Insights

Round one of the HMI: Interpreting X-rays

Shivani Ranchod 11 March 2016   The first round of public hearings for the Competition Commission Health Market Inquiry (HMI) wrap up today. For those of us who have been obsessively following the proceedings it will be a relief to have a break before the next round. As one commentator tweeted: “Spellbound”. It has been a fascinating series of presentations from across the private health sector: medical schemes, administrators, hospital groups, individual patients, brokers, regulators, policymakers and various practitioners groups. If you were to read the media reports the overwhelming sense you would get is of an industry in trouble. Unsurprisingly the media [...]

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Truvada: holy grail or poisoned chalice?

Guest post by Leigh Johnson On Tuesday, 8 December 2015, South Africa’s Medicines Control Council approved the use of Truvada for HIV prevention. Truvada, a combination of two antiretroviral agents, has been shown to be effective in preventing acquisition of HIV in people who take the drug regularly. It is one of two drugs commonly used in ‘pre-exposure prophylaxis’ (PrEP), which refers to HIV-negative people taking antiretroviral drugs prior to sex in order to reduce their risk of HIV infection (the other drug that is often used in PrEP is tenofovir alone). Here we consider a few of the key [...]

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Low Cost Benefit Options: Doomed from the beginning?

Andre Bellingan The medical schemes industry was taken aback when the Council for Medical Schemes retracted its framework for Low Cover Benefit Options (LCBOs) on 12 October 2015, barely a month after it had been published at the end of a consultative process.  It appears that this retraction was at the behest of the National Department of Health, which had received a number of submissions that objected to aspects of the LCBO framework.   The “mandatory minimum” package of benefits as well as the tests and treatments mandated by the LCBO framework was criticised by parties such as the South African Medical [...]

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The lights go out one by one

Shivani Ranchod I have an uncle in his seventies who says that ageing hasn’t been too bad. Luckily, he says, the lights go out one by one. What he means is that your capacity diminishes slowly – giving you time to adjust to each loss. It seems that I have been reading and thinking about ageing a lot lately. It started with Tracy Kidder’s book “Old Friends”. It’s a gentle exploration of the inhabitants of a nursing home: their friendships, tragedies and idiosyncratic journeys to arrive there. I found the book utterly depressing but could not put my finger on why. [...]

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Transformation is not (just) an agenda item

Shivani Ranchod More than twenty years into South Africa’s democracy and we still struggle with what the notion of “transformation” means (never mind how to actually achieve transformation, a struggle on an entirely different scale). It is not entirely surprising given the nebulous and deeply personal nature of the issue. My understanding of transformation comes from my own sense of identity, and my own life experiences. I cannot speak for others, except perhaps to point out that which is clearly not transformation. Having a social responsibility committee where you delegate responsibility for transformation is not transformation. BEE is not transformation. [...]

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Conflict Or Collaboration

Conflict or collaboration – a choice that faces all stakeholders in the healthcare industry. In a sense, the BHF is one area of collaboration that already exists in the healthcare funding industry. To be sure there are many areas for potential conflict. There is a scarcity of resources in healthcare, and so market participants compete for their share. This is an unavoidable reality. What matters is how these shares of resources are allocated. There are many tensions to keep in balance, and many factors to consider – equity, efficiency and efficacy. Among the models for balancing these tensions are [...]

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Benefit Design

At the recent BHF conference we had an opportunity to talk about benefit design – an area that is top of mind for schemes at the moment as 2016 pricing is finalised and preparations are underway to take 2016 products to the market. During this time of year benefit design can feel like just a part of the annual pricing process – a means to an end, a box to be ticked. But in reality benefit design is fundamental to the existence of a medical scheme. Benefit design determines what goods and services are purchased and how rationing decisions are [...]

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Leadership And Accountability

The theme for the BHF conference 2015 was “shared accountability: partnering for success”. This theme, together with leadership, explicitly and implicitly dominated both the formal and informal conversations throughout the conference. The South African private health care industry is at a critical point in its story for several reasons some of which will be highlighted here and all of which point to the need for greater leadership and accountability. Firstly, there are several policy documents that have recently been released, are awaited, are nearing finalisation or are out for comment relating to inter-alia medical scheme regulation, National Health Insurance, demarcation, the [...]

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Efficiency Discounted Options: Will they save the industry?

Efficiency Discounted Options (or “EDOs”) offer an appealing value proposition to medical scheme members. In return for undertaking to make use of a network of healthcare providers you can pay less for the same benefits compared to the price on the option that allows you to visit any healthcare provider you choose. The logic underlying this is that the network of healthcare providers is more efficient and that the efficiency savings are passed along to members. The general consensus is that such an arrangement is desirable. To quote from the Council for Medical Schemes Annual Report 2013/2014: Benefit options with network [...]

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