PrivatePracticeReview2April2021 Viewinwebbrowser

NOTICEPrivatePracticeReviewpresentsthereaderwithasummaryofthemostrelevantbreakingnewsinthelocaland

globalhealthcareindustry,asobtainedfrommediasources,includingthepublicbroadcaster,independenttelevisionbroadcasters,independentnewsagencies,newspapers,radioandnewssites.HealthManstrivestoquotethe

OriginalSource.HealthMancompilesthisinformationtoprovidethereaderwithabriefoverviewofthemostrecenteventsanddevelopmentsastheyarereportedinthemedia.TheviewsandopinionsexpressedinPrivatePractice

ReviewarethoseoftheauthorsofthemediasourcesanddonotnecessarilyreflecttheviewsoropinionsofHealthMan,itsdirectors,employeesandassociates.

InthisNewsletterFoodforThoughtNewsfromGovernmentSpecialNewsFinancialNews

PharmaceuticalNewsGeneralNewsNewsfromMedicalAidsCircularsfromtheCMSSpecialNotes

FOODFORTHOUGHT

THEBADNEWS:

ThisishowSA'shealthdepartments(mis)spend

publicfunds“Therecentlyreleased2019/2020auditoutcomesfornationalandprovincialdepartmentsshowedsomeimprovements,butfortheumpteenthtime,itis

dwarfedbyaverygrimpictureofpersistentwastage,financialmismanagementandlittletowhollyinadequateconsequencesforthoseresponsible,”

wroteAllestineOctoberinanin-deptharticle(Spotlight20April2021)

Forexample:TheGautengDepartmentofHealth’sbudgetforclaimsin2019-20wasR2,6-m,buttotalclaimsofR501-mwerepaidoutfortheyear.Thedepartment‘transferredsavingsfrom

otherlineitemswithinthebudgettoclaimsfromthestateinordertopaytheclaims.Theresultwasthatkeyvacantpositionswerenotfilledatsomehospitals.

StatisticsreleasedbytheMinisterforPublicServiceandAdministration,SenzoMchunu(February2021)revealedthatmorethanathird(3301)ofthe9477seniormanagersinthepublicserviceregisteredonPersaldidnothavetherequiredqualificationsforthejob.Inprovinces,mostofthemwereinhealthdepartments.AccordingtoZukiswaKota,programmemanageratthePublicServiceAccountabilityMonitor(PSAM)therearefourriskareashighlightedintheauditreportoutcomesthatareworthseriousattention.“Procurement,planning,parastatalsand(linkedtoitall)politics.”

ToreadtheSpotlight-article,clickonthelinkbelow

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SouthAfrica‘sAuditor-Generalhaswarnedthatwithouturgentintervention,anumberofprovincialhealthservicesfacecollapse,wroteMedicalBrief.(22April2021).

Outstandingmedico-legalclaimsamounttoR105.8-bn,withfivehealthdepartmentsfacingclaimsinexcessofthisyear’sentireoperationalbudget.

Alsoread:NewsfromGovernment:'ConCourtconfirmsalternativecompensationremedyfornegligence'

THEGOODNEWS:

DrDulcyRakumakoe:'Buildinganempireofaffordablehealthcare’

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DrDulcyRakumakoe,CEOof10clinicsinGauteng,decidedtogointomedicinesothatSouthAfricanslikehergrandmotherwouldnothavetowaitforhoursto

seeadoctor.–ElnaSchütz,BusinessMaverick(12April2021)

AtQuadcaremedicalcentresaroundGauteng,suchasinAlexandraandEdenvale,onecanseeadoctorandgetbasicmedicationsforabasefeeofR350.Profitabilityisbased

onhighturnoverandcarefulmonitoringofprocessesandresources.Thegrouphopestoexpandtoabout30centresinthenexttwoyears.

Toreadmore,clickonthebuttonbelow

'Experts'aboutCOVID-19:Fake,FictionorFaction?

