenfloodedbyhealthcareprofessionalswhofeartheymaybeunemployedbyJanuary,sinceregistrationsclosedon7August.However,theDoHclaimedtheproblemhasbeenrectified.
Statelawyers'rob'SA
AccordingtoareportinSundayTimes(12August)governmenthasdiscoveredoneofthebiggestscamsinSAhistoryinvolvingmedicalmalpracticelawsuits.
Governmentisinvestigatingcollusionbetweenpeoplesuinggovernmenthospitalsformalpracticeandstateattorneyswhoeithersettlecasesthathavenomeritordefendthecasessobadlythattheyinvariablylose.
JusticeMinisterMichaelMasuthaandHealthMinisterAaronMotsoalediconfirmedthatthescamsaresoentrenchedthatthestatehaslostbetweenR60-bnandR100-bnsince2013infraudulentmalpracticeclaims.
"Kingpins'inthescamareunderstoodtohavebeenidentifiedbygovernment.Thereportalsosuggeststhatgovernmentpreviouslylackedthe'politicalwill'todealwiththeproblem.
FinancialNews
CiplaSouthAfricagrowsfootprint
CiplaMedproSouthAfrica,whollyownedsubsidiaryofCiplaLimitedIndia,hasannouncedplanstoacquirea100%stakeinMirren(Pty)Limited.
MirrenisaSAover-the-counter(OTC)pharmaceuticalmanufactureranddistributor,whichhasbeeninoperationfor35years.ThetransactionissubjecttotheapprovalbytheCompetitionCommissionofSouthAfrica.
Aspen’s‘strategyambiguity’inthespotlight
Inthepastfiveyears,AspenPharmacarehasbeenonanaggressivegrowthstrategy,whichhasputitontheglobalmapasaforcetobereckonedwith.However,RayhaanJoosub,deputyCEOofinvestmentcompanySentioCapitalManagement,wroteinBusinessTimes(12August)that,despiteitsexponentialgrowth,therewereafewredflagsaroundAspen.WithamarketcapitalisationofR131-bn,itoperatesinabout50countriesandsuppliesmorethan150countries.Itistheworld’sninth-largestproducerofgenerics.ThemainissueforJoosubwasthatAspenhasahighlevelofintangiblesonitsbalancesheet,anunclearacquisitionstrategyandalackoffocusonwhetheritsmainbusinessisstillgenericmedicationorwhetheritisshiftingintospecialistcategories.
SpecialNews
NHIshouldtakeheedofHMIrecommendations,saysSAPPF
WhileprivatedoctorsappeartobegenerallysupportiveoftheHealthMarketInquiry’srecommendations,concernsaremountingthatimplementationofthedraftNationalHealthInsurance(NHI)BillandtheMedicalSchemesAmendment(MSA)Billintheircurrentstatescouldbepotentiallydisastroustothecountry’swholehealthcaresystem.
SomeofthemainconcernspertaintotheperceptioncreatedinthetwoBillsthatNHIcouldbethepanaceaforfixingthebrokenpublicsector,thelackofclarityonthefundingandcostofanNHI,themassivereorganisationofexistingresourcesthatwillberequiredtofulfillthepromiseofaccesstoaffordablehealthcareservicesforallthroughthepoolingofstateandprivatemoneyintoasinglefund,contractingandpaymentarrangementswithprivateprovidersandmanymore.
SAPPFCEO,DrChrisArchersayswhiletheHMI’srecommendationsarebasedonadiagnosticapproachthatrequiredthecollectionandanalysisofrealdatatoreachconclusions,thisprocesswastotallylackinginthedraftingoftheNHIBill.
GovernmentshouldhavewaitedfortheHMIReportandconsideritsf indingsandrecommendationsinthedraf tingof boththeNHIandMSA
Bills,saysDrArcher.
Toreadmore,clickonthebuttonbelow
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PharmaceuticalNews
Racetofindmoneyforbreastcancerdrug
ProvincesarescramblingtofindresourcestofundRoche’sbreastcancerdrugTrastuzumabaftertheDoHapprovedapolicytoprovideitwithoutsecuringadditionalfunding.
ProvincesthatareprovidingTrastuzumabarehavingtoreprioritisetheirbudgets,ineffecttakingthemoneyfromotherprojects.
ThepolicywaslaunchedinAugust2017byHealthMinisterAaronMotsoalediandprovinceswereexpectedtostartprovidingTrastuzumabtostate-sectorpatientsinJanuary.However,theprogrammehasgotofftoaslowstart.
TrastuzumabhasbeenavailableintheprivatesectorunderthenameHerceptinsince2008,butwasonlyaddedtothestate’sessentialmedicineslistinJune2017because“itwassimplytooexpensive”.
EU’sdrugregulator’sstaffquitsaheadofBrexit
AthirdoftheemployeesattheEU’sdrugregulatorareexpectedtoquitastheregulatorleavesBritainbecauseofBrexit,promptingtheagencytotemporarilyscalebackoperationstofocusonessentialpublic-healthactivities.Employeeswhoaren’trelocatingtoAmsterdamwiththeEuropeanMedicinesAgency(EMA)havealreadystartedtoleave.
