• 12 Feb 2016

    SpesNews Volume 128

    NHI U-TURN

    The Minister of Health, Dr Aaron Motsoaledi, indicated that the role of medical schemes would not be as adversely affected as the NHI White Paper initially would have us believe. In a somewhat unexpected change in approach, he indicated that the prohibition of medical schemes to deliver healthcare in its present form would amount to consumer choice infringement for the patients who could afford medical schemes premiums.

    In the NHI paper released in December 2015, it was indicated that the NHI project would be mandatory and that medical schemes would not be allowed to deliver the same services patients would be able to receive from the NHI. This naturally would have required a change in the current legislation that governs the business of a medical scheme (Medical Schemes Act 131 of 1998). In the White Paper, medical scheme services would be relegated to only that of complementary services.

    The Minister’s change in approach brings the NHI proposal more in line with international standards where people who are able to, are allowed to purchase private healthcare insurance and receive services from the private healthcare sector. It also indicates that the role of the private sector (in particular the functions and abilities within a medical scheme) would in all probability have to be revisited.

    Another clarification on the proposed NHI system came in the form of the estimated cost for the NHI. Whereas the initial projections for the NHI was based closely linked to the South African economy, the Minister now indicated that a better and more effective approach will be a phased approach. The cost for the project would consequently be determined on a programme by programme basis. This could signal a more effective manner in which NHI spending could be managed. While many questions around the White Paper still remain unanswered, the Minister’s comments offers a clearer picture of arguably the most fundamental change in S.A healthcare in recent history.

     

    WELLNESS SCREENINGS

    An increasing number of companies are employing wellness programs for various reasons. Some of these include the promotion of a healthier workforce, the early identification of chronic illnesses and the prevention of catastrophic hospitalization events. The information obtained at the wellness days could however also be used to determine the health status of the workers when it comes to their work. Furthermore, health screening should also not be mandatory and failing to submit the information obtained at the health screening may also not be punished by increased premiums. The very delicate balance between providing health services and what eventually happens with the information, has culminated in legal actions by the Equal Employment Opportunity Commission (EEOC, a U.S. government body) against three different companies. In what is certain to also impact the direction of further U.S. health screenings, the reverberations will be applicable across the globe.

     

    BUREAU SERVICE PROBLEMS

    SpesNet received complaints from some practices regarding a particular bureau service that offers a trial membership to practitioners to “test run” their products. If the product does not live up to its expectation, or no contract is subsequently entered into, the practice is then refused access to data entered for the trial period. In accordance to HPCSA guidelines, records generated by the practice remain the property of the practice. The records only belong to the patients when the patient purchase these records outright or have paid for it via their medical insurance.

    While various explanations could be given as to why the practice is refused access to practice information, it brings to the foreground one of the most important aspects of Modern Clinical Practice: Read the fine print. Then read it again.

    SpesNet would like to remind practices that, where an improper arrangement is signed, or an arrangement is concluded that would breach any HPCSA rules or guidelines (or any laws for that matter), the company proposing such an arrangement definitely is not offering it to the benefit of the practice nor practitioner. Resorting to strong-arm tactics to lock in practices in arrangements in this manner, is deeply concerning in this modern day and age. It also communicates very clearly and explicitly a blatant disregard for ethical principles and a disrespect for practitioners and their patients. Actions such as these should be condemned in the most severe terms and any contact with companies operating in this manner rigorously avoided.

    It is unfortunate that hard-working, honest and diligent medical practitioners come in contact with this type of opportunistic and exploitative actions. A business critical aspect is for practitioners to be aware of this type of behavior and to review their current exit clauses should they be using bureau services. In an industry already over-regulated, managed meticulously and routinely inflexible, practices really do not need this type of antagonistic behavior.

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