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

maretha@healthman.co.za

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