1. Challenges and Solutions : Private Healthcare Industry
Squaring
the Circle
Panel Discussion: HPCSA PERSPECTIVE
BY ADV. BOYCE MKHIZE
CEO AND REGISTRAR : HPCSA
25 JULY 2007
SUN CITY
The BHF Southern African Conference July’07 Sun City

2. Challenges and Solutions : Private Healthcare Industry
Squaring
the Circle
Key Question?
Should we be talking Private healthcare Industry Solutions to the utter neglect of the totality of the Healthcare Industry?
The BHF Southern African Conference July’07 Sun City

3. The BHF Southern African Conference 22-25 July’07 Sun City
The Scary Picture!
Squaring
the Circle
Everyone feels squeezed
- practitioner not compensated adequately
- schemes feel drained and overdrawn
- patients feel over-charged and unable to meet costs
The BHF Southern African Conference July’07 Sun City

4. The BHF Southern African Conference 22-25 July’07 Sun City
The Scary Picture!
Squaring
the Circle
- hospitals feel practitioners are out to squeeze them
- public sector feels like a dumping ground, overloaded and under- capacitated
- Govt battling with cost containment strategies
- Pharmaceuticals with medicine price
Everybody is unhappy!
The BHF Southern African Conference July’07 Sun City

5. The BHF Southern African Conference 22-25 July’07 Sun City
The Scary Picture!
Squaring
the Circle
Private healthcare expenditure increase at rate double that of inflation, as far back as 1996,1998
1998 : increase from R24.7b to R33.3b
The BHF Southern African Conference July’07 Sun City

6. The BHF Southern African Conference 22-25 July’07 Sun City
The Scary Picture!
Squaring
the Circle
Stagnation in numbers of access to private health insurance : multiple factors
- failure to match contributions to expenditure
- erosion of reserves
- reinsurance premiums etc
The BHF Southern African Conference July’07 Sun City

7. The BHF Southern African Conference 22-25 July’07 Sun City
The Scary Picture!
Squaring
the Circle
Problem is bigger than healthcare providers and hospitals (private)
Commercial considerations vs ethical behaviour
Complicated and intricate web of power play between multiple healthcare players : hospital, practitioner, funder, patient and regulators
The BHF Southern African Conference July’07 Sun City

8. Healthcare Providers & Hospitals
Squaring
the Circle
Commerce vs Medicine
- hospitals bottom line driven and thus motivated to create schemes that would open gateway to hospital beds optimum occupancy despising the means
- healthcare providers enjoy benefits in exchange for meeting targets at the expense of patients
The BHF Southern African Conference July’07 Sun City

9. Healthcare Providers & Hospitals
Squaring
the Circle
Commerce vs Medicine
- Inducement and influence to act contrary to ethical codes quite strong especially because of a win- win situation : hospital gets its profit while practitioner enjoys the incentive!
- Reimbursement model : fee for service [ source of inducement]
The BHF Southern African Conference July’07 Sun City

10. Healthcare Providers & Hospitals
Squaring
the Circle
Capacity and Skills
- Powerful and untouchable few!
- Take it or leave it attitude
- Law of Economics : Demand & Supply [Scarcity of resources – determines the rules of play]
- Peer review mechanism erosion [quality concerns]
The BHF Southern African Conference July’07 Sun City

11. Healthcare Providers & Hospitals
Squaring
the Circle
Reimbursement Methods
- Fee for Service
- Capitation
- Managed health care
- Co-payments
- Insurance : Restrictions vs PMBs
Reality : someone is unhappy irrespective of which method!
The BHF Southern African Conference July’07 Sun City

12. The BHF Southern African Conference 22-25 July’07 Sun City
Billing Practices
Squaring
the Circle
Ethical Tariff vs NHRPL
- Ethical tariff provides a guide for determination whether there has been overcharging [it’s not the target]
- NHRPL : benchmark for reimbursement by schemes
- Above rate payable by schemes obtain patient consent
The BHF Southern African Conference July’07 Sun City

13. The BHF Southern African Conference 22-25 July’07 Sun City
The Ethics Discourse
Squaring
the Circle
‘The desire for money is a powerful motivator and our special brand of capitalism has relied on this incentive to make our country one of the most prosperous in the world. Most doctors eschew any commercial arrangements that might compromise their professional values, yet some have not resisted the buzz of the marketplace that values a profitable bottomline & promises…..
The BHF Southern African Conference July’07 Sun City

14. The BHF Southern African Conference 22-25 July’07 Sun City
The Ethics Discourse
Squaring
the Circle
‘enormous personal wealth. Today, the income of many practitioners is several hundred thousand dollars or more and for some joining the ranks of academic medicine can be a ticket to great wealth and privilege. Given the expertise of our practitioners and researchers in diagnosing and curing us and in finding new and better tests and treatments….. …..
The BHF Southern African Conference July’07 Sun City

15. The BHF Southern African Conference 22-25 July’07 Sun City
The Ethics Discourse
Squaring
the Circle
……,few of us would begrudge them such wealth as long as we are confident that they are always using their talents and diagnostic tools in our best interest. But are they?
…The time has come to ask whether all of the money floating around in medicine has created a pattern of corruption.
The BHF Southern African Conference July’07 Sun City

16. The BHF Southern African Conference 22-25 July’07 Sun City
The Ethics Discourse
Squaring
the Circle
..’to be a good doctor requires a life-long commitment to good professional and ethical practices and an overriding dedication to the good of one’s fellow humans and society. In essence the practice of medicine is a moral enterprise.’
Pellegrino ED, Medical Professionalism: Can it, should it survive? J AM Board Fam Pract 2000:
The BHF Southern African Conference July’07 Sun City

17. The BHF Southern African Conference 22-25 July’07 Sun City
The Ethics Discourse
Squaring
the Circle
Patients must be able to trust that their doctors’ motives are not subverted by financial gain, that their doctors are recommending treatments that benefit them, that their doctors are involving them in research projects for the right reasons….’
The BHF Southern African Conference July’07 Sun City

18. The Challenged Solutions?
Squaring
the Circle
The future
- problem of disintegrating the healthcare cycle
- problem of different bargaining positions and strength
- Disjuncture between Non- regulation and regulated
The BHF Southern African Conference July’07 Sun City

19. The Challenged Solutions?
Squaring
the Circle
The future
- Stringent regulatory regimes cutting across the value chain [harmonisation]
- Rigorous practice protocols
- Accountability mechanisms and structures
The BHF Southern African Conference July’07 Sun City

20. The Challenged Solutions?
Squaring
the Circle
The future
- Review of reimbursement models
- Openness and transparency
- Cost-cutting measures
The BHF Southern African Conference July’07 Sun City

21. The Challenged Solutions?
Squaring
the Circle
The future
- State intervention in the provision of healthcare : access, affordability etc
- Private Public Partnerships
The BHF Southern African Conference July’07 Sun City

22. The Challenged Solutions?
Squaring
the Circle
The future
- Review of training modalities: possibly two streams, generalists and mini- specialised (Cuban)
- fast-track supplementary professions
The BHF Southern African Conference July’07 Sun City

23. The Challenged Solutions?
Squaring
the Circle
Clubbing together of Medical Schemes : Practitioners’ Bargaining Power: patients bargaining power????????
The BHF Southern African Conference July’07 Sun City

24. The BHF Southern African Conference 22-25 July’07 Sun City
Squaring
the Circle
Thank You
The BHF Southern African Conference July’07 Sun City