Londiwe Buthelezi: Business Report, 21 May 2013
Tamar Kahn: Business Day, 21 May 2013
Fin24.com, 21 May 2013

MEDICINE pricing should be the first factor that the market inquiry into the private healthcare sector looked at, Netcare chief executive Richard Friedland said, decrying the fact that the group paid 40 percent more for medicines in South Africa compared with those overseas. Friedland's statement supports recent claims by Médecins Sans Frontières (MSF) and the Treatment Action Campaign that medicine prices in South Africa are among the highest in the world because country's patent laws.

Maria Cheng: SAPA-AP, 20 May 2013
MORE than a decade ago, British parents refused to give measles shots to at least a million children because of a vaccine scare that raised the spectre of autism. Now, health officials are scrambling to catch up and stop a growing epidemic of the contagious disease. This year, the UK has had more than 1 200 cases of measles, after a record number of nearly 2 000 cases last year. The country once recorded only several dozen cases every year. It now ranks second in Europe, behind Romania.

Zinhle Mapumulo: City Press, 19 May 2013

HEALTH Minister Aaron Motsoaledi is turning to the taxman to help nab state doctors who ditch patients during business hours to work in private clinics, hospitals and practices. These public sector cheats are already being investigated by the National Health department and its provincial counterparts. Motsoaledi said that criminal charges would be brought against those found guilty of defrauding the system. He hopes getting the SA Revenue Service (Sars) involved will help identify those doctors and specialists who are not declaring the tax on their private work.

SAPA, 8 May 2013

OVER 170 South African claimants will sue hip replacement manufacturer DePuy in a British court for damages related to a recall of hip implants, according to their lawyers. Sunelle van Heerden of medical malpractice attorneys CP van Zyl Inc said their South African clients were unable to sue DePuy in South Africa, and therefore started proceedings in England instead.

Sub-Saharan Africa ranks lowest for mothers

A BABY in sub-Saharan Africa is seven times more likely to die on its first day of life than anywhere else in the world, according to the latest State of the World's Mothers report. The report, which is produced by the children's rights organisation, Save the Children, says of the world's one million babies dying on their first day, 400 000 are from sub-Saharan Africa.

A baby's birth day is considered the most dangerous for both the mother and her newborn child. According to the report, the Democratic Republic of Congo is the worst place to be a mother, while Finland is the best. South Africa ranked as 77th on a list of 176 countries after the Ukraine, Algeria and El Salvador. Namibia ranked at 121, Botswana 116 and Swaziland at 119. The reports states that 7 500 South African babies die on their first day of life every year and 20 200 by the first month. Almost 47 000 children don't live to their fifth birthday.

Though a change in calculation methods makes it difficult to compare this year's rankings to those of previous years, Kate Kerber from Save the Children said South Africa is slowly making progress with maternal and under five mortality rates. She said child mortality in South Africa had improved significantly over the past five years, but deaths during the first month of life had not improved. According to the University of Cape Town's Children's Institute, the country's under- five mortality was 80 per 1 000 births between 2003 and 2005.

The latest Health Department figures show that this had improved to 56 per 1 000 births in 2011. Kerber said most maternal and infant deaths could be prevented by improved access to quality healthcare for pregnant women and their babies. She said that increased attention to cost-effective, life-saving interventions such as antenatal steroid injections to help premature babies' lungs develop and resuscitation for babies who do not breathe at birth could help decrease the number of deaths during childbirth and the first week of life.

Inequalities

However, the organisation warned that the country figures published in the report may mask inequalities within countries. Kerber said there was a drastic difference in the care received in the private healthcare system as opposed to public healthcare. Senior researcher with social justice organisation Section27 Sha'ista Goga said that government's introduction of health reforms, such as the upgrading of health facilities and recruitment of health workers in preparation for the provision of universal healthcare through the National Health Insurance scheme, had the potential to bridge this inequality gap.

Goga said the NHI could address various inequalities, like funding and quality in underserved areas. She said the establishment of District Clinical Specialist Teams - roving medical teams with a nurse, a gynaecologist and advanced midwife, and other specialists, that service specific health districts - was a step in the right direction. The establishment of the Office of the Health Standards Compliance was also a "positive move towards ensuring that the medical care people receive is of a good quality because it will help government identify where the inequalities are, what form they take and therefore allow them to address them". According to Goga, the School Health Programme that the government introduced in October last year, where learners could access health services at school, would address the issue of parents failing to take their children to clinics due to a lack of transport. However, Goga warned that quality healthcare depended on more than the Health Department and said that intergovernmental cooperation was still lacking.