OnMarch30,NickHudson,co-founderoftheglobalthinktankPANDA(Pandemics-dataandanalysis)gavethekeynoteaddressattheinauguralBizNewsInvestment

Conference:TheUGLYtruthabouttheCovid-19lockdowns

"Wehavebelievedfromthegetgothatitwaswrong,onanumberoflevels,toclosesocietydownandthatithasalwaysbeentimetoreopensociety.Wealsobelievethatthe

truthonlyprevailsifplansaretakentobringittolight.Ourworldisgrippedbyfearandthatfearisverymuchtheproductofafalsenarrative."Towatchthevideo,clickonthebuttonbelow(left)

Hudson'skeynoteaddresscausedwide-spreadreactionregardingpolicymaking,targetedprotection,testingforthedisease,maskwearingandvaccines,towhich

PANDA(NickHudson)responded.Toreadtheresponse,clickonthebuttonbelow(right)

TheUGLYtruth PANDAresponds

NEWSONGOVERNMENT

COVID-19rollout:

Private-sectorstillwaitngonDepartmentofHealth

TheNationalDepartmentofHealthhasyettofinaliseapricingstructureforCOVID-19vaccinesfortheprivatesector,leavingmedicalschemesandhealthcareproviders

unsurehowtomakefinancialprovisionfortherollout,reportedBusinessLIVE(20April2021)

AlthoughHealthMinisterZweliMkhizesaidmedicalschemememberswillbeexpectedtohelppayfortherollouttonon-members,theMedicalSchemesActrestrictspaymentstoschememembers.

Thefollowinghasnotbeenfinalised

Accreditedprivatesectorvaccinationsiteswillbepaidanadministrationfeetocoverprofessionalfeesandthecostofconsumables,andwillbereimbursedbymedicalschemes,butthesecostsarestillbeingcalculated;TheDoHreceived24bidstoprovidetransport,warehousinganddistributionservicesforCOVID-19vaccines,buthasyettoawardthetender.

Thefollowingisstillnotclear:

Howmuchthepricepaidbymedicalschemeswilldifferfromthepricethegovernmentpaystovaccinesuppliers;Howthefeespayabletohealthcareproviderswillbepegged;andHowprivatehealthcareproviders,suchaspharmacies,aretobecompensatedfordispensingvaccinestostatepatients.

ConstitutionalCourtconfirmsalternativecompensationremedy

fornegligence

FollowingaConstitutionalCourtjudgement,SAcourtswillnowbeabletoconsiderorderingalternativecompensation–insteadofalump-sumpayment–to

thoseinjuredasaresultofmedicalnegligence,

"TheConstitutionalCourtjudgmentinvolvedanapplicationforleavetoappealagainstajudgmentoftheSupremeCourtofAppeal(SCA).

"Thepossibilityofprovidingphysicalitemsorstatemedicalservices,insteadofmoney,willbewelcomedbytheprovincialHealthDepartmentswhofacestaggeringmedical

negligenceclaims,"reportedMedicalBrief(14April2021).

Inthispastfinancialyear,EasternCapeHealthpaidoutR920-monmedicalnegligenceclaimsandKZN'smedicalnegligenceclaimsincreasedbyR3-bninthe

2018/2019financialyeartoR23-bnin2019/2020.

Johnson&Johnsonvaccinationrollouton

trackagainaftersuspension

FromWednesday,April28,SA’sJohnson&JohnsonSisonke“TOGETHER”COVID-19vaccinetrialrolloutforhealthcareworkers,isbackontrackwitharevisedimplementation

protocol.TheprogrammewaspausedonApril13,afterdiscussionsbetweentheSAMedicalResearchCouncil,theHealthMinister,andresearchersaboutwhethertopause

administeringtheshotsuntilthereisgreaterclarityonthepossiblelinkbetweenthevaccineandtheblood-clottingeventsreportedintheUSandEurope.Firstinlinewillbe

afurther200000healthcareprofessionalsandthenpeopleolderthansixty.

VaccinecontractsawardedThegovernmenthasawardedcontractsforimportinganddistributingCOVID-19vaccines,whichisduetobeginon

May17,reportedBusinessDay(23April2021).

