National Health Laboratory Services & Council for Medical Schemes Annual Reports 2008/09

This premium content has been made freely available


17 November 2009
Chairperson: Mr B Goqwana (ANC)
Share this page:

Meeting Summary

National Health Laboratory Services (NHLS) presented its Annual Report 2008/09 to the Committee, and outlined the plans that would ensure that targets in the subsequent year were met. It listed the need for more affordable services as one of seven key priorities. The three main mandates of NHLS were research, service and academic teaching. National Institute for Communicable Diseases (NICD) played an extensive role in combating communicable disease such as avian flu, Arena virus, meningitis and cholera. Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) were amongst the key priorities of NHLS. The issue of sustaining funding resources for surveillance programmes with grant funding was important, as there had been a trend for the NICD to get less funding from the Department of Health. The main areas of concern included silicosis and TB in the mining sector, the need to strengthen HIV and workplace issues, and the need for better coordination. The trade unions needed to be more involved, and the numbers of people in informal work or small enterprises, and Occupational Health and Safety concerns were also raised. The NHLS noted that the National Cancer Registry provided surveillance data on cancer, but this was one area where not many reports were available. NHLS had developed a Standardised Customer satisfaction Index Tool Pilot in Clinics and Hospitals in each region, which showed some low averages. Certain targets – such as finalising bilateral agreements – had not been reached. NHLS received an unqualified audit, with three matters of emphasis. NHLS outlined the five year strategy plan. It still needed to address the absence of laboratory policy for setting a national framework, to develop a 10 year 'master-plan', a new funding model for providing laboratory services and to review the current funding model for teaching and research. He concluded that there was a need to consider whether NHLS should expand or look at other departments, Non Government Organisations (NGO) or to the private sector for partnership.

Members questioned whether NHLS and the Department of Health worked together, the high levels of TB, whether anything had been done to address the issues of TB and silicosis in mining areas, NHLS's readiness for the 2010 Soccer World Cup, how NHLS bridged the Information Technology gap, late payments, confidentiality issues, funding , rural issues and if there were plans in plans to expand NHLS into the private sector. Members also asked questions of how NHLS reduced costs, the cancer registry, whether the study was national, the ten year plan, how laboratories were accredited and why NHLS had not met its previous targets. The members questioned NHLS on human resources issues such as the matter of employment equity, if it had a retention strategy in place, the prevalence of acting managers and the non-participation of members in Boards. The committee was invited to visit NHLS sites and to join it in a meeting with the Chief Mining Inspector.

The key mandate for the Council for Medical Schemes (CMS) was to promote non-discriminatory access to privately funded health care. Other mandates of CMS were to promote financial stability and sustainability, to encourage active participation of members in scheme affairs, and to investigate and resolve complaints of members. It controlled and coordinated the industry, assisted the Ministry with quality related issues and the investigation of complaints. Other functions included the collection and dissemination of information, the making of rules that were not inconsistent with legislation, giving advice to the Minister on any matter pertaining to medical schemes and performing any other function the Minister would confer. The Council was appointed by the Minister and it reported to the Committee and interacted closely with the Department of Health. It had a total staff of 78 and a total budget of R60 million in the year under review. In the last financial year, it had been working closely on the Medical Schemes Amendment Bill. The Bill sought to address technical amendments, such as dealing with definitions of the business of medical schemes and attempting to thwart opportunistic behaviour that it detected in the environment, around Prescribed Minimum Benefits, and CMS was also investigating possible interventions to address poor governance of medical schemes. CMS had adjudicated 3 138 valid complaints in the year under review. There had been consolidation in the numbers of medical aid schemes but not necessarily a reduction in the number of members. Its four main challenges were named as the demarcation issue, the prices of medical services, prescribed minimum benefits and the lack of sufficient punitive measures, although it had managed in the last year to take Bonitas to court. CMS had achieved an unqualified audit.  Members asked questions about the absence of medical aid schemes in public hospitals, the medication for TB, the Bonitas case, the future of the National Health Insurance (NHI), the structure of the Council and the outcome of court cases. Members concluded by suggesting that future reports should include statistics showing who could afford Anti-Retrovirals and who could afford medical schemes as the Committee wanted to see the day when all South Africans could afford medical cover.

