Special News Food for Thought View on Medical Schemes View … · 2019-04-25 · years ago in...
Transcript of Special News Food for Thought View on Medical Schemes View … · 2019-04-25 · years ago in...
SAPPFHEALTHVIEW:September2018
Content:FoodforThoughtViewonGovernmentFinancialViewViewonPharmaceuticals
SpecialNewsViewonMedicalSchemesGeneralNewsSpecialNotices
FoodforThought
'HealthcareBillwillcostSouthAfricaanarm,alegandsomedoctors'
“ExactlythreemonthsafterHealthMinisterAaronMotsoaledireleasedtheNationalHealthInsurance(NHI)Bill,anewreport,bytheInstituteforRaceRelations(IRR),arguesthatwhileNHIisaimedatensuringdecenthealthcareforall,itisunlikelytomakethisareality,”wroteSipokaziFokaziinTimesSelect,19September.
Inthereport-basedonmorethan100mediareportsinthepastyear,mainlyaboutnegligence,corruptionandmismanagement-authorsMariusRoodtandMailiesFlemingsaidsuchincidentsprovedhealthcarewasincrisis.WhiletheNHIWhitePaperestimatedthecostoftheschemeatR256-bn,theIRRreportedthisamountwasunconvincingandlikelytodouble.Moreover,themoreitcosts,themoretaxeswillhavetoberaised.
RoodtandFlemingsaidtheburdenwillbeparticularlyheavyonsome600000individualtaxpayers,whocurrentlypaymorethan60%of allpersonal
incometaxcollected.
ImplementationofNHIwasalsolikelytotriggeranexodusofhealthprofessionals,whichwillincreasethealreadyheavyburdenonthosewhoremaininthecountry.
PopoMaja,spokespersonfortheDepartmentofHealth,rubbishedthereport,sayingtheinstitutethatproduceditwas“anti-NHIandanti-poor”.
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ViewonGovernmentGEMS-logo.jpg
CMSwantssinglemedicalschemeforpublicservantsInarecentlyreleaseddiscussiondocumenttheCouncilforMedicalSchemes(CMS)proposestheconsolidationofallmedicalschemesforpublicservantsintotheGovernmentEmployees’MedicalScheme(GEMS)inlinewithgovernmentpolicyonNHI.
Theproposalislikelytorunintooppositionfromindustryplayersandpublicservantsalike.Unionisedworkersarelikelytoresistmovestheyseeasathreattotheircurrentbenefits.Statesectorschemesmakeupabout30.3%oftheindustryandincludePolmedforthepoliceandParmedforMPsandjudges.Thecouncilidentified10schemesthatcouldbeamalgamatedwithGEMS,includingthoseofstate-affiliatedentitiessuchastheSABCandRandWater.ItsaidthatconsolidatingpublicsectormedicalschemeswithGEMSofferedpotentialsavingsandalargerschemewouldhavemorenegotiatingpowerwithhealthcareproviders.
*ActingCouncilregistrarSiphoKabanesaidconsolidatingmedicalschemeswouldimprovetheirsustainabilityandwasanimportantsteptowardsrealisingthegovernment’suniversalhealthcaregoalofhavingasinglepayerforhealthservices.*Healthcarespecialist,Prof.AlexvandenHeever,pannedthecouncil’slatestproposals,sayingtheywereatoddswiththeHealthMarketInquiry’sinterimfindings,publishedinJuly.*ThePublicServantsAssociation(PSA)saidithad“seriousreservations”abouttheplan.ThePSA’s242000membersmakeupaboutafifthofthepublicservice.PSAspokespersonTahirMaepasaidthePSAhadreceivednumerouscomplaintsaboutGEMS.
HealthcaremarketreportdelayedTheCompetitionCommission’slong-runningHealthMarketInquiryannouncedyetanotherdelayinthereleaseofitsfinalreport,sayingitwantstogivestakeholdersmoretimetocommentonitsprovisionalfindingspublishedinJuly.
