Anton Ferreira: The Times,

SOUTH Africa has untold potential to develop new blockbuster drugs from indigenous plants, such as hoodia, but is sabotaging the natural-products industry with unwieldy new laws aimed at protecting biodiversity.

Scientists and industry leaders at a conference in Cape Town last week slammed the Environmental Management Biodiversity Act (Emba) as the kiss of death for bio- prospecting - searching for new ways of using plants in areas such as medicine, nutrition and cosmetics.

Multimillion-dollar species that have already been developed include hoodia - now being exploited by Unilever as an appetite suppressant - pelargonium, rooibos and buchu. The value of the German market for pelargonium extract alone, as a treatment for tuberculosis and bronchitis, was estimated to be worth € 80-million in 2006. Pharmaceuticals generated global revenue of 400-billion in 2002, and nearly half were based on plants from the wild.

The Emba regulations published earlier this year are intended, among other things, to ensure that companies that develop drugs from wild plants share their profits with local communities - in hoodia's case, the San people who first recognised its value in combating thirst and hunger. The regulations require that bio-prospectors obtain a permit before they collect any plant material, and that they sign a series of agreements with target species “stakeholders” before they can apply for a permit.

The legislation was drawn up as part of South Africa’s commitments under the Convention on Biological Diversity, which was drafted at the Rio Earth Summit in 1992.

Neil Crouch, a medical plant expert at the National Biodiversity Institute, said the convention was an attempt to control access to natural products and share the benefits more broadly.

“But unfortunately, in translating the convention to national legislation, in South Africa we’ve seen quite tragic consequences. We could end up not receiving any benefits at all.”

Crouch said the legislation had been largely driven by unrealistic expectations of an eco-dollar bonanza from the “green gold” of plant products. He cited the 6-billion annual geranium cut- flower industry, which is based on genetic material from South Africa, but said this was the exception rather than the rule in the natural- products industry.

“We’ve gone from a position of lawlessness to one of over-regulation in 13 years ... from no regulation to almost unbelievable bureaucracy.”

Crouch said a researcher wanting to screen 300 species for a specific chemical property would need more than 900 legal contracts “and at least 300 community resolutions stating that they’ve given you their prior informed consent”.

Crouch and others at the conference predicted that the laws would lead to pharmaceutical companies avoiding South Africa as a potential source of new drugs.

One of the country’s leading experts on medicinal plants, Professor Ben Eric van Wyk, of the University of Johannesburg, said: “There are other parts of the world that are equally rich in biodiversity, so when Japanese companies approach me I advise them to think of Malaysia or the East. In those countries, you have sensible legislation and the governments are trying to promote development rather than suppress it.”

He called the Emba “half-baked”.

“The procedures are impractical. If you follow the requirements of the law, it becomes totally impractical to do bio-prospecting. ”

Ulrich Feiter, whose company uses plant-derived compounds, said trying to comply with the legislation made him feel “like a fish on a bicycle”.

Feiter said he fully endorsed the “noble idea” behind the legislation, but “somehow we have lost the common sense”.

Laura du Preez: Personal Finance,

IT IS IMPORTANT to weigh up what you contribute against what you get out in benefits.

Once you have compiled a shortlist of schemes that are financially stable, have a good membership profile and are governed soundly, you need to look at the options available on those schemes.

Consider your healthcare needs and those of your family, if you have one, in light of your medical history and lifestyle.

Look at what you have spent on healthcare over the past five years. Add up what you have spent on medicines and treatment. If you are already a member of a scheme, obtain a history of your claims.

Then consider your future needs - for example, whether you plan to start a family, engage in hazardous activities, or have hereditary illnesses that might affect you or a member of your family.

Remember that you are more likely to need expensive benefits as you get older, and changing circumstances, such as having more dependants, can affect your healthcare needs dramatically.

List the medical expenses for which you will need cover.