Meeting report

National Health Laboratory Services (NHLS)Annual Report
Mr Sagie Pillay, Chief Executive Officer, National Health Laboratory Services, extended the apologies from the Chairperson for not being able to attend, but stated that the senior management team of the National Health Laboratory Services (NHLS) was present. He outlined the plans for the future that would ensure that targets in the subsequent year were met. He identified seven priority areas: the need to place customers at the centre of everything it did, the need to strengthen stakeholder relations, to create an enabling environment, to position the NHLS as an employer of choice for young health professionals, to encourage research and to introduce a more cost efficient service for clients. He listed NHLS's three mandates as research, service and academic teaching. The NHLS made tremendous contributions into the country's health system.

Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) were amongst the key priorities of NHLS. The National Institute for Communicable Diseases (NICD) played an extensive role in combating communicable disease such as avian flu, Arena virus, meningitis and cholera. He flagged the issue of sustaining funding resources for surveillance programmes, which were initiated with grant funding. NHLS had noted that in the last few years there had been a trend of NICD getting less funding from the Department.

The areas of concern that were identified by NHLS were that Silicosis and TB in the mining sector were a major problem, work around HIV and the workplace had to be strengthened, there were issues around fragmentation, and the need for better coordination. Lack of greater involvement of trade unions, the large numbers of people that were in Small Medium and Micro Enterprises (SMMEs) and in the informal sector and the need for Expanded Public Works Programme (EPWP) and Occupational Health and Safety (OHS) were also cited as areas of concern.

Within the National Institute for Occupational Health (NIOH) was the National Cancer Registry, which provided surveillance data on cancer. However, this was one area where the NHLS was not able to do reports, and was currently raising its profile. The NHLS developed a Standardised Customer satisfaction Index Tool Pilot in Clinics and Hospitals in each region. The pilot measured perceptions, but it was worrying as the averages were low (See slide on Quality Assurance).

Employment Equity in NHLS was in place, most promotions that occurred during the year in review were among black employees. Certain targets were not met, for example the target of finalising 50% of Bilateral Agreements had not been met. The NHLS introduced “TrakCare Labs LIS”, which dealt with issues of billing, quality of service, management costs and offered easy assess to information.

For the third year in a row NHLS received an unqualified audit. However, there were three Matters of Emphasis. NHLS had started a five year strategy plan as it needed to address the absence of laboratory policy for setting a national framework, and needed to develop a 10 year 'master-plan', to develop a new funding model for providing laboratory services as these currently were not affordable, and to review the current funding model for teaching and research. He concluded that there was a need to consider whether NHLS should expand or look at other departments, Non Government Organisations (NGO) or to the private sector for partnership.

The Chairperson thanked NHLS for its presentation and noted that the backlog was increasing and so was the need for funds, so NHLS needed to find innovative ways to decrease the money it was spending. He asked the Committee to focus on the year under review.

Ms M Mafolo (ANC) asked if the Department of Health and NHLS worked together. She said that she would like to see NHLS and the Department meeting on a quarterly basis to strategise better.

Mr Pillay answered that in the last year NHLS and the Department had had a good relationship and it met together on a quarterly basis.

Ms Mafolo asked how involved NHLS was in creating health awareness. She commented that the high levels of TB in the mines were a cause of concern.