EuropeandrugswatchdogwarnsabouttaintedheartmedicationTheEuropeanMedicinesAgency(EMA)estimatestherecouldbeoneextracaseofcancerforevery5000patientstakingacommonbloodpressureandheartdrugmanufacturedinbulkbyaChinesecompanythathasbeenfoundtocontainanimpurity.ThealarmoverValsartanwasfirstraisedinJuly,promptingaglobalrecallofaffectedpills.TheagencybelievestheproblemprobablydatesbacktochangesinmanufacturingprocessesatZhejiangHuahaiPharmaceuticalin2012.
SA'sfirstbiosimilaroncologydrugauthorisedforuse
Cipla,incollaborationwithTevaPharmaceuticalIndustriesLtd,hasannouncedthelaunchofthecountry'sfirstbiosimilarfortheoncologyandhaematologymarkets.
FilgrastimTeva,manufacturedbyTevaanddistributedinSouthAfricabyCipla,pavesthewayformoreaffordabletreatmentstoaidinthefightagainstcancer,accordingtoPaulMiller,CEOofCiplaSA.
Abiosimilarishighlysimilartotheoriginalbiologicreferenceproductintermsofquality,safetyandefficacy.“Forevery1%dropinthepriceoftheselife-savingmedicines,thenumberofpatientsgainingaccesstothemincreaseby1%.
GeneralNews
HealthSciencedean’ssuicidespotlightsSAworkplacestressThesuicideofProfBonganiMayosi–acardiologist‚researcher‚anddeanofhealthsciencesattheUniversityofCapeTown(UCT)–hasbeenattributedtothepressurehehadtoendurefromabusiveprotestingstudentswhooccupiedhisofficefortwoweeksin2016.
ItagainspotlightedtheenormousstressunderwhichSouthAfricanmedicalacademicsandpractitionerswork,withtworecentstudiesshowinghighlevelsofburnout.
Mayosi’ssuicidehaspromptedtheSouthAfricanMedicalAssociation(SAMA)tosetupasupportstructuretoaddresstheunderlyingproblemsofaheavyworkloadandlonghoursthatleadtodoctorssufferingfromstressanddepression.
Britaintoopt-outorgandonationschemetosavelives
Britainplanstoincreasethenumberoforgandonorsbychangingtherulesofconsentandpresumingthatpeoplehaveagreedtotransplantsunlesstheyhavespecificallyoptedout.InWales,asystemofpresumedconsentisinoperationandScotlandhasasystemfordonationopt-out.Around6000peopleinBritainareonthetransplantwaitinglist.Morethan400diedwhilewaitingforatransplantlastyear.
NewsonMedicalAids
Medicalaidcustomersatisfactionslides
MedicalSchemeseemstobe‘aslushfund’forcurator
AccordingtothelatestindexbyConsulta,abusinessstrategyconsultingcompany,theaverageoftheSACustomerSatisfactionIndexformedicalschemesdroppedfrom74.2in2017to72.7in2018.
Bonitas’scoredeclinedfrom73.1to70.2andDiscoveryHealthalsoreportedadeclinefrom74.8to73.1overtheyear.Medihelpwastheonlyopenschemeinthisyear’sbenchmarktoseeanimprovedscore.
Overall,SouthAfricansareincreasinglyfrustratedbyrisingpremiumsandshrinkingbenefits,aswellasafeelingoflowervalueformoneyincomparisonwithotherfinancialserviceproducts.
The13dismissedtrusteesofamedicalaidschemeforunionisedmunicipalworkers,Samwumed,arecontestingthecuratorshiporderonthescheme,whilesomeofitsmembershavealsoraisedconcernsovertheprovisionalcurator’ssuspensionoffourofitssenioremployees.
ThisfollowsthecancellationofkeycontractsthatarebeinginvestigatedbytheCouncilforMedicalSchemes.
AllegationsarethatDuduzaKhosana,provisionalcuratorofCapeTown-headquarteredSamwumed,whichcoversmorethan80000lives,ispayingherselfR240000amonthandincurringexpensesofR200000amonth.
Circulars:CouncilforMedicalSchemesThefollowingCircularswerepublishedbytheCMSinAugust2018.
Visit www.medicalschemes.co.zaformoreinfo.
32of2018AnnualStatutoryReturnsdevelopmentforthe2018fiinancialyear
33of2018Guidanceonbenefitchangesandcontributionincreasesfor2019
34of2018ClarityregardingtheNetcare911ruling
35of2018PostponementoftheAdvancedBrokerTrainingProgrammeinPortElizabeth,to31August201836of2018Auditorapprovals
37of2018QuarterlyStatutoryReturnsSubmissionfor2018
SpecialNotices
PsychiatryPractice:LocumPositionAvailableALocumposit ionisavailableataPsychiatryPract iceintheStrand,near
CapeTown,fromOctober2018totheendofMarch2019.ContactPract iceAdministrat ionat:[email protected]
ToadvertiseinPrivatePracticeReviewcontactMarethaConradie:[email protected].
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