For example, hospitalisation for specific conditions, such as a back operation or child birth, or treatment for specific conditions such as diabetes.

Now scrutinise each of the shortlisted medical scheme's benefits and compare them with each family member's needs.

Benefits offered

Does the scheme have a traditional option with listed and, usually in some way limited, benefits for all kinds of medical needs, or does it offer a new-generation option with a medical savings account?

If it has a savings account, look at how much of your claims must be paid from that account; it may be all the day-to-day benefits or only certain ones not covered by the scheme. Establish whether the contributions to the savings account will be enough to cover all these expenses.

If there is a network option, consider whether you are happy with the limited choice of healthcare providers and whether facilities or practitioners in the network are located conveniently.

Examine the benefits, paying particular attention to the following:

• Annual limits and sub-limits;

• Ascertain whether a scheme has an overall annual limit - for example, R750 000 - or "unlimited" benefits;

• Remember that the cost of a serious injury with a long stay in a private hospital can run into hundreds of thousands of rands for just one person. If you have a family, consider what your bills may be if all of you were involved in a serious motor accident. Would the limit be enough;

• Benefits may be "unlimited", limited to a rand value or limited to a certain number of consultations; and,

• Watch out for combinations of benefits, because this is a way of limiting your cover.

Common combinations are:

• Consultations with general practitioners and specialists;

• Basic and advanced dentistry; and

• Radiology and pathology.

When you consider the benefits offered, particularly on a low-cost scheme, it is vital to check what treatments are excluded - especially expensive ones such as transplants and chemotherapy. If there are limits or exclusions, you need to make sure you have enough money to pay for such eventualities.

Check whether the hospital cover gives you access to care in private or public hospitals. Be clear on whether the hospital limits are per beneficiary (member and each dependant) or whether there is an overall family limit.

The rate at which your medical costs are covered

Check whether the scheme pays claims at the rates in the National Health Reference Price List (NHRPL) or at the actual rates charged by the service providers. If it pays at the NHRPL rates and your pro-vider charges more, you will have to pay the difference. Top specialists usually charge far more than - up to three times - the NHRPL rate.

Co-payments or levies

Schemes use co-payments or levies to manage costs. You may be required to pay R10 a script, or 10 percent of the cost of a visit to a doctor. By making you pay part of the cost, schemes hope you will use only the services you really need.

Restrictions on access

Check whether or not the cover offered by the scheme is conditional on your using certain doctors or networks. Examples are schemes that:

• Use networks, such as Prime Cure, for day-to-day, out-of-hospital cover;

• Cover you only if you use particular hospitals or a particular hospital group;

• Cover medication from certain pharmacies only;

• Have formularies, or lists of medicines that you must use; and,

• Offer certain services only in public, or government, hospitals.

If the scheme does specify the provider and you use a different one, you will either pay an additional levy or penalty, or receive no benefits for that service.

Usually a scheme restricts providers to give you access to more affordable benefits. It is up to you to decide whether or not the inconvenience of having to use certain healthcare providers is worth the saving offered, and if it suits your needs.

Prescribed minimum benefits

Find out how the scheme provides these benefits. For example, do you have to get these benefits from a particular provider or from state hospitals? Do you have to use certain medicines to have cover?

Check costs and regulations

The final step is to work out what you will pay for cover under a certain option.

Also find out if the scheme will impose a waiting period when you join. There are also late-joiner penalties applicable in certain cases to people over 35.

Calculate the contribution you will pay for a particular option, depending on whether you will be joining the scheme as a single member or with dependants.

If your employer pays a subsidy for you to be a member of a scheme, remember to deduct that subsidy from the overall contribution and to establish whether any portion of the subsidy will be taxed.

The final question is, are you prepared to pay the contributions for the benefits offered? If you cannot afford it, you will have to reduce the level of cover until an affordable contribution level is reached.

The range of options available

There are a number of different types of medical scheme options. Before you look at them, you need to be aware of some of the terms used.