Mr Manny Kistnasamy, Executive Director: NIOH, National Cancer Registry, stated that there were meetings being held between NHLS and the Department at both provincial and local level. These had already highlighted that the TB rate in the mining sector was three times higher than that in the public sector. The conditions in the hostel and the mines were unfavourable, and aggravated HIV, TB and Silicosis. Silicosis damaged the lungs, TB resulted from the weakened systems in the damaged lungs and all of these were sometimes also the result of HIV, which weakened the immune system. The levels of Silicosis in South African were the highest in the world and were caused by the unacceptable state of the mines. NHLS wanted the Department to reach out and put a meeting together, as it had the data and could no longer continue to hide it. NHLS needed to convene with the Committee to find a way to intervene. Generally, only mining accidents made headlines but no attention was paid to the slow deaths in the mines.

He said that on the following Tuesday it were scheduled to have a meeting with the Chief Mining Inspector and invited the Committee to attend.

Ms Mafolo asked if the black employees were promoted based on its excellent performances, or merely because of race factors.

Ms Mpho Lecoge, Executive Manager of Human Resources: NHLS, answered that NHLS promoted people based on observed performance.

Ms Mafolo said that the report failed to give assurance of NHLS's readiness for the 2010 Soccer World Cup.

The Chairperson said that a lot of people would be using performance enhancing drugs, and asked if NHLS would be ready for that.

Mr Adrian Puren, Deputy Director: NHLS answered that the NHLS recently had held a two day workshop, mainly about communicable disease and the World Cup. It had drawn from a range of partners and looked at a lot of data about the likelihood of diseases, what the issues would be, and what happened at mass events around the world. It had to be ready, so it had assessed what could be exported or imported, and the likelihood of measles or avian flu. The pandemic flu was an indicator that NHLS was ready to deal with communicable disease. Stakeholders would have to work with NHLS and the provincial departments.

Ms Mafolo noted that NHLS said that Information Technology (IT) was slowing down because of the Department of Health. She said that she would like to see progress in IT.

Mr Stelios Michas, Executive Manager of IT, NHLS, answered that to bridge the gap NHLS had made systems available for the provision of web access to laboratory results to provinces. Unfortunately, Western Cape was the only province that took up the challenge and that highlighted how more commitment was needed from provinces. NHLS worked with Sector Educational and Training Authority (SETA) and provinces to enable connectivity that helped improve turn around time. NHLS had supplied computers to KwaZulu Natal and also had another project where it would make 600 3gig-enabled laptops available to Eastern Cape and Free State. It was also developing applications that ran on cell phones, so that individuals could access results via its cell phone. It would additionally provide 400 Blackberry Phones to technicians.

Ms Mafolo commented on the late payments and non-payment of some debt. She said that if there was late payment then the Department of Health (DOH or the Department) audit should surely have been qualified. She asked how the NHLS could get a clean audit if it under budgeted and people were not paid.

Mr D Kganare (COPE) asked why NHLS was not tougher on debtors.

Mr Pillay answered that NHLS had introduced some incentives to respond to the matter of late and non-payment of debt. There was a once-off 10% discount if the province cleared out the debt, 2% discount if the bill was paid within 21 days and 1% if it was paid within 30 days. Notwithstanding the losses, not all the provinces had taken up the offer. NHLS would charge interest to provinces that did not take up the incentive, as a punitive step. He said that there was a mismatch between the funds NHLS charged and the amount that was available.

Ms M Tlake (ANC) asked what systems were in place for NHLS to expand and provide services to private patients in the private sector.

Mr Pillay answered that the issue had been flagged. NHLS could play a crucial role but should be doing it with other providers. The NHLS could be an important player in the discussion around National Health Insurance (NHI) on benchmarking, and in looking at other sources of revenue. The private sector needed sophisticated logistics and collection points. The current system of handing out forms contributed to the high costs of pathology. A more coordinated and rational system was needed. He stated that within the laboratories, NHLS saw a lot of private patients.

Ms E More (DA) congratulated NHLS on the unqualified audit. Referring to point 7 on the second slide, she requested for some ways that NHLS had explored to help reduce costs.

