Category: Medical Industry

Categories : Ethics and Law Medical IndustryTags :

Fight Not Yet over as Case Against Vertex is Dropped After Cystic Fibrosis Medicine Price Cut

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Cheri Nel launched a court case against Vertex to force them to allow their generic cystic fibrosis drug to be imported into South Africa. Credit: Spotlight

By Catherine Tomlinson

Last year a South African woman took a multibillion-dollar United States pharmaceutical company to court with the aim of securing access to life-changing cystic fibrosis medicines. That case has now been dropped following a reduction in the price charged for the medicines in South Africa.

Cheri Nel, a Johannesburg-based investment banker, has dropped a potentially landmark court case against Vertex Pharmaceuticals. Nel was asking the Gauteng Division of the High Court in Pretoria to grant a compulsory licence to allow generic versions of a cystic fibrosis medicine called Trikafta to be imported into South Africa. No such compulsory licences on medicines have ever been granted in South Africa.

Trikafta, which was registered in the United States in 2019, has been hailed as a “miracle” treatment for cystic fibrosis, which causes severe damage to the lungs, digestive system and other organs in the body. The medicine is effective in treating around 90 percent of people living with the condition. It significantly improves the quality of life of people living with cystic fibrosis, eliminating many of its debilitating symptoms, while also slowing the disease’s progression and extending survival.

In February 2023, when Nel launched her lawsuit against the Boston-headquartered pharmaceutical company, the only way people in South Africa could access Trikafta was by travelling to Argentina to buy it from an Argentinian company selling a generic version of the medicine.

This is because Vertex, the company that holds the patents on Trikafta in South Africa, refused to register the medicine with the South African Health Products Regulatory Authority (SAHPRA) or identify a local distributor that could import unregistered Trikafta via Section 21 authorisations – a mechanism allowing importation of unregistered medicines.

The United States list price for Trikafta is currently over $300 000 (around R5.5 million at the current rand/dollar exchange rate) per person per year, which South Africans feared they would also have to pay if or when Vertex finally started supplying its medicine in the country. Researchers in the United Kingdom have estimated that Trikafta can be produced for under $6000 (around R110 000 at the current rand/dollar exchange rate) per person per year.

When Nel filed the case, generic Trikafta from Argentina – called Trixacar – was much cheaper than Vertex’s product (but still prohibitively expensive for many) at around $60 000, or almost R1 million per person per year. But the Argentinian company selling generic Trixacar faced potential patent infringement challenges if it shipped Trixacar to South Africa. Thus, the only way to get the medicine into South Africa at the time was to travel to Argentina to collect it. People living with cystic fibrosis in South Africa learnt how to do this through an informal network or Buyers Club of people around the world that were reliant on the Argentinian product.

Launching a legal case

Nel argued that Vertex was abusing its patents in South Africa by refusing to make Trikafta available in the country on reasonable terms, while also blocking other manufacturers from supplying the medicine in the country. If successful, Nel’s case would have allowed generic Trikafta to be shipped directly to South Africa, removing the need for travel to Argentina to access the medicine.

According to Nel, Vertex argued in the company’s answering documents to her legal filing that, as she was the only named applicant in the case, a compulsory licence for importation could only be considered for her.

Nel then worked with the South African Cystic Fibrosis Association (SACFA) to get other people living with cystic fibrosis admitted as co-applicants in the case. This process of seeking more people to join her case, she said, was time-consuming, difficult, and expensive, but more than 100 people were working towards being admitted as co-applicants before the case was dropped.

Under pressure, Vertex starts providing Trikafta in South Africa

As the case gained momentum and made headlines around the world, Vertex finally opened the door to allow some people living in South Africa to access their product.

In May 2024, Vertex identified Equity Pharmaceuticals as the local company through which Trikafta could be imported into South Africa via Section 21 authorisations. These authorisations are granted by SAHPRA to enable importation of an unregistered medicine and are meant to be used in exceptional circumstances to remedy the need for an unregistered medicine, such as when there is a shortage of the registered product.

While Vertex has not confirmed to Spotlight or stated publicly the price of Trikafta for people living in South Africa, Nel and Doctors Without Borders’ Candice Sehoma told us that the company is charging around R400 000 ($22 000) for a year’s supply of the medicine.

While still unaffordable for many and much higher than the estimated cost of manufacturing, the R400 000 price is drastically lower than the R5.5 million price charged in the United States and originally feared for South Africa.

It seems improbable that Vertex would have offered the much reduced price to people living in South Africa had Nel not launched the court case

Some medical schemes now paying for Trikafta

As emerged in April this year, Vertex reached an agreement with some medical schemes in South Africa to provide the medicine for people on top-end plans.

“Four private healthcare providers are currently funding Trikafta for eligible patients and we are open for conversations with more insurance companies,” Vertex’s spokesperson Daria Munsel confirmed to Spotlight.

The exact nature of the conversations and/or agreements between Vertex and medical schemes in South Africa however remains somewhat unclear.

Discovery Health‘s CEO, Dr Ron Whelan, told Spotlight it has engaged Vertex about the “benefits available” and “affordable access” of the class of medications that Trikafta falls in but there is “no specific commercial agreement in place” in South Africa.

He noted that Discovery Health Medical Scheme members on the comprehensive and executive plans have a suite of benefits available for the treatment of cystic fibrosis with medicines like Trikafta “of up to R400 000 per annum” for eligible people.

According to Vertex, uptake of its product has been swift and is already starting to make a difference in the lives of people living with cystic fibrosis in South Africa. “Over 100 South Africans with CF [cystic fibrosis] have been prescribed our triple combination treatment in just the first two months of the medicine being available,” said Munsel.

The cystic fibrosis registry, an initiative which seeks to identify and collect data on the outcomes of people living with cystic fibrosis in South Africa, identified 525 people living with cystic fibrosis in the country as of December 2020. Experts believe there are many more undiagnosed cases.

Why did Nel drop the case?

Not only is Vertex’s price for people in South Africa now lower than the 2023 price of Argentinian generics, but the cost of a year’s supply of generic Trikafta from Argentina have increased from around $60 000 to around $100 000 due to hyperinflation in that country.

With Vertex now offering a price lower than the cost of Argentinian generics, Nel decided that her legal case was no longer the best avenue to enhance access to the medicine. The aim of the case “was to get access to the medication… to put pills in patients’ mouths”, she told Spotlight.