BiovacandImperialLogisticshavebeenappointedtoprovideimportationservices,whilethejoboftransporting,warehousinganddistributingthevaccineshasbeensplitbetweenBiovacandDSVHealthcare.Biovacwillcoverallthecoldchainrequirementsforvaccinesthatrequirestorageat2°Cto8°C,at-20°Cand-70°C.DSVHealthcarewillonlyprovideservicesforvaccinesrequiringstorageat-70°C.Athirdcompanyisexpectedtobeappointedshortlytoassistwiththe-20°Cservices.

SPECIALNEWS

Whenconditionskeepchanginginbothyourbusinessandpersonalcircumstances

Theglobalpandemichighlightedhowunpredictablethefuturecanbe.Thatsaid,therearemanyunexpectedeventswecanpreparefor.Overthelasttwelvemonths,thefocusturnedtoriskmanagementandhowitcanhelptosafeguardourfuturelifestyles,stress

andcomfortlevels.Yourbusiness,home,carandotherassetsarevaluableandarethereforesusceptibletodamageandtheft.Short-terminsuranceisthemostaffordable

waytomitigaterisktoyourvaluables.

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Clickheretoreadmoreaboutthefacility

FINANCIALNEWS

Dis-Chem&Clicksgearupforvaccineroll-out

Dis-ChemhasrecentlyannouncedthatitisplanningforthenextstageofthevaccinerolloutinpartnershipwithBusinessforSA(B4SA)andtheDepartmentofHealth.Thecompanyisnegotiatingwithlandlordsandretailersaswellasnursingagenciestosupplythevaccinationservicesthatthe191Dis-Chemstoresplantoprovide.

AccordingtoClicksCEOVikeshRamsunder,theretailerhasthenecessaryinfrastructure,includingmorethan600pharmaciesand192clinics,tohelpfacilitatethevaccinationroll-out.ClicksandDis-Chemwillalsobeabletodistributevaccinestoothervaccinationsites.

ChantalMarx,headofinvestmentresearchatFNB,saidusingDis-ChemandClicksaspartofthevaccinerolloutis“averycleverwayofscalingdistributionandmakesperfectsense”.ClicksandDis-Chem“won’tbemakinganymoney”,butsheexpectsin-store

salestospikeasthenewlyvaccinatedwaittherequired15minutesafterthejabtoensurethattherearenoside-effects.

PHARMACEUTICALNEWS

Vaccineclaimantsgiveuprighttosue

IntermsofnewregulationsforthecompensationfundSouthAfricanswhoclaimfromaCOVID-19vaccineinjuryfundwillgiveuptheirrightstoapproachthecourtstosuethegovernmentorhealthworkers,shouldtheysuffersevereinjuryfromtakingtheinjection

ThisfollowsasdrugcompaniesprovidingvaccinestoSA,likeJohnson&Johnson(J&J)andPfizer,insistedonano-faultcompensationschemerunbythegovernmentasaprerequisiteforsupplyingthevaccines.

TheregulationswerepublishedonApril22.However,itisnotclearfromwhichdepartments’budgetthegovernmentwillsourcemoneytopayclaims.

BrainclotsfarmorelikelyfromC-19thanvaccines

ReutersreportedonApril15,thataccordingtoBritishresearchthereisamuchhigherriskofbrainbloodclotsfromCOVID-19infectionthanthereisfromvaccinesagainstthedisease.

Theresearcherssaidinapre-printstudythattheriskofCVSTwaseightto10timeshigherfollowingCOVID-19infectionthanitwasfromexistingvaccinesforthedisease.TheresearchersfromOxfordUniversity,highlightedthatCOVID-19wasassociatedwithmorecommonclottingdisordersthanCVST-suchasstrokes-andthatrecentdebatearoundvaccineshadlostsightofhowbadthediseaseitselfcouldbe.TheteamworkedindependentlyfromtheOxfordvaccineteamwhichdevelopedAstraZeneca’sshot.