Schemes often distinguish between major medical benefits or hospital benefits and day-to-day benefits.

Day-to-day benefits are those covering out-of-hospital consultations with doctors, dentists and other medical professionals, the treatment they prescribe, medicines, spectacles and so on.

Hospital benefits are those covering your stay in hospital and the cost of your treatment in hospital, including the cost of doctors who treat you while you are there.

Major medical benefits are those covering hospital treatment as well as some higher-cost out-of-hospital treatments such as high-cost scans or oncology treatments.

The prescribed minimum benefits (PMBs) are those your scheme must by law provide.

They cover more than 300 life-threatening conditions - mostly for in-hospital treatment - as well 25 common chronic conditions.

Schemes often refer to insured benefits or risk benefits. These are benefits paid from your contributions, excluding the portion which goes into your medical savings account, if you have one.

Traditional options

Traditional options generally provide only insured benefits, covering both major medical and day-to-day expenses.

They range from being highly comprehensive - and usually expensive - to low-cost options that offer limited benefits.

Often the option will have an overall annual limit on cover provided and various sub-limits within that. Other options have hospital or major medical limits and sub-limits for categories of day-to-day expenses.

Some schemes offer a medical savings account with a traditional option so that you can use the savings to supplement the insured benefits.

Hospital plans

These typically offer cover only for major medical or hospital expenses, and emergency services such as ambulances. No day-to-day expenses are covered.

However, schemes no longer offer pure hospital plans because they all have to provide cover for the treatment of 25 common chronic conditions, which mostly involves out-of-hospital benefits.

New-generation options with savings accounts

These options offer certain insured benefits - usually those covering hospital and major medical expenses. You fund other benefits yourself by contributing to a medical savings account. The amount you can spend on benefits not covered by the scheme depends on how much you have in your account.

These options usually allow you to spend your savings as you wish on any medical expenses. But in some cases the scheme will limit transactions from these accounts to, for example, payments at National Health Reference Price List (NHRPL) rates.

Savings accounts transfer the risk of not having enough to cover claims to you, the member. You need to manage your medical expenses to ensure there is enough in the account to cover you for the year.

Medical schemes use savings accounts to prevent you using more than you need on day-to-day expenses.

Savings accounts are also used in other options as a means to top up the limited benefits the scheme offers.

Medical savings accounts have to comply with regulations under the Medical Schemes Act. These stipulate that:

• You cannot put more than 25 percent of your total contribution into a medical savings account. The aim is to ensure that you are not funding a substantial portion of your benefits;

• Money in your savings account can't be used to offset contributions or debts you owe the scheme, except when you leave it;

• If you have a credit balance in your medical savings account it must be transferred to another medical scheme or benefit option with a medical savings account when you change schemes or benefit options;

• If you change to a scheme or benefit option without a medical savings account or stop being a member of a medical scheme, the credit balance in your existing account must be taken as cash; and,

• Money in your medical savings account cannot be used to pay for the costs of a PMB.

Many options with savings accounts offer you access up front to the amount you will contribute to that account over the year. In other words, the amount you have not yet contributed for the year is available to you on credit. If you leave a scheme before contributing what you have used on credit, you will owe the scheme the balance.

Some medical schemes offer credit or debit cards for medical expenses and this credit may become accessible when savings account benefits are exhausted.

However, payments to these cards are not regarded as medical scheme contributions for tax purposes and they are essentially banking products that operate outside the scheme.

Above-threshold benefits

Some schemes offer above-threshold benefits on options with medical savings accounts. These benefits can be accessed once you have exhausted your savings.

These benefits usually cost more. Paying for them is like insuring yourself against high medical expenses.

The claims that count towards this threshold are usually what are regarded as essential claims. You cannot, for example, spend all your benefits on cosmetic surgery and then claim above-threshold benefits.

Some schemes have what is known as a self-payment gap - in other words, the threshold is higher than the savings account benefit and you must pay some of your claims out of your own pocket before reaching it.