Nel said it is now probably better to redirect efforts to getting government at national or provincial levels to buy the medicine for patients in the public sector.

“There is a lot of work still to be done… my efforts are still there, it’s just being redirected,” she said.

“The fact that Trikafta will now be available in South Africa at a much lower price compared to generic versions globally, certainly undercuts the legal case for a compulsory license,” said Tendai Mafuma of SECTION27, a public interest law centre. The Treatment Action Campaign and Doctors Without Borders, represented by SECTION27, were admitted as friends of the court in the case.

Why won’t Vertex register its product in SA?

While much has changed because of Nel’s legal action, Vertex has held fast on its refusal to register Trikafta with SAHPRA.

When asked about Vertex’s plans to register Trikafta in South Africa, Munsel said: “We strongly believe that this [Section 21 Authorisation] is the fastest and most efficient route to sustainable access in South Africa, which does not require a regulatory filing.”

While registering medicines can be onerous and time consuming, it is a routine practice required for pharmaceutical companies to operate around the world. Full registration also typically requires that safety, effectiveness and quality is more closely scrutinised than is the case with Section 21 authorisations.

Nel believes that Vertex has chosen not to register Trikafta in South Africa because of the price transparency requirements embedded in South African law. If other countries know what price South Africa is paying then they may also demand a lower price, she said.

The law requires that there is a transparent pricing system for medicines sold in the private sector, but these requirements do not extend to unregistered medicines imported through Section 21 authorisations, explained Mafuma.

Note: SECTION27 was involved in the court case that is the subject of this article. Spotlight is published by SECTION27, but is editorially independent – and independence that the editors guard jealously. Spotlight is a member of the South African Press Council.

Republished from Spotlight under a Creative Commons licence.

Read the original article

Categories : Expert Opinion Medical IndustryTags :

From Bottlenecks to Breakthroughs: BHF Report Charts the Course for Southern Africa’s Healthcare Future

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Photo by Hush Naidoo on Unsplash

By adopting bold, transformative strategies, the healthcare industry can overcome critical challenges and foster innovative collaborations to create a more equitable and sustainable healthcare future for southern Africa, writes Dr Katlego Mothudi, Managing Director at the Board of Healthcare Funders (BHF).

Committed to promoting collaboration and creating actionable insights within southern Africa’s healthcare ecosystem, BHF’s recently published report highlights significant trends, obstacles and breakthrough solutions from key figures in the healthcare sector, and charts the course for a robust, inclusive healthcare future. 

By interviewing industry leaders – including funders, hospitals, clinicians, and the pharmaceutical sector – the report presents a strategic path forward that promises to revolutionise the region’s healthcare landscape. As southern Africa grapples with rising healthcare costs, a growing burden of non-communicable diseases (NCDs), and economic instability, this report charts the course for a robust, inclusive healthcare future.

The evolving landscape of southern African healthcare

Healthcare organisations in southern Africa are navigating a complex landscape filled with escalating challenges and promising opportunities. The rapid increase in the burden of non-communicable diseases (NCDs) and economic volatility is driving a critical shift toward more sustainable healthcare models while increasing healthcare costs and reducing affordability. 

Concurrently, there is a renewed commitment to achieving health equity, with concerted efforts to ensure healthcare is universally accessible. Universal Health Coverage (UHC) is in various stages of rollout across the region, reflecting varying national priorities and capabilities. In South Africa, the proposed National Health Insurance (NHI), despite its controversies, is being closely watched for its potential impact on other countries if implemented pragmatically.

In the private sector, the health insurance market shows notable growth. This is in contrast to stagnation relating to traditional medical schemes. These schemes face slow or no membership growth and rising utilisation rates, pushing a gradual shift towards value-based care with strategies to strengthen contracting arrangements, control expenditure and improve health outcomes. 

High levels of fraud, waste and abuse persist, particularly in southern Africa, where economic conditions have severely limited the growth of private health insurance or medical scheme coverage, highlighting the critical need for innovative healthcare financing solutions.

Additionally, the post-COVID acceleration of digital healthcare is gradually reshaping service delivery. Significant investments in artificial intelligence and predictive analytics are set to strengthen health risk management, boost patient care and enhance operational efficiency. 

This era of digital transformation is marked by collaborations with local and global tech innovators and a strategic internal focus on tech integration to overhaul legacy systems and traditional practices. This complex tapestry of trends indicates a critical juncture for the region’s healthcare, laden with challenges, yet rich with opportunities for pioneering change.

Bottlenecks and barriers

Southern Africa’s healthcare systems face significant barriers to sustainability, including inefficient and politicised regulatory environments, inadequate workforce training, economic instability and the growing corporatisation of healthcare, all of which hinder innovation, affordability and access while threatening both public trust and the quality of care.

Reactive responses to emerging challenges

In response to the bottlenecks and challenges facing the sector, healthcare organisations across southern Africa are collaborating with government and business coalitions, such as Business for South Africa, to address fiscal risks and policy uncertainties, and promote private sector participation, regulatory harmonisation and advanced technologies. 

They are prioritising integrated healthcare models focused on primary care and value-based approaches, investing in digital innovations such as telemedicine, electronic health records and AI to improve efficiency and outcomes. Efforts to optimise resource allocation and care quality through digitalisation and process reengineering are also underway. 

While these actions address immediate challenges, longer-term systemic solutions are necessary to achieve UHC and future-proof their markets.

Proactive systemic responses

To create a sustainable and equitable healthcare environment in southern Africa, long-term strategic solutions are essential, and aimed at broadening healthcare access, enhancing system efficiency and ensuring financial sustainability. 

To achieve UHC, access through a multi-payer system that guarantees quality, affordable healthcare for all is instrumental. Implementing UHC principles will promote preventative care, care coordination, and effective management of chronic diseases. Additionally, advancing public-private partnerships (PPPs) can significantly enhance access and care quality, with proactive private sector engagement helping to overcome existing barriers and drive progress.

To improve policy and regulation, it is crucial to enhance the oversight and effectiveness of regulatory institutions while fostering regional inclusivity across the Southern African Development Community (SADC) for better knowledge sharing. 

In South Africa, aligning the NHI with a multi-funder framework will integrate private funders and recognise employers’ roles in system sustainability. Updating benefits to reflect current health needs and economic conditions will make healthcare more affordable and less hospital-centric. Introducing Low-Cost Benefit Options (LCBOs) within medical schemes will broaden access, while strengthening competition and optimising private sector performance, will enhance care quality. Additionally, establishing a risk equalisation fund and mandating medical scheme membership is key to stabilising the insurance market and lowering costs.