Mr Pillay said that the NHLS was looking at ways of reducing costs and he cited the example of the mobile homes it had built in rural areas. The homes were built so that the people there would not have to worry about accommodation and transport costs. NHLS was also reviewing reimbursement systems and wanted to introduce some form of incentive for people who spent time in peri-urban and rural areas.

Ms More asked if NHLS had a plan on how to deal with debtors so that it could get the money owed.

Mr Pillay answered that one option was to punish those that did not pay by shutting them down, but this action was unlikely to be taken because of the nature of the service. NHLS wanted to give the current interventions time to pay off.

Ms More asked if the graphs on page 6 were the result of a decrease in access, funds or some other contributing factor.

Mr Pillay answered that there was not a decrease in volume, but the graph was meant to show that even in the year volumes could increase. The graph showed figures over six months.

Ms More, referring to the slide '2009/10 Strategic focus', asked how much of the funding was NHLS able to receive. She asked why the grant funding had been reduced.

Ms Kerrin Begg, Executive Manager: Academic Relations Research, NHLS, answered that surveillance was a service provision and up until then it had been funded by a conditional grant but the funding had lagged behind.

Mr Kganare asked why research was an unfunded mandate.

Ms Begg stated that in terms of the three mandates of NHLS, academic teaching was linked to service delivery. NHLS had been cross-subsidising surveillance and if it also cross-subsidised research this would burden the cost too much. NHLS wanted to make the services more affordable to provinces. It was intending to engage with the Department of Health on the funding issue. In terms of service delivery NHLS wanted to make conditional grants an option, but was in discussions with the Department. Therefore research was unfounded, as it depended on grants. It had not been a problem until the global economic downturn, when it soon became hard to get grants, and some grants expired, so NHLS needed to look at other ways of getting money. When grants expired, the research ended and NHLS was unable to retain or sustain researchers.

Mr Pillay added that the issue of grant funding was important, as at one level all the researchers were PhD students but once the grant expired NHLS had to let them go. He stressed that there was a need to find a new way to hire researchers as part of a team, so that NHLS did not lose its vital research, time and knowledge. He pointed out that in the last year CMS had had to let four PhD researchers go.

Ms More asked why the latest cancer statistics were not available.

Mr M Waters (DA) echoed the concern that NHLS did not have an up to date cancer registry.

Mr Kistnasamy answered that there were three institutes under NHLS's umbrella. At the beginning of the year he was requested to head the National Cancer Registry (NCR). NCR had not had a director since 2002 and there were consequently some issues with data collection. He agreed that it was unacceptable but stated that there were now mechanisms in place to deal with the data.

Ms More asked why only Gauteng was reflected in the Pap Smear History statistics.

Mr Kistnasamy answered that the study in Soweto was done through Johannesburg General Academic Hospital, where 20 new patients were diagnosed with cancer every month. It was mere perception that national institutes only focused on Gauteng but CMS was setting up a strategic plan to address the issue. There had never been a population based registry in South Africa. NHLS was in discussions with eThekwini and Cape Town metros, who wanted population based registries but needed to discuss the budget and how to access funds. It were going to set up population based registries in the next financial year under the Department and NHLS.

Through NHLS's links with universities in Pretoria, Stellenbosch, KwaZulu Natal and with the University of Witwatersrand, there would be introduction of a  Tissue based industry. NHLS had included the four universities as a start and would report on a provincial and local level. In a few years time it would have a higher level of reporting compared to 2001's figures.

The Medical Research Council (MRC) had a rural population site in Eastern Cape where it would look at the effect of cancer. In a couple of years it should be possible to accurately report on cancer trends in South Africa.

Ms More asked in what year was the pilot study on quality assurance done. She asked if there was a specific plan in place, just in case it was based on fact and not just perception.

Ms More asked when NHLS would have compiled its 10 year plan and she asked if it was not considered good to have a 10 year plan.

Ms Lecoge answered that NHLS had taken into account the time it would take to prepare so it had found it necessary to develop a ten year plan instead of a five year one. It would have a system in place to monitor the plan.

