SAHR 2007 - Health Systems Trust

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Rationing of Medicines and Health Care Technology 8 New drugs and technologies Although modern health care innovations are as a rule inflationary to the health care system, they are nevertheless important, both from perspectives of adding potential clinical value, as well as from an economic perspective. Access to first world health care services may be an important consideration for offshore investors, as well as skilled workers who are internationally mobile. Given this, it is important that these products do find a niche within the South African health care system. However, their introduction must be controlled. Based on the expense of biopharmaceuticals, their projected market growth, as well as the fact that they are often used for prolonged periods, it is unlikely that their meaningful inclusion in a minimum prescribed package in South Africa can be justified at this point in time. Furthermore, the current legislative environment allows for medical scheme members to move relatively freely between different options of their schemes, purchasing care as and when needed. Given this, they can access specific benefits without having cross-subsidized their use. Such practice should be discouraged. The feasibility and appropriateness of introducing demarcated insurance products specifically for purposes of very expensive medicines and technologies should also be investigated. Regarding technology-based procedures, clinical outcomes are highly dependent on the technical skills of the operator. For this reason it is important that any new medical device is only used by those with the adequate training and expertise. To this end novel technologies should be introduced through Centres of Excellence where accredited providers function as part of a multi-disciplinary team, where there is a system of peer review (ideally in collaboration with academic institutions abroad who have established experience with a new technology), where both private and public sector patients are treated in order to ensure a critical mass of patients for optimisation of clinician expertise and where results are audited. To achieve this, there should be a credentialing system for physicians in South Africa which should ideally be a collaborative initiative between the private funding industry, physician groups, hospitals and the Health Professions Council of South Africa (HPCSA). Innovative public-private partnerships are also called for. Conclusion Pharmaceuticals and health care technologies are an integral component of any health care delivery system. However, to be of value and to add to the development of an efficient and equitable system, their quality must be ensured through effective regulatory mechanisms, their prices must be optimised and they must be used appropriately within budgetary constraints. Given the rapid advances in the realms of health care technology, including drugs, together with burgeoning diseases which include lifestyle-related illnesses, infectious diseases and trauma-related inflictions, pressures on available health care funds are increasing steadily. Not only do more patients require care, but more patients are potentially treatable. It is important that government agrees on clear health care financing strategies and invests resources in defining more appropriate statutory minimum benefits for medical schemes. Visible collaboration between various role players in government is of paramount importance. The Department of Health cannot walk this road alone. Acknowledgements The author would like to acknowledge the invaluable support of Dr Derrick Burns (Medscheme Health Risk Solutions) as well as the contribution of data and comments by many of her colleagues in compiling this chapter for the Review. A proposal for the establishment of a national independent physician credentialing infrastructure in South Africa has been collated by Dr J Fisher, Health Care Consultant. 135
References 1 Kaiser Family Foundation. How Changes in Medical Technology Affect Health Care Costs. Snapshots: Health Care Costs; March 2007. URL: http://www.kff.org/insurance/snapshot/chcm030807oth. cfm 2 Technical Review Panel on the Medicare Trustees Reports. Review of Assumptions and Methods of the Medicare Trustees’ Financial Projections; December 2000. URL: http://www.cms.hhs.gov/ReportsTrustFunds/downloads/ TechnicalPanelReport2000.pdf 3 Newhouse JP. Medical Care Costs: How Much Welfare Loss? Journal of Economic Perspectives 1992; 6(3): 3-21. 