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 Preferential Procurement Policy Framework, the Road Accident Fund and BBBEE. They are all likely to (fundamentally) change the way businesses and schemes in the sector do business one way or another.

Whether this is for the better or not, will depend on both the quality of engagement and thinking of all the role-players that comment and participate in the relevant discussions, to influence the final decision made. It will also depend on the accountability that the leadership in every organisation must take in making sure that the way the changes are implemented iteratively leads us to a better state of being.

To illustrate this point, there was extensive discussion at the BHF conference, and in the media, on the proposed change to Regulation 8 of the Medical Schemes Act. Very little of the commentary or positioning has shown sufficient critical interrogation, clarity of ideas and solutions, or clear articulation of the facts, to ensure that the Regulator and industry make the right decisions at the right time, and that medical scheme members understand the value of such decisions. Much air time has been spent blaming, defending or posturing in a non-engaging and non-progressive manner. The deputy director general, did however, end his session by requesting alternative ideas and promising further engagement to try and bring the issues and solutions to the fore.

There was some discussion at the conference which related to some policy decisions that are required to ensure the sustainability of the industry. These included the Low Cost Benefit Options, the need for risk equalisation and risk-based capital. Of great concern is the over-a-decade-long inertia that the industry has experienced in decision-making and implementation of these matters, resulting in the quite-evidently unsustainable position we find ourselves in. The pivotal comment was made on this matter: “there is huge value in smaller incremental reform, rather than waiting for mega reform”.

Secondly, the Competition Commission Market Inquiry into Private Health Care, and the recurrent media pieces on the cost of private healthcare, have resulted in industry-wide hard work and anxiety in the past year. While the need for such an inquiry and the issues raised by the various organisations in their submissions to the Commission has not been surprising, the extent to which the notion of shared accountability has been impeded by the levels of mistrust and some frank animosity between various industry players has been somewhat alarming. The tensions between all the industry players – providers, administrators, schemes, regulators and industry bodies alike – was palpable throughout the conference.

Through the formulation of a road map for the private healthcare sector, and the related engagements, BHF intended to pull together the leaders of this fragmented industry and galvanise the industry toward partnership and taking joint accountability for the creation of an improved, sustainable healthcare system.   The level of focus of the programme and willingness to engage before and during the BHF conference, as well as at the work stream sessions, was positive and encouraging.

The true value of the roadmap and all the work done thereon thus far, will however be shown in the momentum created and progress made in the ensuing months where the roadmap will be further consolidated and then hopefully implemented, through the six work streams that were formed at the conference The success of this rests squarely on the leadership of industry organisations and the level of partnership with each other: in having all the required engagements which were agreed and then making requisite decisions.

The third theme that emerged from the conference regarding leadership is that of the nature of leadership, especially as it pertains to the regulatory bodies. During three very passion-filled plenary sessions, namely “The legal status of CMS circulars”, “Creating access through collaboration: oncology treatment protocols”, and “Regulation 8 amendments”, issues relating to the way regulatory bodies communicate to or engage with the industry, the nature and quality of decisions made and the need for more rigorous and regular review of policy was highlighted. It is hoped that the new head of CMS will raise the bar in this regard because the leadership role of CMS is crucial at this stage. CMS is a critical interface between funders, providers, and the Ministry of Health. Brokering and maintaining healthy relationships between these role players is fundamental to the resolution of some of the more urgent matters at hand.

The overwhelming and undeniable conclusion at the end of the BHF conference was that now is indeed the time for leaders, whether in given positions of authority or not, within the private and public health sectors in all the SADC countries represented to rise up and lead.

Insight was pleased to be actively participating in the leadership discourse during the BHF conference – whether presenting, chairing, participating in panel discussions or contributing from the floor. We are especially proud of Lungi Nyathi winning the Titanium Young Achiever Awards. In all the six pillars of an effective health system, Insight continues to play a role in driving meaningful dialogue and interrogation, as well as providing the analysis, technical rigour and deep expertise to enable accountability and informed decision-making across all the industry players.