Malariavaccinetrialresultsmayindicatea‘game-changer’ThefirstmalariavaccinetomeetaWorldHealthOrganisation(WHO)-specifiedgoalofmorethan75%efficacyhasbeendevelopedbyscientistsattheUniversityofOxford,

reportedReuters(23April2021).TheshotusesMatrix-Madjuvanttechnologyandwasusedintrialsinvolving450childrenages17monthstofiveyearsinBurkinaFasoand

“waswell-tolerated”,theteamattheuniversity’sJennerInstitutesaid.TheSerumInstituteofIndiahasagreedtoproducethemalariavaccineonceapproved.

LesothogrowerisAfrica’sfirsttosellmedicinalcannabis

flowertoEUALesotho-basedcannabiscultivator,MGHealth,hasbeenapprovedbytheEuropeanUnion(EU)asthefirstmanufacturerinAfricatoexportthemedicinalcannabisflowerasanactivepharmaceuticalingredienttotheEU,reoprtedBusinessInsider(16April2021).MGHealthoperatesacannabiscultivationandmanufacturingfacilityinthemountainousregionnearMohaleDam.

MeanwhiledoctorsinOntarioinCanadaarestillhesitanttoprescribemedicalcannabistopatientssufferinglong-termpain–20yearsafteritwasfirstintroducedanddespitehundredsofthousandsofCanadiansusingmedicalcannabis–accordingtoastudypublishedintheCanadianMedicalAssociationJournal.

GENERALNEWS

QualityofHIVcarehigherinclinicsthanhospitals

AccordingtothelatestresearchfromWitsUniversityandBostonUniversityintheUS,HIVpatientsinSA

experience

hugegapsinthequalityofcarealthough96%ofSouthAfricanslivewithin10kmofahealthcarefacilitythatprovidesantiretroviraltreatment(ART).

Qualityofcarewashigherinclinicsversushospitals;inruralhealthfacilities

ratherthanurbanareas;andinlargerfacilities.Qualityofcarewaslowerinareaswithgreaterpoverty.

KZNscoredbestandLimpopoworstonstartingtreatmentontime,retainingpatientsincare,suppressingviralloadandmonitoringpatientsfortreatmentfailure.Researchers

areconvincedthattargetinglow-performingfacilitiesforadditionalsupportcouldreducetheoverallburdenofdiseaseandunderstandingthedifferencesinqualityofcareover

timecouldguideinterventionstoimprovehealthoutcomes.

SouthAfrica'sCoronavirusUpdate:(28April2021)CasesReported:1,578,450

Deaths:54,285Recovered:1,503,611

SA’s‘sugartax’showsresultsAccordingtoaseniorresearcherat

Priceless-SA,thelateststudyhasfounda51%reductioninsugar,a52%decreaseincaloriesanda29%reductioninthevolume

ofbeveragespurchasedperpersonperday.Thisfollowstheimplementation,in

2018,ofSA’s“sugartax”.Thee-studywasrecentlypublishedin

LancetPlanetaryHealth.Thestudyhighlightedthatthe

announcementandimplementationofthetaxcoincidedwithlargereductionsin

purchasesintermsofvolumesandsugarquantitiesfromtaxablebeverages,withnon-significantchangesfornon-taxable

beverages.

NewappdeliversmedicineAnewSAapp,PharmaGo,waslaunchedinMarchtofacilitatefreesame-dayand

next-daydeliveriesforessentialandover-the-countermedication,

reportedFinancialMail(15April2021).PharmaGo,createdbyRaeesCarim,passesthecustomer’sprescriptions,uploadedontheapp,toa“pharmacy

panel”availableonlytothepharmacistfillingtheprescription.Thisensures

informationsecurityanddiscretionandisexclusivetoPharmaGo.Paymentisvia

creditordebitcardandissentdirecttothemedicalaid.

Atlaunch,PharmaGohad73pharmaciesonboard.Itusesexistingdistribution

networksfordeliveries.

NEWSFROMMEDICALAIDS

DoHdeclarescertainDSPpracticesbyschemesirregular

CertainpracticesbymedicalschemesinselectingDesignatedHealthcareProviders(DSPs),aswellasimposingexcessiveco-paymentsonmembers,havebeendeclaredanirregularandundesirablepracticebytheDepartmentofHealth

(Section61oftheMedicalSchemesActNo131of1998).

