Roy Watson's Column

 

‘Facilitator’ Bill put on hold

The National Health Act Amendment Bill 2008, published in April and which, among other amendments to the 2003 Act, proposed the appointment of a facilitator to mediate pricing negotiations between funders and providers, was put on hold in mid-September to make way for National Health Insurance (NHI) planning and implementation – an ANC post-Polokwane priority.
The proposed amendments received a hostile response, mainly from providers who claimed they represented a “violation of rights”, and that the measures proposed were “draconian”.

Delayed by the health portfolio committee in parliament, the Bill, which will probably be subjected to further amendments due to the NHI process, is only likely receive attention again after next year’s general election.

Private sector reforms entrenching public sector ills

“Piecemeal” reforms and policies to regulate the private health sector, rather than transform it, have led to an “ever-greater concentration of resources in a subsidised, for-profit private sector and ever-rising costs of care etc”.

Cosatu secretary-general Zwelenzima Vavi said at the recent SA Medical Association conference that these policies had further entrenched the dualistic, two-tier healthcare system, rather than ending it.

Stressing his point, he added that medical schemes and private providers compete not so much by increasing quality and lowering costs, as by avoiding unprofitable patients and shifting costs back to patients or to the under-funded, under-resourced public health system. This, he said, generated huge administration costs that, along with profits, “divert resources from clinical care to the demands of business”.

Doctor ignorance a test cost driver

Doctors were too quick to rely on diagnostic test results rather than on their own clinical skills, Veripath microbiology consultant, Dr Suliman Hajee, said at a recent risk management breakfast meeting on pathology and radiology costs.

He added that too many additional tests, ‘nice to haves’ not crucial for diagnosis, were ordered – a tendency to order inappropriate and irrelevant tests.

Speaking at the same meeting, Veripath director Chris Adams said that doctors’ awareness, or lack of test costs, was a big problem. As an example, he said that what a doctor believed to be a quick and simple allergy test could result in a R3500 bill.

Poor management major emigration push factor

A Johannesburg-based health professional employment specialist has made the observation that if the number of doctors who have left country in last 15 years had to return, they would fill the current public sector vacancies three times over!

Africa Health Placements chief executive, Saul Kornik, said in a recent interview that the number one “push factor” for doctors leaving the country was consistently management. They don’t feel that they’re being appreciated and they don’t feel that they are being treated well, he said. Poor salaries was also an issue. It was one of the major reasons given recently by community service doctors surveyed, half of whom indicated they would be leaving on qualifying.