Thedeadlineforthepublicationofitslong-awaitedreporthasbeenpushedoutbytwomonths,toNovember30.
TheinquirybeganinJanuary2014andsetouttoinvestigatethebarrierstoeffectivecompetitionintheprivatehealthcaremarketandwhyannualhealthcareinflationconsistentlyoutstripsconsumerpriceinflationbyseveralpercentagepoints.
FinancialView
HealthyincreasedprofitsforJSE-listedAfroCentric
Afrocentric,theblack-ownedJSE-listedinvestmentholdingcompanyprovidingspecialisedservicestothepublicandprivatehealthcaresectors,reportedincreasedprofitbeforetaxof46.9%;R538.4-mupfromR366.7inthesameperiodlastyear.
Thegroupsawearningspershareincreaseby118%andheadlineearningspersharespikeby110.7%.Profitaftertaxincreasedby74.9%.AfroCentric'sprincipalsubsidiaryisMedscheme,with3.7-mlivespresentlyundermanagement.
AfroCentricsaiditwascreatingaplatformtoestablishavaluechainofhealthcarediagnosis,treatments,pharmaceuticalandmedicalservices,tooptimisethepurchasingpowerofthehealthcarerand.
Aspensinksonsaleofbabymilkbusiness
Africa’sbiggestdrugmanufacturer,AspenPharmacare,shedR18.5-bnofitsvalue.
Thisfollowedthedimviewthemarkettookofthe$860-mitgotfromFrenchdairygiantLascalisforthesaleofitsinfantmilkbusiness,fallingshortofthe$1-bn-$1.5-bnthemarketwasexpecting.
On13SeptemberAspen’ssharepricetookitsbiggestintraday
knockintwodecades,plunging26%beforerecoveringtoclose14.8%
loweratR232.06.
InthefiveyearsleadinguptothepeakinAspen’ssharepriceinJanuary2015,thestockhadgainedmorethan600%.Sinceitspeak,thecompany’sshareshaveslumpedmorethan57%.
USinsurertosellonlyVitalitycover
OneoftheUSoldestinsurers,JohnHancockFinancial,hasannouncedthatitwillsellonlyinteractivelifeinsurancelinkedtoFitbitarmbandsthatareprovidedbyVitality.
ThiswillprovideasignificantplatformforVitalityasJohnHancockhasabout10-mcustomers.
MediclinicParkwayopensinDubai
MediclinicParkviewHospital,abrandnew182-bedin-andoutpatientfacility,hasopenedinDubaisixmonthsaheadoftheoriginalschedule.TheprojectisthelargestgreenfieldconstructionprojectbyvalueeverundertakenbyMediclinicInternational,MediclinicMiddleEast’sSouthAfrica-basedparentcompanywhichisListedontheLondonStockExchange.
LifeHealthcareexitsIndia
PrivatehospitalgroupLifeHealthcareisexitingitsIndianbusinessafteralmostayear’stalks.ItwillsellitsstakeinMaxHealthcaretoglobalinvestmentfirmKohlbergKravisRoberts(KKR)foraboutR4.3-bn.LifeHealthcaretooka26%stakeinMaxHealthcare,oneofIndia’sbiggestprivatehospitalchains,in2012.
AscendisHealthpostsstronginternationalgrowth
AscendisHealthwillfocusonitspharmaceuticalandconsumerhealthcareofferings,andmovetodisinvestfromitsbiosciencesbusiness.Thecompanyannounceda35%increaseininternationalrevenuefortheyearendedJune30,2018.IthadsoldAscendisSportsNutritionforR54-m,whileanagreementhadbeenreachedforthesaleofAscendisDirectforR40-m.
Thegroupannounceditwouldalsobeadoptingaglobaloperatingmodel,asopposedtohavingthecurrentgeographicstructuresfocusingonSAandEurope.
NovartistocutjobsinSwitzerlandandUK
Novartiswillcut2550jobsinSwitzerlandandBritainoverfouryears,astheSwissdrugmakerstrivestoboostprofitandfocusonnewmedicines.