Network options

Network options usually offer lower contributions in return for your agreeing to use a particular network of healthcare providers.

In the past these were often lower-cost options, but increasingly medical schemes are introducing networks in an attempt to contain costs and prevent your being faced with a gap between what the scheme pays and what healthcare providers charge.

Discovery Health, for example, has set up its own hospital network and offers lower rates to members prepared to use it.

Discovery Health has also set up direct payment arrangements with practitioners. Members who use these practitioners are assured that the scheme will pay their medical bills in full. However, you don't pay lower contributions for using these practitioners. You only ensure that you don't face paying their bills out of your own pocket.

Lower-cost network options typically restrict members to using certain medicines and visiting certain doctors and hospitals. One of the bigger networks, Prime Cure, has medical centres in certain areas as well as contracted practitioners. Another large network, CareCross Health, is a network of private practitioners.

CareCross also operates a private practitioner network, OneCare, aimed at the middle-income market.

There are also smaller networks of general practitioners, including Faranani, which serves previously disadvantaged areas.

Members are given a list of doctors, dentists, pharmacists and optometrists in the network. Usually visits to these healthcare providers are unlimited.

Certain schemes also limit hospitalisation benefits to certain hospital groups. However, if there is an emergency, you are covered by the PMBs for immediate treatment at any hospital.

Once stabilised, you can be moved to a hospital within the network.

Certain schemes combine network and traditional option features in one scheme.

The lower-cost networks often do not cover things such as advanced dentistry, visits to specialists, advanced pathology or radiology. Certain schemes offer cover for visits to a specialist, but only if you are referred by a network doctor.

Lower-cost network options often limit optometry benefits and have formularies - lists of low-cost medicines, which can be used to treat certain conditions and which may include generic rather than brand-name medicines.

Louise Flanagan: The Star

AN UNRESOLVED debate about patient confidentiality has left cancer researchers without information on new cancer cases for the past decade - although this is crucial for health planning.

The National Cancer Registry (NCR) hasn't produced a report since 2005, and that was based on data that's now 10 years old.

Now draft regulations are under discussion to make cancer a legally reportable disease to get the registry going again.

Cancer researchers, the NCR and health officials are due to meet next week to discuss the regulations and how to get the registry a comprehensive flow of data again.

The department of health's cluster manager for non-communicable diseases, Christelle Kotzenberg, said a decision to set up a task team to develop a regulation on cancer registration was made on October 3 and the first meeting to discuss the draft regulations would be on Tuesday.

Kotzenberg couldn't say why it had taken so long to address the problem, except that this was "mainly I think because there was no concerted effort".

One researcher said there was now a "conducive environment" to get the process under way after years of it not being a priority.

The draft regulations on cancer registration propose making it compulsory to register all cases of cancer.

This means hospitals must keep cancer databases.

Failure to register cases could mean a fine of up to R20 000.

The regulations propose getting the NCR running again, and after a year, the setting up a population-based registry, which is more comprehensive, uses more sources to identify cases, and costs a lot more.

The regulations require "limited and well-defined access" to the registries to protect patients. There are no details on exactly what information should be collected.

The problem arose about seven years ago when the private pathology laboratories stopped sending details of cancer cases to the registry.

The NCR relies entirely on cases confirmed by pathology labs for its information.

But when debates around patient confidentiality arose at the end of the 1990s, the private labs worried they were breaking the law by sending cases with patient details to the NCR.

"Currently pathologists do not feel secure they were not violating patient rights in sending the data to the registry," said Dr Tjaart Erasmus, the president of the National Pathology Group (NPG).

The NPG is part of the South African Medical Association and represents private and state pathology labs.

The labs don't deal with patients directly so could not get informed consent from patients allowing their information to be passed on to a third party, the NCR. What the labs wanted was a legal "blanket ruling" making cancer reportable and thus allowing them to pass on the data.

