Ethics was engrained in professionals. International experience with price regulation offered two options – of which the first was administered pricing, and the second was price negotiation. She felt that Discovery’s costs were legitimate and noted that they were decreasing. HASA had no control over the utilisation levels of patients, and the question must be asked why this was overlooked. He agreed that there could be instances where there was disagreement over price. There was a severe global shortage of nurses. Dr Matlala concluded that HASA remained committed to engagement with the Department. The Department had received reports that doctors often times received perverse incentives. Private hospitals demonstrated a large growth in their return on investment compared to the cost of their debt. Ms Ngcobo then asked what the private sector felt about price negotiation. “In approving these adjustments, the committee took into consideration the current unfavourable economic environment brought about by Covid-19 and its impact on ordinary citizens, as well as the need for the provincial government to generate revenue in order to strengthen its capacity to provide much needed health-care services,” said the committee. The Department of Health, the CMS and the BHF not only supported the regulation of the private hospital sector but insisted that it be done. He also asked in which way HASA was protecting the poor when they took government to court. If that was done, prices would come down. Monitor and NHS England’s 2016/17 National Tariff Payment System will come into effect from 1 April 2016. People who are on social grants, as an example, can be treated for anything without paying. Ms Dube added that the Committee was not here to protect the public sector. It did not, however, mean that the private sector could charge whatever it wished. Pharmaceutical products at private hospitals had to be sold at the Single Exit Price (SEP), which was set by the Minister of Health. Access to medical aid schemes was dictated by the incomes of individuals. HASA had consistently provided the Department with information and engaged in various processes initiated by the Department, which included the Reference Price List (RPL) process. At the time, the Department of Health published RPL tariffs without giving consideration to HASA’s input on the methodology to analyse hospital costs, or to actual hospital costs. Check UK trade tariffs from 1 January 2021; Collection. South Africa had a very high concentration of state of the art technology employed in healthcare. Tariff: A tariff is a tax imposed on imported goods and services. Mr Thulani Matsebula, Health Economist, Council for Medical Schemes, continued with the presentation speaking to the economic considerations. He pointed out that during tariff negotiations bullying tactics take place, with the larger entities exerting power over the smaller. It must also be asked whether there was a direct relationship between quality given and the cost, and whether this amounted to value for money, and he agreed that at present there was no system to check on this. Department of Health briefing She asked whether HASA was listed on the Johannesburg Stock Exchange (JSE). Two years previously, the auditing firm PriceWaterhouseCoopers had done such a presentation. Payments to private hospitals made up 33% of medical schemes’ gross contribution income of R84.8 billion for 2009. Tariffs went … He also asked HASA to elaborate the vertical benefits for specialists and laboratories. The Gauteng legislature’s committee on scrutiny of subordinate legislation (CSSL) has approved new regulations for the health-care sector, which kick in from Wednesday July 1. Dr Gantsho stressed that if there was no intervention, costs would continue to increase. He said that he could not consider “long waiting times” in the same category as overcharging people. Dr Zokufa outlined the gaps in the South Africa healthcare system as the lack of robust quality assurance and assessment systems linked to cost, lack of robust health technology assessment, lack of meaningful peer review processes and inadequate regulatory controls to protect the consumer. Hospitals competed for and attracted specialists through high-tech medical facilities and service offerings. He said that it was necessary to ask whether the consumer was adequately protected, whether the sector had the interest of South African citizens at heart, and who could intervene. In 2007 the RPL schedules were published by the Department, based on the NHRPL, and regulations formalising the RPL were promulgated. He was not sure whether private hospitals were helping people. There was an erroneous perception that the private hospital industry was unwilling to engage with regards to pricing and tariffs. Visit SA Government Coronavirus (COVID-19) website: https://sacoronavirus.co.za, PC Health: Briefing by the Hospital Association of South Africa (HASA) on their tariff structure setting and process, National Department of Health presentation, Hospital Association of South Africa presentation, Board of Healthcare Funders of Southern Africa presentation, BRRR: Budget Review & Recommendations Reports, Code of Conduct / MP Disclosure of Interests, Creative Commons Attribution 3.0 South Africa. Members were unanimous in their support for prices at private hospitals to come down, and for regulation where necessary. There are costs to tariffs, however. Patients seeking medical care at Gauteng hospital s will pay more for services at health care facilities in the province. The Department did intend to increase the number of specialists in the public sector. Time wasted waiting, and bad service, could also be seen as a form of overcharging, although she noted that it was necessary then to define what “overcharging” meant. She asked how this negotiation was done. The public sector hospitals were considered to be in a dismal state. Hospitals competed for specialists and attracted them through hi-tech medical facilities and service offerings. The Board of Healthcare Funders of Southern Africa (BHF) was concerned that there was a gap in the healthcare system, in relation to hospitals, although there was generally transparency on the funding side. He added that a detailed presentation was needed to shed light on the issue of profitability. The Hospital Association of South Africa (HASA), the National Department of Health, the Council for Medical Schemes (CMS) and the Board of Healthcare Funders briefed the Committee on tariff structures in the private hospital sector. The fees appearing in the Schedule are applicable in respect of services rendered on or after 1 April 2015 and Exclude VAT.