4 Department of Health. The Charter of the Health Sector of the Republic of South Africa. Pretoria: Department of Health; 2005. URL: http://www.doh.goz.za/docs/charter-f.html 5 Statistics South Africa. Mid-year Population Estimates. Pretoria: Department of South Africa; 2007. URL: http://www.statssa.gov.za/publications/statskeyfindings. asp?PPN=P0302&SCH=3952References 6 Council for Medical Schemes. Annual Report 2006-2007. Pretoria: Council for Medical Schemes, 30 August 2007. URL: http://www.medicalschemes.com/publications/publications.aspx?catid=7 (accessed 09.09.2007) 7 Blecher M, Harrison S. Health care financing. In: Ijumba P, Padarath A, editors. South African Health Review 2006. Durban: Health Systems Trust; 2006. URL: http://www.hst.org.za/uploads/files/chap3_06.pdf 8 Padarath A, Ntuli A, Berthiaume L. Human resources. In Ijumba P, Day C, Ntuli A, editors. South Africa Health Review 2003/2004. Durban: Health Systems Trust; 2004. URL: http://www.hst.org.za/uploads/files/Ch%2022.pdf 9 Sanders D, Lloyd B. Human resources: international context. In Ijumba P, Barron P, editors. South Africa Health Review 2005. Durban: Health Systems Trust; 2005. URL: http://www.hst.org.za/uploads/files/sahr05_chapter6.pdf 10 National Institute for Health and Clinical Excellence. Social Value Judgements: Principles for the development of NICE guidance. London: NICE; 2005. URL: http://www.nice.org.uk/page.aspx?o=283495 11 Bastian H, Bender R, Ernst AS, Kaiser T, Kirchner H, Kolominsky- Rabas P, et al. Methods. Version 2. Cologne: Institut für Qualität und Wirtschaftlichkeit im Gesundsheitswesen; December 2006. URL: http://www.iqwig.de/download/Methods_a_second_ Version_Produced_by_the_Institutes_Steering_Committee.pdf 12 Harvey K. Pharmaceutical Benefits and Free Trade: Trouble ahead for subsidized medicines in Australia? Australian Review of Public Affairs; March 2004. URL: http://www.australianreview.net/digest/2004/03/harvey. html 13 Barrett A, Roques T, Small M, Smith R. How Much Will Herceptin Really Cost? Br Med J 2006; 333: 1118-20. 14 British Medical Association. The BMA’s Way Forward for the NHS in England (issued 08 May 2007). URL: http://www.bma.org.uk//pressrel. nsf/wlu/SGOY-72VJQX?OpenDocument 15 Republic of South Africa. Medical Schemes Act (Act 131 of 1998). URL: http://www.doh.gov.za/docs/legislation/acts/1998/act98- 131.html 16 Taylor B, Taylor A, Burns D, Rust JD, Grobler P. Prescribed Minimum Benefits – quagmire or foundation for social health reform? S Afr Med J 2007; 97: 446-450. 17 Council for Medical Schemes. Consultative Investigation into Low Income Medical Schemes. Final Report. Pretoria: Council for Medical Schemes; 07 April 2006. URL: http://www.medicalschemes.com/publications/publications.aspx?catid=29 18 Armstrong J, Deeble J, Dror DM, Rice N, Thiede M, Van de Ven WPMM. Report to the South African Risk Equalisation Fund Task Group. URL: http://www.medicalschemes.com/publications/ ZipPublications/Risk%20Equalisation%20Fund/REF_ InternationalReviewPanel_Jan_2004.pdf 19 Republic of South Africa. Medicines and Related Substances Control Amendment Act (Act 90 of 1997). URL: http://www.doh.gov.za/docs/legislation/acts/1997/act90. pdf 20 Forman L, Pillay Y, Sait L. Health legislation 1994-2003. In: Ijumba P, Day C, Ntuli A, editors. South African Health Review 2006. Durban: Health Systems Trust; 2004. URL: http://www.hst.org.za/uploads/files/chap2_03.pdf 21 Gray A, Gengiah T, Govender M, Singh J. Health legislation. In: Ijumba P, Barron P, editors. South African Health Review 2005. Durban: Health Systems Trust; 2005. URL: http://www.hst.org.za/uploads/files/sahr05_chapter2.pdf 22 Regulations relating to a transparent pricing system for medicines and scheduled substances, Government Gazette No.29443, 1 Dec 2006. URL: http://www.info.gov.za/gazette/regulation/2006/29443b. pdf 23 Kahn T. Pharmacy sector poses tough task for state – report. Business Day 16 Jul 2007. URL: http://www.businessday.co.za/articles/article. aspx?ID=BD4A514292 24 Republic of South Africa. Medicines and Related Substances Act (Act 101 of 1965). URL: http://www.mccza.com/documents/ Integrated%20Act%20101.zip 25 Republic of South Africa. Regulations Relating to a Transparent Pricing System for Medicines and Scheduled Substances. Government Gazette No. 28214, 11 Nov 2005. URL: http://www.info.gov.za/gazette/regulation/2005/28214. pdf 26 Republic of South Africa. Hazardous Substances Act (Act 15 of 1973). URL: http://www.doh.gov.za/docs/legislation/acts/1973/act15. html 27 World Health Organization. Medical Device Regulations – Global overview and guiding principles. Geneva: World Health Organization; 2003. URL: http://www.who.int/medical_devices/publications/en/ MD_Regulations.pdf 28 Republic of South Africa. National Health Act (Act 61 of 2003). URL: http://www.info.gov.za/gazette/acts/2003/a61-03.pdf 29 Sinclair S. The GATS and South Africa’s National Health Act. In: Ijumba P, Padarath A, editors. South African Health Review 2006. Durban: Health Systems Trust; 2006. URL: http://www.hst.org.za/uploads/files/chap2_06.pdf 30 Council for Medical Schemes. Annual Report 2006-7. Pretoria: Council for Medical Schemes, 30 August 2007. URL: http://www.medicalschemes.com/publications 136
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South African Health Review 2007 LI