To advance healthcare, investments in infrastructure and technology are essential, especially in underserved areas, to ensure equitable access. Strengthening healthcare training and updating practice guidelines will improve care quality and expand capabilities, while better workforce planning and collaboration between academia and healthcare providers will align training with industry needs. Additionally, leveraging digital health initiatives, such as telemedicine and electronic health records, will enhance service reach and efficiency.

Furthermore, incorporating Environmental, Social, and Governance (ESG) principles is crucial for promoting resilience and establishing southern African healthcare systems as leaders in sustainable practices. Adopting ESG standards will enhance the sustainability and governance of these healthcare systems.

These strategies are designed not only to address immediate healthcare challenges, but also to establish a robust foundation for a future where high quality healthcare is universally accessible in southern Africa. By implementing these solutions, the region can bridge the current gaps and pave the way for a resilient healthcare system.

Through collaborative efforts, strategic reforms, and innovative solutions, southern Africa’s healthcare sector is not only meeting current needs but also preparing for future demands that are defined by innovation, equity and sustainability. 

Categories : Medical Industry Metabolic DisordersTags :

Sanofi Commits to Affordable Insulin Pens for Diabetic Patients

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Novolog insulin pen. Photo by Dennis Klicker on Unsplash

Over the past few years, there has been a notable shift towards the use of insulin pens in the public sector, replacing traditional vials. This transition has been driven by the advantages insulin pens offer, including improved dosing accuracy, ease of use for patients, greater convenience, and better adherence to treatment.1

The move to basal insulin is in line with the National Strategic Plan for the Prevention and Control of Non-Communicable Diseases 2022-2027, which outlines specific targets for managing diabetes. This plan aims to improve early detection and treatment of diabetes by ensuring that 90% of people over 18 know their blood pressure and blood sugar levels. It also aims for 60% of those with high levels to receive treatment, and 50% of those treated to have their levels under control. These measures are designed to improve the management and outcomes of diabetes in the population.2

Since May 2023, the Department of Health has faced insulin pen rationing as the previous sole supplier opted not to tender. Nearly 50% of the insulin required for patients was expected to come in pen sets. To mitigate the impact, the health department has sourced a limited supply of insulin pens and analogues for vulnerable groups like the elderly, young children, and visually impaired individuals, despite the higher cost of insulin analogues, which offer more convenient and effective blood sugar management.3

In 2021, long-acting analogue insulins were added to the WHO Model List of Essential Medicines (EML) and have significantly reduced aligning with those of human insulin.3 Recognising this need, Sanofi has adjusted the price of its basal insulin to the cost of human insulin in South Africa.

Sanofi has been engaging with the National Department of Health to meet the needs of vulnerable patient groups,” says Dr Asafika Mbangata, Medical Advisor for Diabetes and Established Products, Sanofi. “A circular has been released by the department, identifying patient groups that would benefit from analogue insulins. This includes vulnerable groups like the elderly, young children, and visually impaired individuals. Sanofi is committed to ensuring that patients have access to treatment which will help control the disease by achieving adequate glycaemic control and eventually, prevention of complications in South Africa.”

Long-acting insulin analogues offer significant clinical benefits over human insulin, including prolonged duration of action,4 more stable glucose control with less hypoglycaemia, and reduced need for multiple daily doses.5 These benefits are particularly crucial for patients experiencing dangerously low blood glucose levels with human insulin.5 In addition, reductions in HbA1c (a key blood sugar indicator) are greater with all basal insulin analogues compared to human basal insulins.6

Diabetes Type 1

It’s estimated that more than 31 000 people in South Africa live with Type 1 diabetes and require full insulin replacement therapy, with multiple daily injections. Among them, 5000 are children.7

“Insulin pens, which are more accurate, user-friendly, and associated with less pain when used with short and fine needles, significantly enhance their quality of life,” says Dr. Mbangata. “This is particularly important for children, who are more likely to adhere to their treatment schedules with the easier-to-use and less painful pens.”

Diabetes Type 2

According to the International Diabetes Federation (IDF), 4.2 million South African adults are living with diabetes, primarily type 2.7 Of these, 84% access diabetes care in the public sector. Diabetes is the second leading cause of death in South Africa, following tuberculosis, and the leading cause of death among females.8

More than 9% of the South African population is 60 or older.9 Around 600 000 elderly individuals are living with diabetes, with approximately 500 000 of them accessing public sector healthcare.10

Treating diabetes in the elderly often requires a multidrug regimen, including insulin therapy. However, due to comorbidities such as dementia, vision loss, neuropathies, poor mobility, and manual dexterity issues, elderly patients are at increased risk of hypoglycaemia and dosing errors associated with insulin administration. Insulin pen devices have been shown to provide more reliable, accurate, and simplified dosing, making them a safer and more acceptable method of insulin delivery for the elderly population.11

Impaired vision

Diabetic retinopathy (impaired vision) is the third most common cause of blindness in South Africa, following cataracts and glaucoma​​.12 A pilot project screening for diabetic retinopathy in primary care at three Cape Town community healthcare centres assessed 400 patients living with diabetes. Over 80% had significantly reduced visual acuity, and 63% had retinopathy.12 These visually impaired patients would greatly benefit from using insulin pens, which make a clicking sound when the dial is turned, indicating the dose.

“Against the backdrop of these statistics, Sanofi continues in its efforts to make insulin pens more affordable and accessible, and our aim is to improve the quality of life and healthcare outcomes for South Africa’s diabetic population,” says Prudence Selani, External Affairs Head, Sanofi.