It's the department of health's responsibility to make such legal provision, but for years the matter was debated and nothing happened.

"We really tried," said Erasmus.

Although many of the private labs stopped sending data to the NCR years ago, they still have it.

"The laboratories felt they were morally obliged to continue keeping the data," said Erasmus.

The problem means the NCR has lost about a third of its data, said NCR acting manager Patricia Kellett.

She understands the labs' ethical dilemma. "All they want is the okay from somebody in government to release the data."

Kellett said the data from the labs was very good and provided a reliable source of statistics.

The confidentiality issue arises because the registry needs case information which identifies the patient.

This is because a single patient may have numerous tests, may have more than one site of cancer, and may have a cancer which recurs after being dormant for years. As the NCR counts new cases, it needs some way to identify linked cases to prevent double-counting.

"Once is once. They might present again but we're not going to count them as a newly diagnosed cancer," said Kellett.

The NCR data is crucial for health planning.

"It's hugely important," said Kellett, explaining it was needed to assess trends, geographical incidence of disease, life-time risks, age-related incidence and whether screening for cancers worked.

"If you don't have stats, how do you know if anything's working?"

The NCR has also been hampered by lack of key staff. The small unit's director left years ago and the acting director has also gone.

"It's a tragedy that we've missed so many years with not having this information," he said.

Kotzenberg said although the last published NCR data was old, it was not useless.

"Luckily the trend of non-communicable diseases does not change dramatically over a short period of time, as you can find with communicable diseases," she said.

"The national department does not render services thus we use the information for strategic planning and projections. Provinces will use the information for short-term planning."

During 1998/9, the last years for which data was analysed by the NCR, about 60 000 new cases a year were reported.

Preliminary unpublished information from 2000 and 2001 NCR data is that, despite the drop in case reporting, the total number of newly diagnosed cancer cases remained constant.

There were 59 410 new cases reported in 1998, another 57 921 new cases in 1999, 55 752 in 2000, and 59 213 in 2001.

The most common types of cancer reported remain largely the same.

Basal cell cancer (a type of skin cancer) is the most common cancer for both men and women. Prostate cancer remains the second most common cancer for men, while breast cancer has moved from the most common cancer for women in 1998 to the second most common.

The most noticeable change was Kaposi's, a cancer associated with AIDS, which moved from 17th most common in men in 1998, to ninth most common in 2001.

MORE than 400 complaints of medical negligence were made at Gauteng state hospitals in the past four years. Gauteng Department of Health spokesperson Phumelele Kaunda said 115 cases were reported during the 2007/8 financial year, 112 cases during 2006/7, 80 cases in 2005/6, and 126 cases in 2004/5 - a total of 433 cases. No details were available of which hospitals were involved or how many complaints were still unresolved. Eight of the cases were investigated by the Chris Hani Baragwanath Hospital in Soweto since 2003, Gauteng Health MEC Brian Hlongwa. Hlongwa was replying to a question by Democratic Alliance MPL Jack Bloom. Hlongwa said these dealt largely with allegations of negligence levelled against the hospitals while patients were in its care. Most of these were subjects of litigation, therefore disclosing findings would be prejudicial. Six of the Bara cases were referred to the committee during 2007/8, and two between 2005 and 2007. Hlongwa said as a result of the Bara cases, the Serious Adverse Events Committee was set up at the hospital and guidelines on management of certain conditions had been developed. He said that the very system of compulsory reporting of serious adverse events had resulted in institutions having to be accountable.