Ms More asked if NHLS had a retention strategy and asked what compelled people to terminate their contracts.

Ms Lecoge answered that NHLS did not even have sufficient staff, and people did not want to go to rural areas. Therefore the long working hours created strain and people were compelled to quit.

NHLS had a retention rewarding strategy and was looking at means of rewarding those who stayed in rural areas. NHLS had mechanisms in place and had an elaborate detailed system that recognised career development. It was not just looking at core disciplines but other disciplines too as it wanted to retain talent that it had. It had sponsored technology scientists and pathologists for development and had a 'work back pay back' system. This system locked in scientists for 18 months, and pathologists for three years, as it was a contractual process and helped retain staff.

Mr Pillay added that NHLS did not want to throw money at the problem as it adopted a value driven approach. It wanted people to choose NHLS for reasons beyond money. 

Ms More asked if electronic laboratory results delivery affected privacy.

Mr Michas answered that SMS printers were in secure areas, so patient confidentiality would not be breached and NHLS had not extended this to HIV testing.

Mr Waters noted that NHLS had said that it had a problem with the current legislation that hampered its attempts to collect data from private sector. He asked for elaboration on the new legislation that NHLS had said would help.

Mr Kistnasamy answered that some private laboratories hid their data and stated that it was confidential. However,  the legislation was vital as some people went to several different laboratories, so NHLS wanted to get the identity numbers of people who had already had tests so that data would not be unnecessarily replicated.

Mr Waters said that there were many different acting managers, who were all coincidentally female, and he asked if there were systems in place to make them permanent.

Mr Kistnasamy answered that there was no link between the acting positions and the gender of the acting managers. NHLS had to look at the structure, policy framework and the legislation framework. There was a structural approach. NHLS was currently in talks with the Department.

The Chairperson asked what Mr Kistnasamy's position was, as he seemed to do a lot and to be connected with the policy workers.

The Chairperson thought that Committee Members should pay a visit to the mines in the following year. He said that silicosis had been a problem since he was young, but the problem had been that in the past there were simply reports of high figures of TB in the country, but no information as to where this was dominant.

The Chairperson asked what the relationship between NHLS and MRC and the Academy of Science and Technology (ASAT) in Pretoria was, as ASAT did not have laboratories and depended on NHLS.

Mr Waters asked NHLS to explain the link between HIV and cancer.

The Chairperson responded that HIV weakened the immune system. Kaposi sarcoma, one of the cancers that was not prevalent before, but had now become common, attacked weak immune systems as the bodies became predisposed to other diseases.

 Mr Kganare asked how NHLS utilised its surplus in terms of investment. He asked what was meant by the term 'rendering of quality laboratory services' and asked if NHLS had a plan to ensure that all laboratories would be accredited.

Ms Begg answered that there were four aspects that contributed to the quality of laboratory services, namely quality assurance, management quality, benchmarking and customer satisfaction surveys. Quality assurance ensured that the laboratory offered results that were valid and could be trusted. There were systems, processes and management systems in place to ensure efficient management quality. NHLS had introduced a management audit two years ago and every single laboratory was audited annually. Over the past year it had seen a 10% improvement in audit figures.

Benchmarking dealt with accreditation. NHLS did not have accreditation in all laboratories as it was a tedious and expensive process. All reference and most academic laboratories were accredited, and 29% of regional laboratories too. NHLS did not think it was in the country's best interests to accredit peripheral laboratories. It wanted to make an interim accreditation system. Two thirds of the assessors were NHLS employees so there was no reason why it could not set up an internal accrediting system.

Up to now, NHLS had not measured customer satisfaction. The reason for the pilot was to see whether it was a valid tool. The survey suggested that it was. Every single hospital and 10% of clinics were visited. NHLS fed the results to the stakeholders and it had placed an improvement target on every manager. It was also running internal satisfaction surveys.