References

  1. Diabetes Spectr 2012;25(2):117–122
  2. Health Policy Watch. New WHO Essential Medicines List Includes Controversial Insulin Analogues. Available from: https://healthpolicy-watch.news/who-essential-medicines-insulin-analogues/
  3. Brunetti VC et al. Diabetes ObesMetab. 2022;1–13
  4. Sims EK et al. Nat Med. 2021;27:1154-64
  5. MannucciE et al. Endocrine. 2021;74:508-17
  6. IDF Diabetes Atlas 10th edition 2021
  7. Report-03-08-012018 (www.statssa.gov.za)
  8. StatsSA report: Marginalised Groups Series VI: The Social Profile of Older Persons, 2017–2021
  9. Werfalli M, Kassanjee R, Kalula S, Kowal P, Phaswana-Mafuya N, Levitt NS. Diabetes in South African older adults: prevalence and impact on quality of life and functional disability – as assessed using SAGE Wave 1 data. Glob Health Action. 2018;11(1):1449924. doi: 10.1080/16549716.2018.1449924. PMID: 29699475; PMCID: PMC5933282.
  10. Wright BM, Bellone JM, McCoy EK. A review of insulin pen devices and use in the elderly diabetic population. Clin Med Insights Endocrinol Diabetes. 2010;3:53-63. doi: 10.4137/CMED.S5534. Epub 2010 Nov 22. PMID: 22879787; PMCID: PMC3411523.
  11. Bertram MY, Jaswal AV, Van Wyk VP, Levitt NS, Hofman KJ. The non-fatal disease burden caused by type 2 diabetes in South Africa, 2009. Glob Health Action 2013;6:12944. [http://dx.doi.org/10.3402/gha.v6i0.19244]
  12. Cairncross JP, Steinberg WJ, Labuschagne MJ. Prevalence of eye pathology in a group of diabetic patients at National District Hospital Outpatient Department in Bloemfontein, South Africa. Afr J Prim Health Care Fam Med. 2017 Sep 27;9(1):e1-e7. doi: 10.4102/phcfm.v9i1.1440. PMID: 29041796; PMCID: PMC5645559.
Categories : Medical IndustryTags :

Spiralling Costs Squeezing Medical Schemes – and Where does This Leave NHI?

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Photo by Towfiqu barbhuiya on Unsplash

Pressure from ageing populations, stagnant growth and growing medical costs will mean that medical aid schemes will make above-inflation rate hikes, reveals Momentum Health marketing officer Damian McHugh. He made the comments at Momentum Health Solutions’ virtual Healthcare Insights Summit on Tuesday (30 July), where he also noted that the same demands on medical funds are serving to put NHI even further out of reach, estimating a budget of some R1.3 trillion.

If one take’s McHugh’s figures and projects into the coming years, these above-inflation hikes make the target an ever increasing-one, steadily sending the current estimates even further from the realms of affordability. This is a situation which national health schemes of far wealthier countries are now encountering.

This comes as the Council for Medical Schemes advised the 1st of August of inflation plus “reasonable utilisation estimates” resulting in a recommendation to keep under 8.5%. But it given the pressures on medical aid schemes, this is unlikely to be adhered to, as last year already saw increases in excess of this.

Medical aid cost pressures

The CMS acknowledged that above-inflation medical cost increases are inevitable due to “unique industry factors such as technological advancement, the ageing population, and the increasing prevalence of chronic diseases.”

Last year, Discovery Health Medical Scheme (DHMS) announced a weighted average increase of 7.5%, for 2024 – but its comprehensive “premium” segment rose by 13%. Both Momentum and BestMed announced weighted increases of 9.6% for 2024, while Bonitas managed to contain its increases to 6.9% (though its comprehensive cover rose to 9.6%). MediHelp surged to 15.96%, though it justified this increase as its options were the lowest-priced on the market.

Medical aid scheme growth is slow, at best around 0.5% per annum, while there is considerable pressure on subscriber income. Low income brackets only spend around 4% on healthcare, while middle and high income brackets spent 6% and 7%, respectively.

But with claims on the increase, many medical aids are having to tap into reserves and reducing solvency. Many medical aids are running close to 100% claims ratio – obviously a very bad situation for them to find themselves in.

These cost pressures result in a reduction in benefits, with the burden being shifted by reducing day-to-day benefits and members moving to Efficiency Discount Options (EDOs) – in turn, reducing the risk contribution income received by the schemes.

Rate hikes inevitable

In its recommended guidelines for 2025 released in Circular 35 of 2024, the CMS advised that medical aid schemes limit their contribution increases in line with CPIThis was based on the Reserve Bank’s latest inflation forecast which expects headline inflation to average 4.4% and 4.5% in 2025 and 2026, respectively. With last year’s estimated of an additional 3.2% to 3.8%, that works out to about 8.5%. But the CMS noted that medical aid schemes have historically had increases in excess of CPI+4%.

The COVID pandemic bucked the trend, resulting in – though many medical aid schemes saw record profits as procedures were deferred. Price increases were deferred, with increases kept below inflation for 2021 and 2022, with an uptick in 2023.

McHugh pointed out that growth in medical aid schemes has remained largely flat, and the ageing of the insured lives was linked to increasing claims costs as health problems became more complex. He revealed that claims costs per life had risen from about R15 000 in 2017 to R21 000 in 2022. This, spread across the population of South Africa, would require an NHI budget of R1.3 trillion.

Source: CMS Circular 35 of 2024

Breaking down the expenditures, McHugh said that medical schemes spent 37% on hospitals and 28% on specialists, while medicine accounted for 16% and GPs a mere 5%. The CMS also noted that hospitals and specialists had seen greater relative increases than other areas. For the essential coverage of hospitals, medicines, GPs, and dentists, that would amount to R363 billion.

Looking ahead with a little maths

One can take simple compound interest to McHugh’s figures, and even applying the CMS’ best-case “reasonable utilisation estimate” of 3.2%, for say 20 years from will mean that costs rise by 87% in today’s rands. That means the NHI’s ‘basic’ coverage would rise to R682 billion and the full coverage amounting to an incredible R2.4 trillion.

But this nothing special to South Africa. The UK’s NHS costs have similarly grown, at 3.6% per annum in real terms. And that growth has to come out of the GDP: from 3.6% of the GDP in 1949-50 to 8.2% in 2022-23, with a surge to 10.5% in the COVID pandemic.

The UK has now put measures in place to constrain cost growth to 1%, but it remains to be seen whether this will be effective without compromising service delivery. How South Africa can even contemplate an NHI where, 20 years from now, private scheme medical costs run to R39 000 per person in the best case scenario.

While McHugh did not mention the recent High Court blow to the NHI Act that found a key part of it unconstitutional, he described the legal challenge process that would see that part sent back to the National Assembly and the president.

McHugh however struck a note of optimism, noting that the public-private partnerships of the COVID pandemic showed a way forward for NHI and universal healthcare in South Africa. The 2024 elections bring the possibility of the same historic benefits for the population as the 1994 ones.