Louise Flanagan: The Star,

THE Government Employees Medical Scheme (Gems) will increase its contributions by 11.18 percent next year. For a family of three, this will amount to an increase in rand terms of between R12 and R188, depending on the benefit option and the salary level of the member, according to Dr Eugene Watson, the scheme's principal officer. Watson said the scheme had also adjusted the income bands for its contribution rates, and many members might find that they had moved "down" the income bands. In setting its contribution rates for next year, Watson said Gems took into account the anticipated medical inflation rate for 2009, in light of the current high-inflation environment; the adjustments to public service salary bands; Gems's need to raise its solvency ratio; and the scheme's expected growth in membership over the next year. Since 2006 the government has been offering higher medical scheme subsidies to employees who join Gems to encourage them to move from other schemes. It pays 100-percent subsidies for those who join Gems's lowest-cost option. Gems has grown its membership to 300 000 principal members or 800 000 lives (members and dependants). The rapid growth in membership resulted in the scheme's solvency ratio declining to 8.4 percent at the end of last year. Watson said next year's contribution rates took into account that Gems was growing rapidly and that its membership profile was changing, affecting its claims patterns. He said benefits on the two network options would increase by 10 percent, while benefits on other options would increase by five percent. The scheme is introducing a maternity programme for all members next year. Members of the lowest-cost option, Sapphire, which offers state hospital cover only, will enjoy private hospital cover for maternity care from next year. Gems claims its benefit plans are 10 to 25 percent less expensive than those of other medical schemes with similar or better benefits. Pro Sano, another large medical scheme with over 30 000 members, said its contributions would increase by an average of 11.7 percent next year, with members' increases ranging from 7.5 percent to 16.5 percent. The scheme has launched a new comprehensive option, ProElite, which covers hospital expenses at 300 percent of the National Health Reference Price List rates.

Laura du Preez: Personal Finance,

ACCORDING to the Democratic Alliance there are more than 12 times the number of applicants seeking to train as doctors as there are positions available at South Africa's medical schools. This is among the reasons for the "astounding" skills shortage in the country's public health sector, DA health spokesperson Mike Waters said. He said there were 46 000 vacancies for nurses and 11 700 vacancies for doctors in public hospitals. Medical schools at universities around the country had 1 226 positions for students, while the number of applicants (in 2006) was 15 794. Waters noted that the capacity of medical schools had not increased significantly since the 1970s. The solution, he said, was to involve the private sector, yet the Health Department deliberately limited the involvement of the private sector in training medical staff. He added that universities had reached their maximum and other avenues needed to be explored. There had been an application by a private institution to open up a medical school at Midrand in Gauteng two years ago, but this was rejected by government. Waters said what was needed were public-private partnerships to establish training facilities, an approach that did "not place the entire financial burden on the state". Contacted for comment, health department acting chief communications director, Fidel Radebe, said there were doctor training programmes underway at a number of institutions. Asked if government, given the shortage of doctors, planned to enter into partnerships with the private sector to build more medical schools, said he was "not aware of such moves". On training for nurses, Waters said this had been severely constrained by a decision, in the 1990s, to close certain nursing colleges. According to a discussion document, a total of 2 629 registered nurses graduated from local colleges in 1996. Ten years later, the figure was 1 493.