Mr Kganare asked if there was a programme in place to improve turn around time, particularly in areas such as Transkei.

Mr Jone Mafokeng, Executive Manager: Northern, NHLS: answered that it was working on coverage and turn around time in Transkei. In Eastern Cape there were several clinics in the rural areas but bad roads affected accessibility, so it had to put a transport system in place. NHLS had the intention of a clinic being visited at least once a week, which was not always the case. There was the issue of workload, as sometimes the inspectors would visit a clinic but failed to find what they needed. In Northern Transkei NHLS did not spend less than R250 000 a month on clinic visits, but it had made the Department of Health aware of the costs involved.

The Chairperson asked if NHLS was using private companies or structures within NHLS, and if it was not then he asked who it was using. He had heard that taxis were being used.

Mr Mafokeng answered that NHLS was outsourcing in Eastern Cape. It was using a couple of private companies but he was not certain of their names. At a particular time it was using private couriers but taxis in the area chased the couriers away, and the private couriers were on certain occasions threatened. NHLS therefore involved the local community and sourced from those people. It never used taxis.

Mr Kganare asked why members of the board did not want to participate like Trade Unions. He asked if NHLS was actively pursuing the amendment of the legislation.

Mr Pillay answered that people were so overwhelmed by other things that NHLS was not a priority. It would have to consider how the board should be constituted, whether it would be constituted on a constituency basis or on the basis of technical expertise.

He said that the matter of legislation had been identified as a lot of work had to be done. NHLS was engaging with the Department as the Board needed to be more proactive.

Mr Kganare asked why previously disadvantaged institutions did not utilise travel grants.

Ms Begg answered that NHLS wanted to take South African generated research around the world. It was concerned with some universities such as Walter Sisulu University whose academic departments were weak and it found it hard to recruit good academics into such historically disadvantaged institutions. However NHLS believed that once it got a good cohort of academics there, the research would follow.

Ms M Dube (ANC) commented that the report was mixed with future suggestions.

She asked how many bursaries NHLS had granted and from which countries the recipients hailed.

Mr Pillay answered that bursaries were only for South Africans and it had granted 165 in the last year. There were strict policies governing the bursaries and they locked people in to work for the organisation for a period in return.

Ms Dube asked how it would be possible for NHLS to open 44 labs by April when it had only been able to open nine out of 53 labs in the last year.

Ms Dube asked if there was a guiding document that stipulated how long a person could be in an acting position.

Mr Pillay answered that a person only got paid from month two as there was a policy for acting. He said there were currently only two positions open, linked with the strategic direction of NHLS. It was conscious about people acting for too long.

The Chairperson stated that a lot of targets were not achieved in its report yet NHLS had set the targets. He asked if it was because it had been overzealous. He asked how the Committee could be reassured that it would meet the targets it set for the following year.

Mr Pillay answered that NHLS had been circumspect at setting targets for the coming year. It had then identified targets that were achievable. It had allowed for targets and stretch targets.

The Chairperson said that he hoped he would get to see those statistics.

Mr Kistnasamy answered that he could get them to him in a week but the data was only up to 2001, as NHLS had not cleaned the data yet.

The Chairperson asked what NHLS's connection was with rapid HIV testing.

Mr Puren answered that rapid tests did very well at laboratory level but once the tests were rolled out in non-laboratory settings, issues arose with them. NHLS was working with the Department because getting quality assurance around tests was critical. It did not want people to enter programmes with the wrong diagnosis, so additional tests were done to ensure that people were treated in the appropriate way. There were funding issues and implications for NHLS and the Department, so, with guidelines, they could ensure that tests were done efficiently.

 Mr Pillay invited the Committee to visit NHLS sites.

Council for Medical Schemes Presentation of the Annual Report
Mr Patrick Matshidze, Chief Executive Officer: Council for Medical Schemes, stated that the key mandate of the Council for Medical Schemes(CMS) was to promote non-discriminatory access to privately funded health care through open enrolments, community rating and ensuring guarantee of benefits. The other mandates of CMS were to promote financial stability and sustainability, to encourage active participation of members in scheme affairs, and to investigate and resolve complaints of members.