Categories : Expert Opinion Medical IndustryTags :

Transforming South Africa’s Healthcare Sector: The Essential Role of Leadership

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Dr Ali Hamdulay

By Dr Ali Hamdulay – CEO, Metropolitan Health Corporate

South Africa’s healthcare sector, a sophisticated and ever-changing industry, is central to the health and prosperity of our communities. Its effective operation, however, hinges on the strength and direction of its leadership.

Leadership, given the broad healthcare landscape, is far from a singular role; it’s a complex undertaking that requires comprehensive understanding of the wide medical ambit, the regulatory environment, compassion, and a forward-thinking mindset. Leaders are the primary builders of healthcare infrastructure, moulding it to encourage innovation, prioritise patient-focused care, and maintain the highest ethical standards.

Attracting and retaining skilled healthcare workers is a critical role that leadership in South Africa’s healthcare landscape must play. This includes attracting and retaining a diverse range of healthcare professionals such as doctors, nurses, and specialists. Leaders are responsible for creating a conducive work environment that not only draws in skilled workers but also motivates them to stay and thrive. Furthermore, leaders are advocates for healthcare workers, ensuring they have the necessary resources and support to carry out their roles effectively.

The rise of technology has ushered in substantial shifts in the healthcare sector. From telemedicine and AI diagnostics to electronic health records, technology has revolutionised how we provide care. Integrating these innovations into the healthcare system, though, is a challenging task that demands visionary leadership.

Leaders must understand these technologies, evaluate their potential advantages and risks, and oversee their implementation in a manner that enhances patient care without jeopardising privacy and security. Teams must also be equipped with the necessary skills to adapt to these changes and effectively implement new procedures.

A pivotal role of a healthcare leader is to champion health equity. Despite progress in healthcare, disparities in access and outcomes remain. Leaders play a crucial role in creating pathways to eradicate these disparities and to ensure that everyone, irrespective of their background, has access to quality healthcare. This involves understanding the social determinants of health, implementing policies that promote equity, and establishing an inclusive and respectful culture within the healthcare environment.

This cannot be done without support.

Leadership isn’t solely about leading; it’s also about inspiring others to lead. By exemplifying excellence and integrity, leaders can inspire their teams to aspire to the same standards. They can cultivate a culture of continuous learning and improvement, encouraging everyone to contribute their ideas and expertise.

A resilient healthcare system is anchored by robust leadership. It requires a mix of knowledge, skills and attitudes, a thorough understanding of the healthcare landscape, the ability to make critical decisions, the vision to embrace innovation, the empathy to advocate for health equity, and the charisma to inspire others.

We must elevate both individual and group thinking within our operating environments if we are to make meaningful progress in establishing a healthcare sector that prioritises access and quality. This approach contributes to a resilient healthcare workforce—one that can adapt to the dynamic landscape and is essential for the sector’s long-term viability and the overall health of South Africa’s population. By embracing this combination of collective and individual thinking, we propel the sector forward across businesses, the healthcare industry, and the nation as a whole.

Navigating the intricacies of the healthcare sector, particularly in the dawn of South Africa’s Government of National Unity, underscores the critical role of strong and reliable leadership. This fresh political landscape brings with it a wave of optimism. It has the potential to catalyse transformative change in our healthcare sector, from policy reforms and resource reallocation to the introduction of initiatives aimed at enhancing healthcare quality.

In our journey towards a more equitable and efficient healthcare system in South Africa, the focus on public-private partnerships must remain steadfast. These partnerships are instrumental in leveraging the strengths of both sectors to deliver better healthcare outcomes. They foster innovation, improve service delivery, and enhance accessibility, making them a crucial component of a robust healthcare system.

During this era of change, leadership is our compass guiding us towards quality access to healthcare for all. The role of leadership in ensuring progress and maintaining stability cannot be overstated. It is the driving force behind a healthcare sector that truly serves its people.

The future of South Africa’s healthcare sector is promising, but it requires the collective effort of all stakeholders. As a business, we recognise the critical role of nurturing our emerging leaders through mentoring and coaching. Our partnerships ensure continuity and preserve the essential skill and knowledge base of our healthcare workforce. These partnerships are key in establishing a healthcare system that is accessible to all and provides quality care.

As we commemorate Nelson Mandela Day, let us honour his unwavering commitment to justice, equality, and compassion. Our responsibility lies not only in the present but also in shaping a legacy for future generations. Let us build a healthcare system that echoes Mandela’s vision—a system that ensures access for all and equips our leaders to carry forth their roles with purpose and resilience.

Categories : Ethics and Law Medical IndustryTags :

High Court Ruling Strikes Down Key Part of NHI Act

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Photo by Tingey Injury Law Firm on Unsplash

A key part of the National Health Insurance Act is the requirement of private healthcare facilities to obtain a Certificate of Need (CON) in order to practise. Now it, this component has been struck down by a Pretoria High Court judge. Judge Anthony Millar struck down the Act’s key section, saying that it was “akin to an attempt to indenture the private medical service in the service of the state”.

The case had been brought by the Solidarity Trade Union, the Alliance of South African Practitioner Associations, the South African Private Practitioner Forum, the Hospitals Association of South Africa (HASA) and a number of healthcare providers and owners of healthcare establishments.

Sections 36 to 40 of the NHI Act would introduce a Certificate of Need (CON) scheme, essentially tying down doctors to a specified geographical location, which would be the only location where they could render their services.

It is declared that sections 36 to 40 of the National Health Insurance Act 61 of 2003 are invalid in their entirety and are consequently severed from the Act.

Judge Anthony Millar’s ruling

Any new healthcare facility would have to apply for a CON, which would be valid for 20 years. Existing facilities would have two years’ grace period to apply. This would applicable to hospitals, clinics, pharmacies and even to private rooms set up within the home of the practitioner. Operating without one would be a criminal offence – punishable with a fine, five years in prison or both.

It had been argued that because the regulations for CON had not been promulgated, the applicants’ argument was “hypothetical” and not “crystallized”. In Tuesday’s ruling, Judge Millar cited previous rulings and the constitutionality of the matter was still worth testing.

The CON scheme was extensive, Judge Millar noted, and would impact not only healthcare practitioners who worked in healthcare facilities and their employees, but also “juristic persons“, ie corporations or other organisations that can be legally liable.

Read the judgment here

‘A blunt instrument’

In terms of its constitutionality, the applicants’ argument was that, “at least six constitutional rights are infringed. They say it tramples on their rights including where they want to reside, send their children to school and the communities they belong to.”