SAPA,

THE Gauteng health department has halted the filling and advertising of all vacant posts, although it has more than 20 000 such positions. Department head Sybil Ngcobo wrote to all senior officials in the department last month, telling them to "put in abeyance" the filling and advertising of posts, including contract posts, until further notice. In the letter she said that due to the challenges the department was facing regarding the cost of compensation of employees, an analysis into the overexpenditure in respect of personnel compensation was being completed. About half the vacant posts are for nurses and clinical professionals, including doctors. Gauteng hospitals need 8 974 nurses and 1 417 clinical professionals. The department has 21 923 unfilled posts, including administration, support and management. Mmakgosi Mosupi, the department's chief director of information and communications technology, said not all vacant posts were funded. A senior official in the provincial government said the "freezing" of posts also applied to nurses and doctors, which affected service delivery in already understaffed hospitals. However, the department said a circular was sent to all managers of institutions requesting submission on all critical posts that needed to be filled. Department spokeswoman Zanele Mngadi said this list would be considered by senior management and essential posts would be authorised accordingly. This meant that all facilities would have their critical posts or post-filling plans approved and would be at liberty to fill them as the need arose. The filling and advertising of posts now vested with Ngcobo. She would approve them only if she was satisfied statutory requirements necessitated it and if public peace and order were threatened. Senior managers who wanted posts filled in their departments would have to prove that a loss of life might occur and that a delay in filling a post could result in a substantial financial loss to the department. Proof should be provided that appointments were crucial and exceptional. Mngadi said 80% of the department's expenditure was related to the personnel budget or staff costs. Such expenditure was partly caused by the increase in the number of healthcare professionals recruited, which exceeded the annual target for the 2007-08 financial year, and the implementation of a 10,5% annual salary increase, she said. Mngadi said hospitals would be able to prioritise posts to be filled in line with the recommendations that would come from the definition of service packages, to be completed at the end of March next year. Any other critical vacant posts would have been considered beforehand, she said. Meanwhile, the department's deputy director-general, Obakeng Mooketsi, said the department had turned down the acquisition committee's decision that approved the extension of scope of the project management unit contract amount by R138m. The unit oversees all department projects and was criticised for relying heavily on consultants who cost millions of rands. Mooketsi said the department decided not to approve the decision, and instead authorisation was granted for essential work within priority projects to continue within the available tight budget, as long as they were budgeted for. He said it was decided to use what amounted to cost-effective measures to deal with problems within the department.

Sibongakonke Shoba: Business Day,

A BROKER who negotiated payments in excess of the commission limits from a medical scheme that subsequently went bankrupt has lost his licence and his accreditation as a medical scheme broker. Ettienne de Villiers, who operated as Afrisure, has not only lost his licence to operate as a broker but also has to repay the R5.4 million he took from Publiserve Medical Scheme, plus interest, and foot the legal bill of challenging the scheme's liquidator in court. Brian Watson, the liquidator of Publiserve, initially successfully sued De Villiers and Afrisure in the Cape High Court for the money he was paid by the scheme between October 2000 and January 2001. Publiserve was placed under liquidation in May 2001. De Villiers took the matter on appeal to the Supreme Court of Appeal. In

September, that court dismissed his appeal and awarded costs against him. Subsequently, the Financial Services Board has denied De Villiers and Afrisure a licence to operate as a financial services provider on the grounds that he is not fit and proper. The Council for Medical Schemes has also withdrawn De Villiers and Afrisure's accreditation as a medical scheme broker. The council says De Villiers mostly served members of Selfmed Medical Scheme, who will now have to appoint a new broker if they want one. In 2000 Publiserve, the Public and Allied Workers' Union's medical scheme, was struggling to survive, with only 3 000 members. De Villiers offered to move about 9 000 members on to the scheme. In return, he asked for a R250 placement fee and a R100 ongoing administration fee for each member he moved to Publiserve. At the time, the scheme's administrator, Metropolitan Health, was being paid R58 per member per month. The payments De Villiers received exceeded three percent of members' contributions - the commission limit in terms of the Medical Schemes Act and its regulations. De Villiers also became a trustee of the scheme. The Supreme Court of Appeal upheld the Cape High Court's ruling that De Villiers should repay the money as he had unjustly enriched himself by receiving illegal payments and he breached his fiduciary duties as a trustee by allowing the payments.