The functions of CMS entailed the protection of members, the control and coordination of the Industry, assisting the Ministry with quality related issues and the investigation of complaints. Other functions were the collection and dissemination of information, the making of rules that were not inconsistent with legislation, giving advice to the Minister on any matter pertaining to medical schemes and performing any other function the Minister would confer. There were other legislative provisions that affected what it did. The Council was appointed by the Minister and it reported to the Committee and interacted closely with the Department of Health. CMS had a total staff of 78 and a total budget of R60 million in the year under review.

CMS had been working closely on the Medical Schemes Amendment Bill. The Bill sought to address technical amendments, such as dealing with definitions of the business of medical schemes and attempting to thwart opportunistic behaviour that it detected in the environment. This last matter dealt largely with Prescribed Minimum Benefits (PMB): where opportunistic providers in the past had charged whatever they thought their members could bear. CMS had been thinking of interventions it could implement for medical schemes' bad governance problems.

The normal operational activities of CMS were ensuring that contributions and benefits were adjudicated upon, ensuring the adequate enforcement and compliance by entities in the environment and ensuring that it train, inform and educate all the stakeholders in the environment. CMS had had to adjudicate 3 138 valid complaints in the year under review. CMS had seen consolidation in the number of medical aid schemes but had not necessarily noted a reduction in the number of members.

There were four main challenges that CMS encountered, mainly around the demarcation issue, the prices of medical services (as it believed prices should be standardised) and the issue around PMB. He stated that it needed clarification on what the legislature envisaged when it said that payment for PMB should be done in full. The last challenge was that CMS did not have sufficient punitive measures even though it had managed to take some medical schemes, such as Bonitas, to court.

He stated that it was aware that the landscape had shifted and CMS had been familiarised on the 10 point plan of Government. He concluded that CMS was keen to engage in discussion on the Audit report, which it did not include in full in this presentation, and that it was happy with the Auditor General's pronouncement of an unqualified audit for the ninth consecutive year.

The Chairperson remarked that the presentation was not that different from the one that had been done before but was certain that the Members must have some questions. He asked why public hospitals were not using medical aids.

Mr Matshidze answered that its first challenge was that in 2004 the Department of Health amended the legislation to say that when PMB was involved, a scheme should have a designated service provider. That was done to minimise the financial risk. The thinking was that not only would the private sector benefit, but the intention was to skew the advantage towards public hospitals, given the network they had. There were attempts made by medical schemes to contract with provinces, as it was not possible to contract with individual hospitals. Western Cape had made a bid and currently had contractual arrangements with a number of medical schemes. Gauteng had tested the waters but had pulled back. KwaZulu Natal came in late in the year, with the result that public hospitals had not benefited. Sometimes, because of incompetence or a lack of adequate systems, the hospitals were unable to follow up on the money and that had created problems.

In other instances, there were revenue retention challenges, as the hospitals asked what was the point of following up on money if it ended up in the Central Treasury. There were a myriad of factors that led to public hospitals not taking advantage of the opportunities that were given to them. Two years ago, the Department created the Designated Service Provider Networks, but it was not clear whether these were successful or not.

The Chairperson asked if other countries had Extremely Drug Resistant TB (XDR) and why South Africa did not use them.

Mr Matshidze said that there was an XDRTB package that covered TB, and by extension HIV and medical scheme members had had this since the inception of the legislation. It was enhanced when the national standard was determined. CMS had done a study in 2004 as to why people were not taking advantage of the scheme and discovered there were many challenges. There were issues around confidentiality and the stigma associated with the disease. CMS had always assumed that private practitioners knew how to treat HIV, but to its surprise CMS found out that most of them were not at the required level of competence. TB was currently a PMB and had to be treated in that matter. There had been a proposed initiative by the Minister to cover HIV and TB widely, and CMS were requested to research how that would be done.

