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HMI talks PMB’s, price, regulation

The Health Market Inquiry heard today (23 February 2016) from health care professionals in the ongoing public hearings held by the Inquiry’s esteemed Panel headed by former Chief Justice Sandile Ngcobo.

Dr King, a cardiologist at Sunninghill Hospital, started the day discussing prescribed minimum benefits, particularly in relation to medicines. Dr King said that the formularies for medicines set by each medical scheme disrupt the physician’s ability to the do the best for their patients and suggested that this practice compromises the quality of care for patients. Dr King told the panel about the way he manages his practice to bring down hospitalisation rates of patients, which ultimately saves the schemes money and is in the best interests of the patient. However, he indicated that the schemes and their administrators are more interested in short terms savings than long term savings or long term health benefits of the patients.

Dr King was concerned that the incentives of the medical staff sitting on the schemes’ clinical committees, and who made decisions on the clinical care of patients, were skewed to save money for schemes but were not necessarily in line with the best interests of patients.

In answer to questions from the Panel about the possible use of an independent reference group to address clinical differences between schemes and practitioners, Dr King agreed but said that such a group would have to involve a large number of practitioners, whose tasks would include the drafting of guidelines that could be used to adjudicate such differences. Such capacity is limited in South Africa.

The Panel questioned Dr King about the levels of trust between health practitioners and medical schemes has previously been raised in these public hearings and also came up in the presentation by the Occupational Therapy Association of South Africa (OTASA). The chair of the Panel, former Chief Justice Ngcobo, said that he is troubled by what appears to be the diminishing faith in the HPCSA, and asked OTASA directly how that faith can be restored. OTASA said that the HPCSA needs to be more responsive to the needs of the profession and provide support and guidance to practitioners.

The Pharmaceutical Society of South Africa told the Panel about the highly regulated nature of the pharmacist profession. There are approximately 12,500 pharmacists in South Africa, all of whom are bound by provisions of the Pharmacy Act, the Medicines and Related Substances Act, the Medical Schemes Act and others. The Society argued that the rules of medical schemes affect the income of pharmacists, which on the whole is very limited.

The Pharmaceutical Society of South Africa (PSSA) argued that because dispensing fees and medicine prices are regulated by law, it was an unnecessary restriction on the profession to have negotiated designated service providers (DSPs). These arrangements simply cut out those pharmacists who are not DSPs but who, presumably, would provide the service at the same cost to the scheme. It was argued that this mostly affects smaller pharmacies. However, the Panel in a later discussion with the Independent Community Pharmacy Association suggested that DSPs are not just about the dispensing fee alone but includes a range of contractual obligations between the health service provider and the schemes.

Just like the Southern African HIV Clinicians Society (SAHIVSOC) did in their presentation on 17 February, the Pharmaceutical Society complained about the use of courier pharmacies by schemes as a method of delivering medicines directly to members. The Society addressed the actual service that goes along with the delivery of medicines, including counselling, discussion about side-effects and correct dosages etc. This value added service that goes along with pharmacy services, is missing when couriers simply deliver medicines. The SAHIVSOC complained in particular that schemes will unilaterally change a patient’s dosage without consultation with the prescribing doctor, which has an impact on clinical outcomes.

The Occupational Therapy Association of South Africa (OTASA) stated that they received many calls from occupational therapists who were unsure about how to charge for their services, which indicates the need for a benchmarking system of tariffs, associated with procedural codes. OTASA said that even though they have confidence in their colleagues in the board of the HPCSA, there are operational challenges, possibly relating to resources, and the HPCSA had not adapted to the growth in numbers of occupation therapists in South Africa. The HPCSA was also delaying the finalisation of a revised scope of practice drafted by the occupational therapists, which is important when it comes to coding and reimbursement of the therapists for their services.

On Wednesday, 24 February 2016, the hearings will commence with the South African Medical Association and the South African Private Practitioners Forum.

For more information contact:

Umunyana Rugege on +27 83 458 5677 or rugege@section27.org.za

Luvo Nelani +27 79 381 8521 or nelani@section27.org.za

 

 

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