Novartisemploysabout124000peopleworldwide.
Butfollowingtheplannedspin-offofeyecareunitAlconinearly2019thatwouldfalltofewerthan100000peopleby2022.
Novartis’snetworkof66globalfactoriesisoperatingbelowcapacityaftertheexpiryofpatentsonhigh-volumepills.
PharmaceuticalView
'Miracle'sensortakesprickoutofdiabetes
Previously,diabeticshadtopricktheirfingerseighttimesadaytochecktheirsugarlevels.However,duetonewtechnologytheycannowwearsensorsontheirabdomenthatmeasuretheirsugarlevels24hoursadayandwarnthembeforetheirbloodsugargetsdangerouslyhighortoolow.
Thismeanstheydon’thavetopricktheirfingers,avoidingbothpainandtherealriskofinfection,saidProfessorDavidSegalfromtheJohannesburgCentreforDiabetesandEndocrinology
InIsraelandEurope,adevicecalledGlucoTrackisusedbyType2diabeticstomeasurebloodsugarafewtimesadaythroughasensorattachedtotheirear.
SpecialNews
NHI:‘nomatchingofaspirationstocapabilities’IfuniversalhealthcareistocontributeinanywaytoincreasingthelifeexpectancyrateinSouthAfrica,alotmoreco-operationbetweenallgovernmentdepartmentsisgoingtobeimperative.
InherpresentationontheeconomicsofuniversalhealthcareanditsimplicationsforNHIinthecountryduringtheISPORConferenceinKemptonParkthisweek,LulluKrugel,Partner,Strategy&ChiefEconomist,PwCSouthAfrica,alludedtothegovernment’svisionofalifeexpectancyrateof70forbothmenandwomenbytheyear2030andreferencestosocialdeterminantscitedintheNationalDevelopmentPlan(NDP)inthisregard.
Introducingitschapteronhealth,theNDPnotes:“Whilemedicalcarecanprolongsurvivalandimproveprognosis,thesocialandeconomicconditionsthatmakepeopleillareimportantforthehealthofthepopulation.Universalaccesstomedicalcareisclearlyoneofthesocialdeterminantsofhealth.”.
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ViewonMedicalSchemes
MedschemewarnsregardingICD10codeInanewsletter,releasedon27September,Medschemeasksallhealthcareproviderstoensurethesustainabilityoftheprivatehealthcareindustrybyensuringtheaccuracyandintegrityofcodingusedontheirclaims.
Questionablebehaviourthathasbeenidentif iedincludethefollowing:
AdvisingthehealthcareprovidertoinappropriatelychangetheICD10code(therebychangingtheinitialdiagnosis)inordertogetreimbursedatahigherrate;ChangingthetariffalreadychargedandpaidforwhenresubmittingwithamotivationforPMBentitlement;FinanciallyincentivisingemployeesoftheAgencytomaximisebillingby‘padding’theclaimswithunnecessarycodes,orresubmittingpaidclaimswithPMBmotivationunnecessarily;Promisinghealthcarepractitionersincreasedrevenue,irrespectiveofthestatusoftheircurrentbillingpractices;andRefusingtocooperatewithForensicclaimsauditsandnottakingaccountabilitywhenoneoftheirclientsissanctionedforirregularbilling.
AsperHPCSAEthicalRules–Book2–Rule7(3):“Apractitionermaynotunder-service,over-serviceorover-chargea
patient”.Anyformof ‘up-coding’,‘codeun-bundling’and/or‘codefarming’willbedeemedasover-chargingshouldouranalyticssystemidentifysuch
apatterninyourclaims.
“Medschemeremindsallhealthcarepractitionersthatyouremainresponsibleforyourownbilling,andtheliabilityassociatedwiththisresponsibilitycannotbecontractedouttoapracticemanagerorthirdpartyagency.”