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Foreword The 12th edition of South
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12 Traditional and Complementary Me
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Other Funders for the Health System
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This response raises a number of qu
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The authors conclude that mandatory
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servicing and inappropriate hospita
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systems is also critical; worrying
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Authors: Laetitia Rispel i Geoffrey
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Stewardship: Protecting the Public
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Introduction The importance of the
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diseases such as tuberculosis and t
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17 of 2002). This Act entirely repl
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(d) and any other matter relating t
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Year Act No. Title Objects 1997 90
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References 1 Department of Health.
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Purchasing of Health Care 33Pooling
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Introduction This chapter presents
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Medical schemes are the largest fin
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per person dependent on the public
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An increase in hospital expenditure
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private pharmacy do so for self-tre
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References 1 McIntyre D, Thiede M,
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Policy and legislative framework In
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Medical schemes and revenue collect
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There is evidence that when faced w
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are thus contributing factors to th
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Figure 2: Historic membership of me
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Solvency of the risk pools has beco
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Figure 4: 100 Proportion of risk be
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will retain that benefit for their
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There is a general sense (but often
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and towards competition based on ef
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37 Du Preez L. Registrar wants cura
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Introduction There has long been co
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an element of cream-skimming which
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Table 1: Distribution of health car
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isk equalisation mechanism were imp
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once the cost spiral in medical sch
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Revenue collection: Collecting orga
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Page 196 and 197: Traditional and Complementary Medic
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Traditional and Complementary Medic
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Traditional and Complementary Medic
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Authors: Myles Mander i Lungile Ntu
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Economics of the Traditional Medici
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Authors: Marion Stevens i Edina Sin
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HIV and AIDS, STI and TB in the Pri
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Indicators 213
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Authors: Candy Day i Andy Gray ii 1
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Health and Related Indicators 15
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Health and Related Indicators 15 MD
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Glossary AFA AIDS ALP AMA ANC ART A
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Glossary KZN LFS LIMS LP LPP MAR MC
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Glossary SAPC SARS SASIM SASSA SEP
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Index A Acts (Legislation and Bills
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Index N and O National Health Refer
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SAHR 2007 - Health Systems Trust

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