---Wp7.44 47..4 MN OLIPHANT, MP MINISTER OF LABOUR DATE. The Chairperson asked medical schemes present if they wished to make inputs. The general perception and belief was that private hospital costs were too high. The relationship between private hospitals and specialists was a consideration, given that specialists determined how long a patient stayed in hospital. According to the committee, children under six, pregnant women, pensioners and anyone receiving social grants are exempt from paying for health-care services. Specialists were independent and charged their own fees. These included the fact that private hospital costs had increased, medicine prices had decreased, and specialists’ costs had increased, which led to an increase in private hospital costs. Public hospitals were mainly funded by government, whereas private hospitals accessed capital from the open market. Dr Pillay said that the alternative reimbursement model not only benefited medical schemes but administrators as well. Mr Waters then referred to the CMS’s presentation document, which stated that the public sector was responsible for the training of medical professionals, and pointed out that government did not allow anybody else to train doctors. The main issue related to who would look after the interests of the poor. HASA took action against health practitioners who not adhere to ethics. The price increase can be thought of as a reduction in consumer income. Mr Zokufa stated that the monitoring would be by way of regulation, which must clearly be done in order to solve a problem. Cost information should form the basis of the negotiations. The main cost drivers were hospitals and specialists. The problem was that government was not monitoring either public or private hospitals, although healthcare professionals were being monitored. It would be unfair if a patient could negotiate, as a body of knowledge was needed to make an informed decision. The French state cut hospital tariffs between 2010 and 2018, which had a negative impact on hospitals' financial position. Consultations between the government and private hospital representatives have been progress for the past five weeks over tariffs. The Department believed that private hospital costs were too high, that spare capacity existed in private hospitals which could reduce prices if utilised, that there seemed to be a reluctance to price negotiation. The regulations give authorisation to the department to make adjustments to these fees annually to ensure it can generate enough revenue to meet the increasing demands of the health-care sector. Mr Hoosen stated that HASA alleged that there were no benefits for doctors from private hospitals but the Department had stated that there were. He welcomed further interactions with the Committee on this issue. He responded that HASA did not deal with primary healthcare, as the licence held by HASA held was an acute licence. Dr Humphrey Zokufa, Managing Director. As of Tuesday, the number of pupils across Gauteng who have contracted Covid-19 is 58, while 188 educators have contracted the virus. The private sector had little involvement in primary health care. Specialists were independent and charged their own fees. Many of the extra admissions in private hospitals were linked to the tuberculosis and HIV value, which the Minister of Health spoke about. Tariffs structures in private hospitals It would seem that everyone present was in agreement that regulation was needed. Every private hospital or unattached operating theatre needs to be registered. However, they had no illusions about the bottom line in business being to make a profit, but noted that in the health sector, it was people’s lives that were involved. “The committee noted that the fee adjustments are necessary to ensure public hospitals have necessary resources to operate effectively.”. The state of the public healthcare sector was a side issue to the seemingly high tariffs charged by private hospitals. Private hospitals derived market power from market concentration and medical schemes and administrators were weak by comparison. Pharmaceutical products at private hospitals had to be sold at the Single Exit Price which was set by the Minister of Health, so no profit was made by private hospitals on these products. Dr Roelof Botha, Economist, Council for Medical Schemes, pointed out that hospitals within the South Africa context operated in a complex environment, but important areas must be considered. Public hospitals obtained pharmaceuticals at state tender prices, mooted to be between 50% and 70% cheaper than private sector prices. It was, however, felt that primary health care should be re-engineered. The health sector was covered by the Public Finance Management Act and the Medical Schemes Act. The private hospital industry trained more nurses than the public sector. In relation to technological advances in surgical products, he noted that this was considered part of progress. ' The government has to remove the minimum tariff package system delivered under the INA-CBG in carrying out the JKN program and replace it with a fee-for-service system,' Said added. He confirmed that HASA and the Department negotiated on the reference price, but at the point where the Department had asked HASA for information that could be verified, the discussions started to break down, and eventually led to Court action, as HASA refused to allow Department the opportunity to verify the information that