John Harvey: Business Day, 9 May 2013

THE Western Cape government is warming up to National Health Insurance (NHI). The only Democratic Alliance (DA)-run province in the country launched the NHI pilot project in February in the Eden district on the Garden Route. There are 10 NHI sites in the country that are "piloting" various models around the country. The DA in the province said the plan was well on track, with more than 12 000 school children in the Eden district having already been screened by health workers. While the party is proud of the achievements to date, health MEC Theuns Botha was adamant that its efforts do not indicate unqualified support for the "as yet not formally tabled policy document for NHI". He said there was no final model, but the reason for the Western Cape participation was the belief that the province could contribute to the development of the best ultimate model.

Sipokazi Fokazi: The Cape Argus, 9 May 2013

AN AUDIT of the country's health facilities has produced dismal results, with very few scoring above 50 percent in terms of providing services. Dr Olive Shisana, chief executive of the Human Sciences Research Council, told Parliament's oversight committee on health that she was concerned about falling healthcare standards as represented in the audit.

Editorial Comment: The Times, 8 May 2013

THE standoff between medical specialists and the department of health in Gauteng must be resolved before patients' lives are placed in harm's way. At the root of the problem, it seems, is a decision by the department to cut overtime pay and stop private work by specialists. Charlotte Maxeke Johannesburg Academic Hospital has been particularly hard hit – it was reported last month that seven specialists had resigned in just three weeks, and that more resignations were on the way. At the time, medical staff warned that the venerable institution could lose its academic status if the flood of resignations continued.

Katharine Child: The Times, 8 May 2013
SAPA, 8 May 2013

THE resignation of 12 specialist anaesthetists at Charlotte Maxeke Johannesburg Academic Hospital will halve the number of surgical operations at one of the country's biggest hospitals. In only one month, 12 anaesthetists resigned and two say they will quit by July - this will leave the hospital with only 12 of the 28 it needs.

Six of the anaesthetists have already found work in private practice. The anaesthetists are angry because the Gauteng health department cancelled an agreement that allowed them to work one day a week in private practice to supplement their income. Private work offers at least three times more pay. The department has said the doctors did not work the agreed 40 hours a week at the government hospital. But the specialists say they worked at least 10 hours a day and put in overtime at night and at weekends. Five of the anaesthetists together handed in their resignations on Tuesday last week.

One of the doctors said she was tired of being labelled a "thief and criminal" by senior management and claimed she always worked a minimum of 40 hours a week. The final straw for the doctors was being insulted by a senior hospital official who shouted at them in public that they were criminals for resigning. Another senior doctor at the hospital said the resignations would have severe consequences for the operating schedule. He said from June major surgeries would have to be cancelled every day because of the lack of specialist anaesthetists.

A senior doctor said supervision of registrars and doctors at night would suffer because the number of specialists to cover them would not be enough to have a specialist on call every night - and overtime had been cut for specialists. The overtime issue has spilled over to specialist theatre nurses, who are refusing to work extra overtime. Night emergency operations are already being reduced because of the shortage of these nurses. They had their overtime pay capped at 30 percent of their normal-rate pay and are now working only the hours they are paid for. This has meant that, instead of three operating theatres being available at night for emergencies, the hospital now has only two that can be manned at night.

The SA Medical Association has asked lawyers to find out why overtime pay for specialists was cut from April, resulting in their earning R8 000 less. The health department said it would use registrars to fill vacated posts as soon as they qualified.

Meanwhile, health department spokesman Simon Zwane had again denied there is a crisis at the hospital, saying the hospital had 21 filled posts, three had already left, six would leave at the end of May; there were 39 registrars with about half of these already senior registrars who worked as consultants] and there were six medical officers. He said 19 theatres operated on a daily basis. Zwane said if it was possible to shorten the waiting times for operations the department would do it, but this was not realistic. He said it must be understood that while any health system wanted to get patients through the system as soon as possible, it was not always possible. He said insufficient operating time, limited available specialist surgeons, nursing staff, and theatre auxiliaries resulted in backlogs for surgery. Operations were given priority, with those of high-risk patients topping the list.