Judge Millar noted, would mean that setting up a hospital was a hefty investment of R500 million or so, and there was no provision any support. Taken together with the 20-year CON validity, would serve to discourage private investment and became a “blunt instrument” with which the Director-General of Health could control private healthcare in the country.

Even though this provision was ostensibly to serve many, this could not come at the cost of individual freedoms, among them Section 22 of the Constitution which provided for the freedom to choose an occupation within the rule of law.

“The scheme is silent on the extant rights of both the owners of private health establishments, private healthcare service providers and private healthcare workers. Such extant right include their integration and professional reputations in the communities which they presently serve together with the significant financial investments and commitments made by them to be able to render the services that they do.”

Since health establishments are purpose-built and hard to convert for other use, this constitutes a de facto deprivation, he wrote.

“It does not behove government in pursuing transformation, to trample upon the rights of some ostensibly for the benefit of the many.”

‘Effective indenture’ of private healthcare

While the legal teams for President Cyril Ramaphosa, the minister of health, Dr Aaron Motsoaledi, and the director-general of health, Dr Sandile Buthelezi, argued that the public healthcare sector was overburdened, Judge Millar replied that this amounted to the effective indenture of the private healthcare system.

Among other problems, contesting CON issuance was without recourse and by turning down a certificate the DG could essentially deprive the affected parties of income, as doing so would see them prosecuted under Section 40.

The ruling was welcomed by healthcare professional associations.

As reported in the Daily Maverick, Solidarity chief executive Dr Dirk Hermann said, “This judgment is a major blow to the total NHI [National Health Insurance] idea, as the principle of central management is a core pillar of the NHI Act itself. A more extensive consequence of this ruling with regard to the certificate of need is that parts of the NHI Act are now probably also illegal in principle.

“The NHI in its current format cannot be implemented as the essence of the NHI is central planning – and this has now been found unconstitutional.” 

In a statement, HASA said that it regretted that the matter had to come to court. “We would have preferred achieving the objective of a stronger health system through a negotiated and collaborative effort to increase the number of medical students and nurses in medical training facilities to address the healthcare system’s needs,” the association stated.

Categories : Medical IndustryTags :

Opinion Piece: Claims on the Increase

On By ModernMedia

Gap cover providers are seeing more claims of higher values than ever before

Photo by Cottonbro on Pexels

By Brian Harris, General Manager Operations at Turnberry

As medical inflation has continued to rise and the cost of medical procedures has increased, medical aid companies are faced with the juggling act of keeping premiums affordable while still offering adequate cover. In addition, new procedures such as robotic-assisted surgery and new cancer drugs offer better outcomes, but at a greatly increased cost.

As a result, we are seeing increased medical expense shortfalls, particularly when it comes to specialists, as well as increased co-payments and sub-limits. The upshot of this, for the consumer, is vastly increased out-of-pocket expenses, which is why gap cover has become critical. Given the increase in both the frequency and Rand value of claims, having gap cover in place has never been more important.

The state of gap cover

The frequency and value of gap cover claims have increased dramatically over the years as the gap between what medical aid covers and what specialists and providers charge continues to widen.

In 2023, Turnberry paid out R119 968 466 in claims, proportionately this accounted for 56% of the total claims, with medical aid covering the remaining 44%. This figure includes a significant number of high value claims, with many of them exceeding R100 000. Three of the highest claims in 2023 were R129 193.60 for heart disease, R128 485.43 for a nasal polyp, and R125 735.08 for a spinal fusion surgery.

These are figures paid out over the course of a single year and for a single diagnosis. Gap cover policies are subject to an overall annual limit (OAL) per individual covered by the policy, and this limit is increased in April each year, and is currently R198 660.43 per insured person. This limit resets every year, which means that over a lifetime, the amount paid out for individuals and families is far higher. At Turnberry, the top three lifetime claims are figures in the hundreds of thousands of Rands: R502 983, R450 225, and R414 331 respectively.

What does this mean for me?

The most common procedures we see as a gap cover provider are spinal disc problems, cancer, heart disease, cataract surgery and maternity, and these claims can and often do exceed R100 000 per incident. These figures highlight the fact that in South Africa, gap cover is essential for anyone wishing to access private healthcare without potentially incurring significant out of pocket expenses.

The reality is that even young and healthy people could need costly medical procedures, and as your age and life stage changes, your medical needs do too. Accidents can happen to anyone, regardless of age, and injuries related to sports and physical activity are also common in younger age groups. Starting a family inevitably involves increased medical expenses, from pregnancy and childbirth to raising children who frequently need medical attention. Health issues related to stress are also on the rise, including anxiety and depression. In later life stages, chronic diseases like high blood pressure, high cholesterol, and prediabetes become more common. Cancer can strike anyone and is increasingly seen in younger population groups.

The cost of quality medical care continues to increase, and medical expense shortfalls as well as co-payments and sub-limits are becoming more and more common, at higher amounts. This means that any medical treatment, regardless of your age or life stage, can end up costing tens of thousands of Rands out of pocket. Over a lifetime, these sums could potentially add up to millions.

It is important to engage with your broker to make sure you have the right medical aid in place first, and then to supplement this with appropriate gap cover, to ensure that you are able to access the medical care you need without the financial burden of out-of-pocket expenses resulting from medical expense shortfalls, co-payments and sub-limits.

About Turnberry Management Risk Solutions

Founded in 2001, Turnberry is a registered financial services provider (FSP no. 36571) that specialises in Accident and Health Insurance, Travel Insurance, and Funeral Cover.

With extensive experience across healthcare and insurance industries in South Africa, Turnberry offers unsurpassed service to Brokers and clients. Turnberry’s gap cover products are available to clients on all medical aid schemes, as they are independently provided and are therefore transferable in the event of a change in the client’s medical aid scheme.

Turnberry is well represented nationally, with its Head Office based in Bedfordview, Johannesburg with Business Development Managers in Cape Town and Durban. The Turnberry Team’s focus on outstanding client service comes from having extensive knowledge and experience in the financial services sector and is underwritten by Lombard Insurance Company Limited. Lombard Insurance Company Limited is an Authorised Financial Services Provider (FSP 1596) and Insurer conducting non-life insurance business.