Fedhealth’snewoptionsgivemembersmorechoice
Alackofflexibilityregardingtheiruniquehealthcareneedshasbeenfoundtobethesinglebiggestconcernofmedicalschememembers.
FedhealthMedicalSchemehaslaunchedaredesignedoptionrangeofoptionsitsays“representthemostadvancedinnovationtothecurrentmedicalschememodelseenin20yearssincetheintroductionofsavingsaccounts”.
MedshieldappointsMedschemeMedshieldannouncedtheappointmentofMedschemeastheScheme'snewHospitalBenefitandDiseaseManagementproviderfrom1October2018.
MedicalServicesOrganisation(MSO),anEOHsubsidiary,hasbeentheScheme'sHospitalBenefitandDiseaseManagementproviderforthepastnineyearsandhasbeenreplacedbyMedscheme,duetochangesintheEOHbusinessstrategy.
GeneralNews
InsurancecostsputdoctorsondefensiveThereisageneralfeelingthatdoctorsgetsuedforactsofomissionratherthancommission,saidDrChrisArcher,CEOof theSouthAfricanPrivatePractitioners’Forum.
Doctors,particularlyobstetricians,whowerepayinguptoR250000ayearfouryearsagoinmalpracticepremiums,arenowpayingaboutR900000asaresultoftheescalationinmalpracticeclaims.
Aresultoftheincreaseinlitigationisthatdoctorshavebeenpractisingdefensivemedicine–theyprescribemedication,testsandtreatmentthatapatientmaynotneedinordertoprotectthemselvesagainsttheriskoflitigation.
Thisputsanadditionalburdenonpatients,medicalaidschemesandhealthcarefacilities.Forinstance;ArcherplacedSA’scaesarean-sectionrateatabout80%inprivatehealthfacilities.
AccordingtotheMedicalProtectionSociety(MPS)medicalclaimsagainstitsmembershadincreased57%between2008and2017,andtheaveragecostofmedicalclaimshadshotup42%.
Cannabis:1in6teenagerswhousewillbecomeaddictsInresponsetotherecentlegalisationofcannabisforpersonaluse,theSouthAfricanSocietyofPsychiatrists(SASOP)notedwithconcernagrowingpublicperceptionofcannabisasa‘harmless’plant,andthatfewmeasureshavebeeninstitutedtoaddressthis.Researchhasshownthat9%ofindividualswhoexperimentwithcannabiswillbecomeaddictedtoit.
AccordingtoDrAbdulKaderDomingo,memberof theSASOPSpecialGrouponAddictions,itisestimatedthat1in6teenagersusingcannabiswillbecomeaddictedtoit.
“Humanbraindevelopmentandmaturationisaprocessthatisguidedbythebody’sendogenouscannabinoidsystemandoccursuntiltheearly20’s.Exposuretophytocannabinoids(cannabinoidsobtainedfromthecannabisplant)duringthisvulnerableperiodmaydisrupttheprocessofbrainmaturationandaffectaspectsofmemory,attention,processingspeedandoverallintelligence.Cannabisuseduringtheadolescentperiodmaycauselastingcognitivedeficits,evenaftersustainedabstinence.”
SpecialNoticesVacancyatBusamedSomersetWest
BusamedPrivateHospitalbasedinSomersetWest,CapeTowniscurrentlylookingtorecruitanobstetrician.
"Asahospitalgroupwewillbeabletoprovidethesupport,anewlyqualifiedspecialistorsomeonewhowantstorelocatetoCapeTownwillrequire."
Contact:DrChristelleDeJager,HospitalManager:0837814946
Vacancy:GeneralPractitionerinWelkom
GreatopportunityforaGPtotakeover/buy24yearold,established,lucrativeGeneralPractitionerPracticeinWelkom.
Serviceshavebeenrenderedtomedicalschemeandcashpatientsforthepast24years.Ownerhaspassedaway.PleasecontactChristelleSchoemanon0823776605formoreinformation.
ToplaceanadvertisementorspecialnoteinthenextissueofSAPPFHealthView,contactMarethaConradieat
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