HASA had provided. This stability could be attributed to interventions by the Committee and the Department. Mr Matlala stated that because the patients did not know the prognosis of a disease they could not negotiate on price. There was also a nursing council and the Council for Medical Aid Schemes. Mr Hoosen also asked whether the trajectory of the private healthcare sector was it on the incline or decline. here. Dr Pillay then gave the Committee a brief history of the RPL. Currently, it must be noted that medical aids negotiated with hospital groups on tariffs. The gist of the presentation was to explore cost trends, cost drivers and to explain them by considering competition dynamics, private hospital behaviour and ownership. If a person needed healthcare, there was no choice, and the person should be assisted. Finally, he noted that public sector hospitals did not have a tariff list that was made public, but it was available if needed. The increase was attributed to sign-ups to Government Employees Medical Schemes (GEMS), which was government subsidised. This would not happen when regulations were introduced. Furthermore, she noted that soon a standards compliance office would be opened, and the issue of primary healthcare would be dealt with, and she asked also what the private sector’s view was on this. Girl dies after brutal sjambokking by parents, Gauteng has 13,023 Covid-19 cases, 3,716 recoveries and 87 deaths, Joburg woman evicted after testing Covid-19 positive, Six more people have died of Covid-19 in Gauteng — Check your suburb here, Concern at Covid-19 test result delays, notably in Joburg hotspot, 419 people hospitalised with Covid-19 in Gauteng, death toll nears 50. The Chairperson stated that the Health Practitioners Council of South Africa monitored health professionals. The private hospital industry trained more nurses than the public sector, and this too added to its cost pressure. The general perception and belief was that private hospital costs were too high. Health-e News has spoken to a few Gauteng residents to hear their views on the increase. Chairperson’s opening remarks The amended regulations were presented by the Gauteng health department for approval by the committee and will come into effect from Wednesday. By 1996 half of the hospital beds were in the hands of the major private hospital groups, compared to 2006, when only 12% were in the hands of independent private hospitals. Members also discussed issues around the training of nurses, incentives for doctors in admitting patients to certain private hospitals and the profit motives, with the Committee expressing scepticism about the relationship between doctors and the private hospitals where the worked. This publication provides an explanation of the tariffs charged in government hospitals. Members had received the impression that health was a commodity, and there was some question as to whether the interests of patients or shareholders came first. He commented that the public sector should start looking at ways to improve services in order to attract people back to it. Another point was that medical aids negotiated with hospital groups on tariffs. A neutral body had to be responsible for tariff setting. HASA maintained that it was necessary to ask whether the prices were too high in relation to the input costs. The Hospital Association of South Africa (HASA), the National Department of Health, the Council for Medical Schemes (CMS) and the Board of Healthcare Funders briefed the Committee on tariff structures in the private hospital sector. The Chairperson repeatedly stated that the poor should be protected. The UK Government is also being urged to set out what engagement it has with the European Union to settle the dispute that resulted in the tariffs being imposed. “There are tariffs for procedures. A regulatory framework was needed for private hospitals. Each hospital group had its own utilisation figures. Dr Pillay stated that there was no regulation on the certificate of need. Mr Matlala stated that the private hospital industry was willing and prepared to be regulated. The Chairperson asked why the same procedures cost different prices at different private hospitals. The NHRPL was used as a guide to industry from 2004 to 2006. Asymmetry of information caused increased prices for health services, because it gave market power to the holder of better information. All hospital groups had norms and standards to which doctors had to adhere. We use this information to make the website work as well as possible and improve government services. A legal framework was needed to regulate prices in the private healthcare sector. The private sector served an important health system objective of improving access to care. Mr G Lekgetho (ANC) stressed that something urgent needed to be done to close the gap. More Covid-19 restrictions for Nelson Mandela Bay as Ramaphosa declares metro a ... Makhura shuffles cabinet to 'strengthen Gauteng'. We don't have attendance info for this committee meeting. If prices were to increase continuously, the gap between those with and without the necessary means would widen. He pointed out that the private hospital only made profit on 60% of the total hospital bill. Ms Penny Tlhabi, Representative, Discovery Health, said that since Discovery had been mentioned by the Department, she wished to make an input. Individuals in most instances did not have a choice as to which private hospital was used, as the specialist would simply admit the patient to the hospital where s/he worked. The Chairperson stated that there might be two systems of health but both fell under the Department. Pretoria - The Health Professions Council of South Africa (HPCSA) says the implementation of the new Guideline Tariffs for medical and dental services will serve to protect the public and guide healthcare practitioners on the rendering of accounts in terms of the prescribed ethical guidelines. After sharp increases from 2000 to 2005, real claim costs had remained stable from 2005. 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