Categories : General Interest Medical IndustryTags :

Essenwood Residential Home – A Case Study in Elevated Care Through Staffing Partnership

On By ModernMedia

Essenwood Residential Home, a haven for senior women since the 1850s in Durban, South Africa, provides exceptional care for its residents. However, managing the complexities of HR for a growing number of caregivers became a burden, taking away time and resources from core resident care duties. This is where Allmed, a specialist medical personnel solutions provider, stepped in to make a significant difference.

A long history of caring
Founded by the Durban Benevolent Society to provide care for elderly women, it initially resided on Victoria Street and in 1921, the home relocated to its current location on Essenwood Road, a larger and more suitable site. The Greenacre family played a pivotal role in this development, with Walter Greenacre donating the land and a bequest from his father, Sir Benjamin Greenacre, facilitating the construction.

Over the years, Essenwood has continuously evolved to meet the needs of its residents. It acquired autonomy in 1950 and established a dedicated assisted living wing in 1970. Most recently, in 2015, the home underwent extensive renovations to ensure it remained a safe and comfortable haven for its residents. Currently, Essenwood is home to 85 residents, with the capacity to care for 110.

The challenge of HR burdens stifling quality care
Essenwood, like many care facilities, struggled with the time-consuming tasks of HR management. Nursing Services Manager, Colleen Dempers, found herself spending a considerable amount of time on tasks like rostering, replacements for absent staff, and disciplinary issues. This detracted from the home’s primary focus – ensuring the well-being and individual care of residents.

“We found that we were spending so much time on HR issues that it became a huge distraction, Dempers explains. “It detracted us from additional time on HR issues that could be better spent on quality of care. This is what led us to Allmed for a solution.”

Allmed to the rescue with a partnership for success
Building on their established trust with Allmed, a partnership that began in 2016, Essenwood Residential Home made a strategic move to elevate resident care. Allmed was already providing relief support for registered nurses and enrolled nurses, offering a flexible solution for fluctuating staffing needs. The governing board made the tactical decision to entrust Allmed with their entire caregiving staff, ensuring continuity and quality.

“Our core function is resident care,” clarifies Chad Saus, Essenwood Residential Home’s General Manager. “We need to provide individual attention, activities, and a stimulating environment. By outsourcing HR, IR and payroll for 56 caregivers, along with the flexibility of additional resources when needed, Allmed frees us to focus on what truly matters – our residents.”

Streamlining operations for quality care with the Allmed advantage
The partnership with Allmed has yielded multiple benefits for Essenwood:

  • Reduced HR burden: Allmed took over recruitment, payroll, and disciplinary processes for caregivers, freeing up Essenwood’s staff to focus on resident care and quality of service.
  • Enhanced responsiveness: Allmed provided prompt and efficient support, addressing Essenwood’s concerns quickly and professionally. Whether it was staffing issues, training needs, or resident care challenges, Allmed offered round-the-clock support, solutions, and a “can-do” attitude.
  • Improved caregiver fit: Allmed understood Essenwood’s care philosophy and resident needs. The caregivers placed by Allmed at Essenwood integrated seamlessly into the environment, providing the high-quality care residents deserve.
  • Leadership that listens: Essenwood valued Allmed’s commitment to open communication. Any concerns raised by Essenwood were addressed promptly and collaboratively.

The impact: residents feel the difference
The positive ripple effects of the Essenwood-Allmed partnership are evident in the high standard of care received by residents. With a dedicated and well-matched caregiving staff, Essenwood can cater to individual needs and provide a more enriching environment for its residents.

A model partnership for senior care
The Essenwood Residential Home exemplifies the success achievable through a well-structured healthcare staffing partnership. By outsourcing HR and leveraging a qualified care staffing agency, Essenwood has demonstrably improved the quality of care for its residents. This model can serve as an inspiration for senior care facilities seeking to elevate their services and prioritise resident well-being.

Categories : General Interest Medical IndustryTags :

Social Media’s Double-edged Sword: Boosting Connections or Risking Careers?

On By ModernMedia
Photo by Pexels on Pixabay

Social media has become an integral part of our daily lives, revolutionising how we communicate, connect and share information. So much so that insights suggest that over 5 billion people worldwide use social media, with 259 million users coming online within the last year. Closer to home, of the 45 million internet users in South Africa, 26 million use social media. 

Platforms such as Facebook, Instagram, LinkedIn and X (formerly Twitter), have bridged gaps, brought distant loved ones closer, and created communities around shared interests and passions. While these platforms have enriched our personal lives in countless ways, they are also a mixed blessing, impacting the professional lives of some individuals in unprecedented ways.

According to Jennifer Barkhuizen, Head of Marketing at MIE, companies are increasingly relying on screening the social media platforms of potential and current employees to gain a window into a candidate’s true self, and provide insights into their hobbies, interests and overall personality. 

“For companies, social media has become an invaluable tool to find the perfect cultural fit for their organisations. However, this practice also uncovers another side of the coin, exposing any unprofessional or inappropriate behaviour that companies may not want to be associated with,” she says.

A significant 70% of recruiters, both across the human resources industry and those within companies, now use social media to screen potential candidates, a trend that continues to grow rapidly. As the digital footprint of individuals becomes more prominent, the trend of social media screening is expected to continue its upward trajectory, reshaping the recruitment landscape.

While the increasing reliance on social media screening by recruiters is bolstering the recruitment process, it is also having a profound psychosocial impact on employees. 

“Knowing that their online activities are being screened can lead to anxiety and a sense of privacy being invaded,” adds Barkhuizen. “Employees may feel pressured to meticulously curate their online presence and the content that they post, which can be mentally exhausting and foster a sense of inauthenticity. The fear of being judged for past posts or casual comments can undermine personal freedom and contribute to a perpetual state of vigilance.” 

Although social media screening helps companies make more informed hiring decisions, it is crucial to acknowledge and address the psychological burden it places on individuals navigating the increasingly blurred lines between their personal and professional lives.

For individuals, balancing positive and negative content on social media is crucial, particularly in the context of social recruiting. Here, studies indicate that positive content, such as showcasing achievements, sharing inspirational messages, and participating in professional discussions, can significantly enhance a candidate’s appeal. Furthermore, positive interactions on social media can create a favourable impression, portraying candidates as engaged, motivated and a cultural fit for the organisation.

“Conversely, negative content, including illicit activity, unprofessional behaviour and controversial opinions, can be detrimental and raise red flags about a candidate’s suitability for a professional environment,” explains Barkhuizen. “So much so that a survey conducted by CareerBuilder found that of the 70% of employers who screen candidates on social media, 54% have decided not to hire a candidate based on their online presence.”