AnoticetothiseffectwaspublishedintheGovernmentGazette(23April2021)ThisfollowsinformationprovidedbytheCouncilforMedicalSchemes(CMS)regardingthewayinwhichsomemedicalschemes:

Unilaterallyandwithoutrestriction,determinethecriteriatoapplywhenselectingtheirDSPs;SelectDSPswithoutengaginginafairprocurementprocess;Unfairlylimitsthenumberofselectedserviceproviders(includingpharmacies)availabletoprovidehealthcareservicestothemembers;andObligememberstouseonlytheselectedlimitednumberofDSPsorriskpayingexorbitantco-payments.Regulationswillbepublishedinthenext6monthstoprovideguidelines.

MedicalSchemeshaveturnedintoa

'businessscience'

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ProfMarietjiedeVilliers,formerdeputydeanofthemedicalschoolatStellenboschUniversityandformerdeputychairpersonoftheMedicalandDentalProfessions’Board,

saysmedicalaids"haveturnedintoabusinessscience".

AccordingtoDeVilliersthedaysarelonggonewhenmedicalaidsweretomakeiteasiertopayforpatientsandeasiertocollectmoneyfordoctors.

Theyhavebecome"entrepreneurialbusinessesandafocusontheclientormemberisnolongerthepoint,”reportedChrisBatemaninMail&Guardian(16April2021).

“Acombinationofanoutdatedregulatoryenvironmentwellbehindtheglobalcost-efficiencycurve,ineffectivefee-for-servicestructures,highspecialistandhospitalcosts,

plusanever-ageingmedicalschememembershipcreatewhatonefundingexpertcallsa‘deathspiral’.”

Toreadmore,clickonthebuttonbelow

C-19vaccine:

MedicalSchemeswon’tsubsidisenon-members

Threemedicalschemes,DiscoveryHealth,FedhealthandProfmed,havepouredcoldwaterontheideathattheycouldsubsidisevaccinationsforpeoplewhodonothavemedicalcover,reportedTimesLIVE(14April2021).

DiscoveryCEOAdrianGoresaidasaresultofglobalvaccineshortages,procurementshouldbelefttothestate,thoughwithstrongprivatesectorcollaboration.

However,ProfmedCEOCraigComriesaidwhilemanufacturerswerenotyetwillingtosellvaccinesdirectlytoprivatebusinessorganisations,theschemehadhaddiscussionswith“many”manufacturers.

Fedhealthprincipalofficer,JeremyYatt,saidsubsidisingvaccinationswouldbeillegalasamedicalaidisanot-for-profitorganisation,andthefundsthereforebelongtothememberswhocontributeeverymonth.

CircularsfromtheCMS

ThefollowingCircularswerepublishedbytheCMS

inApril2021.

22of2021RevisedexemptionconditionstoCircular56of202023of20212021/22leviesformedicalschemes24of2021PublicationofSection61Gazette25of2021ManagedCareOrganisationsAccreditedbytheCMS

26of2021SAICAAccountingGuide27of2021COVID-19VaccinesMembershipData28of2021InternetServiceProviderMigration

SPECIALNOTES

RegisterforHSSworkshop

HealthSystemsStrengtheningResearchWorkshop13May2021

HSSisacollaborationbetweentheUniversityofStellenboschBusinessSchool(USB),theSchoolofPublicLeadership(SPL),theDepartmentofEconomics(Facultyof

EconomicandManagementSciences),theIndustrialEngineeringDepartment(FacultyofEngineering)andtheDepartmentofGlobalHealth(FacultyofMedicineandHealth

Sciences).Thisworkshopaimsto:

Strengthenandexpandcross-facultyresearchnetworksofresearchersandpostgraduatestudentswhostriveforoptimalhealthcarequalityandequityinoursociety;Facilitatecross-disciplinarythinkingandproblemsolvinginhealthsciencesthroughsharingresearchplansandprogress;andThinkinnovativelyaboutsolutionsthatwillworkforpublicandprivatehealthcareusers.

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