Vuyo Mkize: The Star, 8 May 2013

ONE baby an hour dies within 24 hours of birth in South Africa because the country does not have enough skilled healthcare workers. According to a hard-hitting report released yesterday, 7 500 babies a year who are born alive, died on their first day – that is 21 babies a day, or almost one an hour. In addition, 3 000 mothers a year die of complications in pregnancy or childbirth.

Jeremy Laurance: The Independent via The Cape Times, 8 May 2013

A 15-YEAR-old US high school student whose uncle died of pancreatic cancer has developed the first test for the disease that could detect tumours before they become too advanced to treat. Pancreatic cancer has the lowest survival rate for any cancer, which has remained unchanged for 40 years. It is symptomless in its early stages and strikes more than 8 000 people a year in the UK and 45 000 in the US. Four in five patients are inoperable by the time they are diagnosed and fewer than four in 100 live for five years.

SAPA, 7 May 2013

ECONOMIC Development Minister Ebrahim Patel has announced that the Competition Commission will start a long-awaited market inquiry into pricing in the private healthcare sector in September. Speaking during debate on his budget vote in the National Assembly, Patel told MPs it would be a "historic inquiry", because it would be the first time competition authorities would use new powers conferred upon them.

Susan Du: The Star, 7 April 2013

THE 10 021 patients who are awaiting major surgery in Gauteng hospitals can expect to remain without treatment for about 18 months. The Gauteng department of health has revealed that backlogs in cataract, knee, hip, spine and cardiac operations are so immense that thousands of people in need of relief are left in the lurch due to "service demands or loads that exceed the capacity of resources".

News24.com, 7 May 2013

A breakthrough in the way human diseases are treated has been made by researchers at the University of the Free State. The researchers from the Departments of Microbial Biochemical and Food Biotechnology and Physics at the university were recently exploring the properties of yeast cells in wine and food to find out more about how yeast was able to manufacture the gas that caused bread to rise, champagne to fizz and traditional beer to foam. And the discovery they made is a breakthrough that may have enormous implications for the treatment of diseases in humans.

Tamar Kahn: Business Day, 7 May 2013

SOUTH Africans participating in clinical trials should pressure researchers to investigate issues relevant to patients and demand that the results are published, according to Cochrane Collaboration founder Sir Iain Chalmers. SA is an attractive destination for clinical trial research conducted by multinational companies, donor organisations and academic institutions as it has a well-established health infrastructure, a high disease burden, and the cost of doing business here is less than in the US or Europe.

Kashiefa Ajam: The Saturday Star, 4 May 2013

THE public has a right to complain when it receives poor healthcare services. And many have exercised this right, with the number of complaints against medical practitioners steadily increasing by 25 percent since 2009. The Health Professions Council (HPCSA) has received 248 complaints since April last year, ranging from misdiagnosis and unethical advertising to unacceptable or inappropriate relationships with patients, and bringing the profession into disrepute.

Anso Thom: Health-e News Service, 6 May 2013

REMUNERATIVE Work Outside the Public Service (RWOPS). It is a mouthful, and as provincial health departments start tightening the screws, it has become a hot potato, especially in Gauteng, where some specialists are threatening to resign. Up to now, those who have shouted the loudest have been the specialists and doctors who believe that sticking to the letter of the law will lead to a mass exodus from the public sector.

Sipokazi Fokazi: The Cape Argus, 6 May 2013

THE MEDICAL Research Council (MRC) has confirmed that it will downsize its research units, including those that research HIV/AIDS and tuberculosis (TB), due to funding constraints in an effort to improve the quality of its research work. The council's president, Professor Salim Abdool Karim, said the revitalisation process, which would see some research downsized and consolidated into other units, was expected to be completed before the end of the year.

Mia Malan: Mail & Guardian: 3 May 2013

ACCORDING to Humphrey Zokufa, managing director of the Board of Healthcare Funders (BHF), private medical administrators' skills should be regarded as a national asset from which National Health Insurance (NHI) can greatly benefit and not as something that cannot be used outside of the private sector. Zokufa said the sophisticated funding and administration skills built up over the years by the private healthcare industry "cannot just be thrown away". The NHI scheme is currently in its first, five-year implementation phase - during which health facilities are being upgraded and health workers recruited. Health Minister Aaron Motsoaledi has said the second phase will focus on the financing and administration of the scheme, which is likely to involve the introduction of either additional general taxes or compulsory salary deductions to fund the NHI. During this phase, final decisions on how the scheme will be administered - how services will be purchased and claims and payments processed - will also be made.