The Chairperson asked how far CMS was with the Bonitas case, but noted that CMS should answer without divulging confidential information.

Mr Matshidze answered that Bonitas was a reflection of many ills in the system. It was not beyond possibility that people would take advantage of the system. When CMS identified the unfortunate developments it had to approach the High Court as it realised the legal challenges Bonitas wanted to launch. The High Court hired an independent body to conduct some investigation and the evidence was so weighty that Bonitas could not oppose. CMS had the conclusion of the report and was still debating what to do about the issue.

 The Chairperson asked if Bonitas was a non-profit organisation, as many of the schemes were. He suggested that the legislation was perhaps failing them.

Mr Matshidze answered that all medical schemes were for profit but unfortunately some of them were administered by entities that had other commercial interests.

Mr Waters asked for the Council's view on how medical schemes would fit into the NHI.

Mr Matshidze answered that he had to take a contextual view on where CMS came from with regards to health reform processes. In 2004 CMS had assisted the Department in developing a logistics framework, which was to assist in conceiving the NHI. It currently knew that the process was short circuited but it was aware of what DOH was trying to do, and it was on that basis that CMS was participating. He hoped the question could be answered once a peer review, expected to be finished at end of November, was completed.

Mr William Pick, Chairperson, CMS, added that the long term vision was to grow the pool of insured people in South Africa and the debate was already done in the 1980s. He asserted that the experienced people in the field could contribute their expertise in developing NHI.

The Chairperson remarked that Ghana had National Health Insurance but he had not had the time to assess if it was efficient.

Mr Waters remarked that it was a disaster.

The Chairperson asked if it was legally correct that medical schemes had to go through provinces and not individual hospitals.

Mr Matshidze responded that CMS had considered a direct approach but was advised that provinces would be better custodians and that individual hospitals might not have the capability to maintain the contracts. Province contracts could generate revenue without prejudice to non-contractual entities. He was uncertain as to the legal status.

Referring to demarcation, he remarked that the process was administered by the National Treasury and CMS was just one of the participants. CMS participated to ensure that whatever outcome was arrived at and whatever legislation flowed forth was consistent with the prevailing health policy. It appeared that the provinces were captured by a vested interest, and that was why it was considering a different route.

Ms T Kenye (ANC) asked how long the term of the task team was.

Ms Kenye asked what the structure of the Committee was, considering the vast amount of complaints that it had to deal with.

Mr Matshidze answered that the Council had sub-committees and the Appeals Committee consisted of external members with legal expertise. The Medical Schemes Act had created a quasi judicial body, where it was possible for a complaint to be handled, without referring it to a court. The highest body that a person could appeal to was the Appeals Board, which was appointed by the Minister, who chose three people to sit on this Board.

Ms More commented that there was another acting manager working for CMS.

Mr Pick answered that the Committee was well justified in its concerns about acting appointments. He noted that the previous Chief Executive Officer had been on leave for six months. Applicants had been short listed and CMS was hoping to fill the appointment soon.

Ms Dube asked how long it would take to regulate the tariffs.

Ms Dube asked if CMS won court cases and if it did, whether it was awarded the costs.

Mr Dan Lehutjo, Chief Financial Officer, CMS, answered that when it won court cases the medical schemes paid the CMS and these payments were reflected in the report.

Ms More noted that there was nothing on HIV in the presentation. She said she would like to see such statistics as this would give some idea of who could afford Anti-Retroviral drugs in the country.

The Chairperson said that there was no need to reply to this question now. However, he too would like to see data of who could and who could not afford medical care. He would like to see a point where everyone in South Africa would be able to afford medical care.

The Chairperson said that this was the last meeting for the year. The last six months had been challenging for the Committee, many of whom were new Members.

The meeting was adjourned.



Share this page: