Category Healthcare
SUB CATEGORIES General  |  HIV |  Medical Schemes | 

Unravelling health regulation and costs

17 July 2006 Neil Kirby, Werksmans Attorneys

In South Africa, the traditional western approach toward medicine and medicine regulation is changing, and the country is embracing a broader range of treatment options.

Neil Kirby, Director of Healthcare and Environmental Law, Werksmans Attorneys provided a fascinating insight into current health legislation at the annual conference of the Board if Healthcare Funders in Durban.

South African law deals with generic and patent medicines, he said, these are substances which make health-related claims and are registered. Complementary medicines on the other hand are not registered and thus not subject to medicine pricing regulations.

He pointed out that Allied Health Professions adopt alternative health practices which differ from modern medicine in that they take a holistic perspective, considering the whole body, including emotions, mind, spirit and lifestyle. In other words there is more than one system of healing and it is important that the law respond adequately and accurately to support the integrity of the allied health professions, Kirby stressed. The recent Allied Health Professions Act aims to regulate and endorse this sector. An Allied Health Professionals Council has been established to consider all issues related to this sector, particularly in terms of accountability, responsibility, democratisation and transparency of the professions. Thus the Allied Health Professions will be regulated in the same way as formal medicine. This is an attempt to equalize the two sectors. In other words, South Africa has elected not to regulate the Allied Health Professions within the parameters of the existing health profession, but has established a second set of legislation. This, he believes, could be setting trends for the rest of sub-Saharan Africa as well as influencing attitudes in third world countries such as Brazil and India.

The allied health professions and the traditional formal medicine sector are underpinned by different ideologies: the latter based on diagnosis, prevention and treatment and the former on the promotion of health and relief of physical or mental defects of disease. Thus their means to attaining the objectives differ. Alternative medicines are not those defined in the Medicines Act whose provisions apply only to medicines registered in terms of that Act. So as things stand, the ability of the allied health professions to perform the task of primary healthcare service with safe, registered medicines is frustrated. Consequently, a resolution is needed to bring complementary medicine regimes into line with medicine regulations. South African law has to respond with flexibility by introducing legislative amendments to promote the allied health professions.

The National Health Policy relates to all national health issues as approved by the Minister of Health, Kirby continued. There is an increased volume of legislation dealing with policy-making powers, regulating national health and providing uniformity in the delivery of health services on a national basis, combining resources to achieve greater access, establishing the rights and duties of healthcare providers, users, establishments and the like, protecting and respecting the right of access to healthcare services for all the people of South Africa. Unfortunately, despite a plethora of representatives from various local provincial and regional government departments, there is no representative from the private healthcare sector This means there is a real risk that future policies will fall short of the realities faced by the private sector and the provision of healthcare services.

There are discrepancies in the private sector concerning tariffs and this leads to uncertainty about what medicines should cost. Kirby stressed that the proposed Government Employee Medical Scheme (GEMS) and the Low Income Medical Scheme (LIMS) were controversial and would be in the forefront of policy-making in the future. It is important the private sector provide clarity on the issue, he emphasized. We must use opportunities like this conference to move forward on a collective recommendation on price otherwise policies may be prescribed to the private sector by Government.

Enthusiastic audience participation revealed a hung house on the question about whether current legislation, such as the Charter, pricing regulations, the Risk Equalisation Fund, GEMS, Prescribed Minimum Benefits, LIMS and the Social Health Insurance would be effective in achieving their objectives. General opinion revealed a deep-felt need for more debate and discussion in terms of both policies and mechanisms to achieve common goals. The paucity of representation from the private sector was a great cause for concern. An effective forum is still needed so that government and private sector can talk to each other more effectively.

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