Laura du Preez: Personal Finance,

Zelda Venter: The Pretoria News

THE condition of both State and private hospitals and the chronic shortage of medical staff in South Africa have resulted in the courts handling more and more medical negligence cases each year. The Pretoria High Court last week confirmed an agreement made by the Gauteng department of health to pay R600 000 in damages to Bernadette Jooste, the mother of a four-year-old Down's syndrome girl, Brenda, who died following an alleged overdose of ketamine. Earlier this year, R7,3-million of taxpayers' money was paid out after Rochelle Jordaan was blinded when staff at a state hospital failed to properly monitor the amount of oxygen being pumped into her incubator. Adele van der Walt, an attorney who specialise in medical negligence cases, said that since 1994's Constitution, the consumer had become much more aware of their rights. She said patients were entitled to information regarding a diagnosis, risks and alternative treatment and added that it was important that patients read all documents when being admitted to a hospital. An attorney from a leading firm in Pretoria said prospective patients signed such documents usually while under stress and very few read the fine print. He said some hospitals were fair in this regard and first warned people of their rights before having them sign the document. However, he said that in many cases patients were not in safe hands as several hospitals lacked sufficient equipment, nursing staff and proper care. More doctors in private practice were also insuring themselves through the Medical Protection Society (MPC) against things going wrong. This was because they knew they were more exposed these days. The reason why some matters were long and drawn out, he said, was because the MPC employed its own counsel, who often fought until the patient threw in the towel because they could no longer afford the legal costs. However, the attorney added that the MPC would often agree to a settlement in cases of clear negligence. But, he said litigation against the medical fraternity was not easy, as they were a band of brothers who stuck together. The courts usually see a mixed bag of medical negligence cases, but claims arising from something going wrong during birth have increased in number.

Tamar Kahn: Business Day

THE rate of increase in deaths among young adults - the group hardest hit by the HIV epidemic - appears to have slowed since the government began providing AIDS drugs, according to the latest mortality report from Statistics SA (Stats SA). The United Nations estimates 5,7-million South Africans have HIV, the highest prevalence in the world. Stats SA's report shows the number of deaths in people aged between 30 and 34 rose 17% between 2002 and 2003, rising from 47 208 to 55 301. Deaths in this age group climbed a further 5,9% in 2004, rose another 1,7% in 2005 and then fell very slightly (0,3%) in 2006. A similar pattern is seen among people aged between 25 and 29 over the same time period, and the rate of increase in deaths among people aged between 35 and 59 also slowed. Two of SA's leading experts on death data attributed the slowdown to the government's provision of AIDS drugs, which began in 2004. Prof David Bourne, an epidemiologist at the University of Cape Town (UCT) said it was surprising that Stats SA had "buried" this good news in the report. He asked why it was not being shouted from the rooftops. He criticised Stats SA's report, saying it was long on methodological detail but short on commentary. He said AIDS-related mortality was massive, but it was not tackled in the report. There was no discussion of "the huge peak in mortality" among people aged between 15 and 49, he added. UCT demographer Prof Rob Dorrington agreed with Bourne, saying there had undoubtedly been a slowdown in deaths, "consistent with the provision of antiretroviral therapy". The drugs are not a cure, but do slow the progression of HIV. Dorrington said that it was worrying that very little was offered by way of interpretation of the results. The pattern and trend were uniquely associated with deaths due to AIDS and yet Stats SA seemed to be avoiding, almost studiously, even the suggestion that this was an explanation, he said. Stats SA's report, which is based on death certificates submitted to the home affairs department, said the data collected provided "indirect evidence that HIV may be contributing to the increase in mortality among prime-aged adults, given the increase in the number of deaths due to associated diseases", but did not elaborate further. It said total deaths rose 2,3% in 2006 to 607184, up from 593 337 in 2005. Tuberculosis was the leading underlying cause of death, followed by pneumonia and influenza. It put HIV as the ninth leading cause of death, responsible for 14 783 deaths. Stats SA's manager for births and deaths Maletela Tuoane-Nkhasi said the agency saw its job as collecting and publishing death data, not interpreting it. Maletela said the reported slowdown in the rate of increase of deaths in young adults could be explained by changes to the proportion of deaths registered with home affairs, as the completeness of records improved markedly in the early 2000s and flattened out between 2005 and 2006. Her interpretation was rejected by Dorrington and Bourne, who said the slowdown in the numbers of deaths was confined to the age range likely to be receiving AIDS drugs.