Dr Humphrey Zokufa
Pricing, affordability and sustainability were in the spotlight at the Board of Healthcare Funders’ (BHF) Conference, held in Sun City earlier this month.
The conference theme, The Turning Point, was reflected in all the presentations, with the 900 local and international delegates being urged to assess and reassess the role of healthcare funders and providers in South Africa.
The conference opened with a presentation by renowned economist Dr Roelof Botha, who assured delegates that the future for the healthcare industry in this country is bright. He predicted increased standards of living, was confident that the recession is over and predicted 4.5% GDP growth this year. He pointed out that more needed to be spent on health infrastructure and training, but said that he was confident that the healthcare sector was facing a period of unprecedented growth.
Dr Clarence Mini in his Chairman’s Report, told delegates that the BHF had formed an NHI Committee, and had invited Managed Care Organisations to join the BHF as full members from 1 June 2011.
“Their expertise in chronic medication pre-authorisation and hospital benefit management has strengthened the BHF team to be better able to provide strategic leadership by becoming part of a social compact for better health outcomes in line with the National Department of Health’s ten priority areas,” he said.
The ten priority areas were under the spotlight as corporate South Africa looked more closely at its role in healthcare funding. Len Deacon, Director of BHF, pointed out that NHS is just one item on the plan, and that the other nine should not be ignored. He called for corporate South Africa to have a social compact with government, where strategic leadership and teamwork result in better health outcomes.
Teamwork was emphasised in the session which focused on the high cost of cancer care and treatment, with Dr Barry Kistnasamy from the National Cancer Registry and Dr Buddy Modi of Bankmed, both urging increased use of early screening to reduce the prevalence of preventable cancers. Dr Leon Gouws, founder member of the Independent Clinical Oncology Network (ICON) and a cancer survivor,called for a system of multidisciplinary care, where cancer is treated by a team, each member of which has the experience of their core disciplines.
The conference also heard about the challenges facing pharmacists as well as the use of generic and cost effective medicines.
Medscheme’s Professor Praneet Valodia pointed out in his presentation that the legislation to determine fair and reasonable prices for all had certainly been successful, with medicine costs to consumers and to the medical aid schemes only increasing by a total of 30.4% over the past five years. The downside has been that the dispensers of medicines have borne the brunt of these decreases.
Valodia also pointed out that cost effective medicines become cost-ineffective if used badly and irrationally, and pointed to a number of studies which show low adherence to treatment guidelines.
Dr Anban Pillay, Cluster Manager - Financial Planning and Health Economics for the Department of Health, was also concerned with issues of pricing and affordability, saying that the high prices currently being charged for healthcare are “a clear threat to the government’s ability to meet the population’s healthcare needs”.
Of particular interest to delegates concerned about the implications of the NHI in a country with vast income disparities, was the presentation via Skype from Colombia. Dr Ramon Castano-Yepes discussed the financial sustainability of PPPs in health care reform. Colombia is similar to South Africa in terms of population numbers, and has 46.8% of its people living below the poverty line.
He outlined an innovative two-tier model which allowed for a contributed (by employers and employees) and a government-subsidised scheme. Both pay contributions into an equalisation fund which means that the right to healthcare can be enjoyed by all citizens. The model is not without its problems, but it certainly sparked some intense debate.
The conference also heard presentations about the implications of the new Consumer Protection Act. Mamodupi Mohlala, Commissioner: National Consumer Commission outlined a number of the Act’s provisions that have specific bearing on medical schemes, and explained that the medical industry was one of the three earmarked for special investigation this year.
Consumer law expert Matthew Gibson from Edward Nathan Sonnenbergs told delegates that the CMS is considering applying for exemption from the Act on the grounds that the Medical Schemes Act applies. “But the Minister will have to agree that the existing legislation offers the same protection as the Consumer Act ... and the Consumer Act is really comprehensive,” he said.
In his closing statement, BHF Chief Executive Dr Humphrey Zokufa, urged delegates to ‘allow the BHF to work on their behalf’ in response to a letter received by some of the country’s largest medical administrators, questioning their eligibility to be accredited as administrators.
Dr Zokufa was reacting to a letter, sent to some BHF members by the Council of Medical Schemes, saying that it is reconsidering their fitness to be accredited as administrators because they have failed to comply with Regulation Eight in the Medical Schemes Act by paying PMBs in full.
Dr Zokufa urged the administrators to stick together and to challenge the Council’s demands, saying that it was ‘disingenuous’ of the Council to write such a letter when a court hearing on the matter has already been scheduled for September 23 and 24.
Dr Zokufa emphasised that the relationship between the BHF and the Council remained cordial, as was evidenced by the presence of Dr Monwabisi Gantsho, the Registrar of Medical Schemes, who was one of the speakers at the event. PMBs were clearly on his agenda, however. He told delegates in his presentation that the law on payment of PMBs had not changed, and that these claims must be paid in full.
Dr Gantsho placed strong emphasis on the good governance of medical schemes, and warned that compliance officers would be appointed for schemes where governance was problematic.
The keynote speaker at the conference was the Minister of Health, Dr Aaron Motsoaledi who was particularly outspoken about the high cost of private hospital treatment, and called for a stronger emphasis on primary care, rather than the present curative system with its “rapidly escalating” costs.
He told delegates that their concerns over PMBs were “zama zama – you are trying your luck. You are trying to paper over the cracks. Whoever wins, it will not change the system at all. The crux of the issue is to look at what costs what, and is it realistic”.
The conference delegates also heard presentations on:
The conference was ably and entertainingly facilitated by Dr Victor Ramathesele.
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