The Health Department has to decide whether it will implement a single purchaser system, in which a single fund purchases health services across the NHI, or a multi-purchaser system, in which different funds - for instance district health departments or medical schemes - may also purchase medical services on behalf of the NHI. The NHI green paper, which was released in August 2011, envisaged a single NHI fund operating as a single purchaser but allowed for the possibility of a multi-payer system to be explored, according to pharmaceutical association Innovative Medicines South Africa. South Africa could therefore have a single NHI fund, or single purchaser, with multiple payers (the administrators managing the payments). This leaves open the option for the NHI to contract private medical administrators to assist with the processing and management of claims. A Treasury document on NHI funding, which could provide more clarity on this matter, has yet to be made public. Motsoaledi says he is studying the draft NHI white paper, which will provide more information on the direction the government wishes to go, in preparation for its "urgent release".

Private stakeholders 'nervous'

André Meyer, chief executive officer of Medscheme, South Africa's third-largest medical scheme administrator, said private stakeholders were nervous about what would be proposed in case this would have negative implications for their future. Motsoaledi is critical of private healthcare costs. At forum last month, he said most private healthcare services, including their administration, were "designed for the rich with exorbitant prices that are unaffordable to the NHI". The Actuarial Society of South Africa has estimated that the implementation of the NHI would cost R235-billion, but it could be as high as R336-billion if modelled on current private sector expenditure. But, according to Rajesh Patel from the benefit and risk department of the BHF, the cost of setting up a new NHI payment system from scratch would be more expensive than using the private administration systems that were already in place and had proven to work efficiently. Meyer said administrators had built up impressive IT infrastructure that effortlessly processed payments and, more importantly, actively managed a large number of lives to promote wellness and prevention. The Council for Medical Schemes says only 8.5-million, or 16 percent, of South Africa's 52-million people belong to a medical aid.

Therefore, the NHI would have to administer healthcare costs of more than six times than the private industry currently manages. Zokufa said the resources and skills required to administer the extreme amount of NHI costs was immense. He asked what infrastructure government had in place to manage that, mitigate the risks, and satisfy patients' needs. He said it was clear that the NHI would need all the help and expertise currently present in South Africa and would have to bring it on board.

Negotiate lower prices

Patel said the NHI would be able to negotiate lower prices both with medical schemes and administrators should it decide to make use of their services. He said that through a proper tendering system and economies of scale [a significant increase in the size of services currently provided by the private sector], prices should go down. However, Meyer said that the NHI would also force private healthcare providers to think differently as to how services were provided as it would not be business as usual for them under a public health insurance system. He said the current infrastructure was just too expensive for the NHI environment and, in fact, also for private health. Meyer said it was not sustainable and hospital groups needed to think about a different model with a cheaper infrastructure. A hospital in Sandton could not compete in the NHI environment, even at 100 percent occupancy, he said. Meyer said Medscheme was forced to find ways to lower its administration costs for the country's second largest medical scheme, the Government Employees' Medical Schemes (GEMS). Medscheme used technology to streamline and automate processes. It also allowed 230 staff members to work from home. Meyer said measurement of productivity had shown that they were 30 percent more productive compared with when they worked from the office and the company saved on space and related expenditure. As a result of this, Medscheme managed to decrease the cost of the administration and management of GEMS members' claims to R58 a member per month as opposed to the average of R76 a member per month of other employer-specific or company medical schemes.

Discovery Health, the country's largest private medical scheme and administrator, has achieved noticeably lower hospital costs through the implementation of a tool known as "diagnosis-related groups". Patients admitted to hospitals are allocated a clinical code based on their diagnosis and the treatment required. These codes have an overall price tag attached to them, which prevents doctors from splitting up the procedure into different, smaller codes for which they charge separately. According to Discovery Health's chief executive, Jonathan Broomberg, it moved the focus away from hospitals generating itemised bills for every service and drug used within the admission [which creates an incentive to use many and expensive items]. Instead, the focus of the bill was on correctly capturing, by clinical coding, what was wrong with the patient, because the remuneration would depend on this. At present, 70 percent of all hospital admissions funded by Discovery Health managed schemes were subject to reimbursement contracts using diagnosis-related groups. However, Motsoaledi said, despite the introduction of cost-saving measures, private medical schemes and administrators still charged "unacceptably high fees" that "punish the poor". He said South Africa's private healthcare system did not need the NHI to force down its prices as it would collapse by itself within the next two decades if it continued in this way.