Barkhuizen adds that while people seek to be publicly visible online as they look to share their own ‘personal brand’, thoughts and opinions with the world, it is only when an individual crosses into engaging in undesirable or illicit content that they risk their own reputation and that of their employer.

Despite social media screening potentially leading to anxiety for individuals, it’s a crucial step for businesses to ensure they hire the right candidates. This practice helps protect the company’s reputation by identifying online behaviour that could negatively impact the organisation. It also helps ensure a good cultural fit by revealing candidates’ values and interests, aligning them with the company’s ethos. 

To mitigate the risks associated with using social media during the screening process, Barkhuizen points to five key best practices that HR professionals should abide by. These include:

  1. Develop a social media screening policy: Document a policy outlining the purpose, scope and procedure for social media screening to minimise bias or discrimination. Separate decision-makers from those conducting checks to ensure a fair and compliant hiring process.
  2. Educate staff: Train staff on the legal and ethical aspects of social media screening, ensuring they apply the process consistently to all candidates in the same job category,
  3. Be transparent: Inform candidates about the screening process and obtain their written consent if a social media check is conducted. 
  4. Be respectful: Respect candidates’ privacy settings and only view publicly available information. Avoid “friending” or “following” candidates during the hiring process.
  5. Be impartial and job-specific: Focus on professional information relevant to the job, such as skills and accomplishments. Document information consistently and avoid using protected characteristics like race, religion or gender. To this end, it is advisable to use a third party supplier to avoid bias. 

In today’s digital landscape, where social media is a powerful yet double-edged sword, leveraging the expertise of industry leaders such as MIE can make a significant difference. 

With trusted and innovative smart vetting solutions, MIE’s extensive industry knowledge ensures thorough and reliable background checks, helping businesses navigate the complexities of social media screening to make informed, strategic hiring decisions while safeguarding their reputation and maintaining a positive workplace culture.

Categories : Expert Opinion Medical IndustryTags :

Building a Culture of Wellness by Fostering a Healthy and Financially Secure Workforce

On By ModernMedia
Photo by RDNE Stock project

By James White, Sales Director at Turnberry Management Risk Solutions

Celebrating Corporate Wellness Awareness Week by highlighting the vital role that companies play in fostering employee health and well-being is not just a matter of timing; it’s a matter of necessity. A healthy workforce is a productive workforce, and a focus on wellness goes beyond just physical health.

This is particularly relevant given that the magnitude of medical expenses has shifted over the years. While common illnesses like influenza pose a threat, the bigger concern lies in hospital stays and unexpected medical procedures. These events can leave employees with significant financial burdens, impacting their well-being and productivity.

The role of employers in mitigating costs

While encouraging healthy lifestyles through fitness programmes and mental health support is vital, ensuring financial security in the face of unforeseen medical expenses is equally important. Employers play a significant role in ensuring their workforce has access to adequate healthcare. Traditionally, medical aid cover has been a common employment benefit, but rising costs have made it less affordable for some employers and their employees. Nevertheless, employers can still help by offering their people assistance through:

  • Understanding medical aid options: A knowledgeable broker can guide employers through the complexities of medical aid options. This includes explaining the benefits, limitations, and potential shortfalls associated with each plan.
  • Considering primary healthcare: For employees who cannot afford comprehensive medical aid, primary healthcare plans are short-term insurance products that offer access to doctors, specialists, and medication, often with capped benefits for private hospital visits.
  • Offering gap cover: Gap cover bridges the gap between medical aid payouts and the actual costs charged by specialists and hospitals, acting as a financial safety net to provide peace of mind for employees facing unforeseen medical expenses.

Common unforeseen medical expenses

  • Hospital stays: These can be particularly expensive, with costs varying depending on the condition and treatment required.
  • Specialist charges: Specialists often charge above the rates covered by medical aid plans, leaving patients with significant bills.
  • Emergency room visits: Even a seemingly minor trip to the ER can result in a hefty bill.

Addressing misconceptions about medical aid

Many employees believe that medical aid offers complete coverage. Brokers can help dispel this myth by explaining the intricacies of the available plan options, such as co-payments, network restrictions, and shortfalls. Some plans limit coverage to specific hospitals or providers, and employees need to be aware of these restrictions to avoid surprise costs, while certain medical aid plans require co-payments for specific procedures or medications, leaving employees with out-of-pocket expenses. Even with medical aid, specialists’ fees often exceed the amount reimbursed and gap cover addresses these shortfalls.

Financial security boosts workplace wellness

By offering (and even subsidising) a combination of medical aid, primary healthcare options, and gap cover, employers can significantly improve the well-being of their people. This is because financial security in the face of medical emergencies will reduce stress and boost morale. Employees with peace of mind regarding healthcare costs are more likely to be happy, productive, and less prone to absenteeism.

However, such assistance is more than simply offering access to such benefits. Employers need to ensure that their workforce can make informed decisions about the healthcare benefits available to them by partnering with a qualified broker. The broker can fulfil a vital educational role by conducting informative workshops to explain medical aid options and limitations and advocate for the value of gap cover.

It makes business sense to invest in a healthy workforce

By prioritising a holistic approach to employee wellness that encompasses both physical and financial health, companies can create a thriving workplace environment. Offering a more comprehensive benefits package that includes access to gap cover demonstrates a commitment to employee well-being, ultimately leading to a happier, healthier, and more productive workforce.

About Turnberry Management Risk Solutions

Founded in 2001, Turnberry is a registered financial services provider (FSP no. 36571) that specialises in Accident and Health Insurance, Travel Insurance, and Funeral Cover.

With extensive experience across healthcare and insurance industries in South Africa, Turnberry offers unsurpassed service to Brokers and clients. Turnberry’s gap cover products are available to clients on all medical aid schemes, as they are independently provided and are therefore transferable in the event of a change in the client’s medical aid scheme.

Turnberry is well represented nationally, with its Head Office based in Bedfordview, Johannesburg with Business Development Managers in Cape Town and Durban. The Turnberry Team’s focus on outstanding client service comes from having extensive knowledge and experience in the financial services sector and is underwritten by Lombard Insurance Company Limited. Lombard Insurance Company Limited is an Authorised Financial Services Provider (FSP 1596) and Insurer conducting non-life insurance business.