BHF 360 into Healthcare 2017

BHF360° JULY 2017

into healthcare

Embracing Universal Healthcare Coverage -

RISING TO THE CHALLENGE

Cover: Dr. Ali Hamdulay Chief Executive Officer - Metropolitan Health & BHF Interim Chairman p. 17 - 19

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B

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

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FOREWORD

Editor in Chief: Zola Mtshiya Copy-editor: Peter Wagenaar Design & Layout: Akimbo Designs

Advertising

Tel: 011 537 0236 Email: marketing@bhfglobal.com Editorial

Email: zolam@bhfglobal.com Published by the Board of Healthcare Funders of Southern Africa Not-Profit Company Registration no. 2001/003387/08 Lower Ground Floor, South Tower 1Sixty Jan Smuts Avenue Cnr Tyrwhitt Ave

From the EDITOR’S DESK

W

elcome to this, the fourth edition of BHF360 ° – themed Embracing Universal Healthcare Coverage – rising to the challenge. I hope that you find it an informative read and that it complements your enjoyment of our annual conference.

As many health systems move toward Universal Health Coverage (UHC), I am excited that the South African Cabinet approved the National Health Insurance (NHI) White Paper, which gives us hope that the promise of healthcare for all despite their socio-economic status and income is closer than we think. With the growing need for healthcare systems to improve access to affordable and appropriate services with better outcomes, the role of the private sector in achieving this global agenda will be important.

It is clear that the journey towards UHC will present new challenges. However, the promise of partnership, political will and good leadership might make the journey ahead

Rosebank, Johannesburg

a lot easier than we all imagine. Partnering towards NHI seems the most prudent move to

P.O. Box 2324, Parklands, 2121

I would like to welcome all delegates – BHF members, partners, sponsors and speakers

Tel: +27 11 537-0200 Fax: +27 11 880-8798 Email: bhf@bhfglobal.com Client Services: 0861 30 20 10 Web: www.bhfglobal.com

ensure that our industry participates fully and is not left on the outside.

– to the 18th Annual BHF Southern African Conference. Appropriately themed “Private Sector Embracing Universal Healthcare” it will focus on how the private healthcare sector can embrace the move towards universal healthcare, identify areas for participation, explore strategies for involvement, and effectively prepare for the changes ahead.

We are excited to host the third annual Titanium Awards. Adjudicated by a panel of wellrespected professionals, the awards recognise and honour top performers in the public and private healthcare sector in southern Africa - those delivering superior service to their customers and members. By recognising benchmarks for exceptional performance, we aim to drive standards and service delivery that in the long term will help build a more effective healthcare industry overall.

Zola Mtshiya

Manager: Marketing, Branding and Communications – BHF BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

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IN THIS ISSUE

Contents >> p.4

>> p.8

>> p.17

2

>> p.14

4

HEALTHCARE 360° The private sector’s role in universal health coverage: Rising to the challenge

8

INDUSTRY PERSPECTIVES The BHF welcomes competition commission inquiry into pricing of cancer drugs

– By Dr. Rajesh Patel

9

Progressive benefit design - The way of the future for universal coverage?

– By Barry Childs and Masimba Mareverwa

10

Defining the role medical schemes can play in an NHI environment – A unique challenge

– By Dr. Stanley Moloabi

11

Nedgroup Medical Aid Scheme - Our journey towards improved healthcare

12

National Health Insurance (NHI) – lessons from Ghana

– By Nathaniel Otoo

14

TRIBUTE Tribute to Dr. Humphrey Zokufa

– By Dr. Clarence Mini

17

ON THE COVER Getting to know Dr. Ali Hamdulay

BHF360° spent some time with Dr. Ali Hamdulay to chat about his contributions to business, life experiences and lessons learnt along the way.

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

– By Dr. Mark Britnell

– By Julia le Roux

B H F 3 6 0 ° | JULY 2017

IN THIS ISSUE

>> p.20

20

HEALTHCARE INSIGHTS The BHF Healthcare Forensic Management Unit – Fighting healthcare fraud

22

What NHI will mean to me – A millennial’s personal perspective

– By Sindisiwe Kubeka

>> p.22

– By Dr. Hleli Nhlapo

26

TITANIUM AWARDS The Judges 2017 Awards..................................................................27 The Winners 2016 Awards.................................................................29

30

THE 18TH ANNUAL REPORT BHF CONFERENCE Summary of the 2016 Conference and looking ahead: A roadmap to universal healthcare – By Zola Mtshiya Conference Programme....................................................................36 Conference Speakers........................................................................40 Conference Sponsors & Exhibitors....................................................65

80 REGIONAL UPDATE Botswana..........................................................................................80 Lesotho.............................................................................................81 Malawi..............................................................................................82 Mozambique....................................................................................83 Namibia............................................................................................84 Swaziland.........................................................................................85 Zimbabwe.........................................................................................86

>> p.83

>> p.86

80

BHF AT A GLANCE BHF Members...................................................................................87 SADC Members.................................................................................88

>> Advertiser Index

Universal Healthcare.........................................IFC Medshield............................................................7 Thebemed..........................................................16 GEMS.................................................................21 Hosmed.............................................................24

EOH....................................................................35 Medikredit..........................................................43 FNB....................................................................54 Afrocentric..........................................................64 POWA.................................................................74

Mediscor............................................................78 Westin...............................................................IBC BHF.................................................................. OBC

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

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HEALTHCARE 360°

The private sector’s role in universal health coverage:

RISING TO THE CHALLENGE

By Dr. Mark Britnell

CHAIRMAN: GLOBAL HEALTH PRACTICE, KPMG

4

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

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HEALTHCARE 360°

O

ne of the striking differences between the early push toward the Sustainable Development

expertise. With 12% of the global

chains, community care, telemedicine,

healthcare resources, low- and middle-

Because the target populations for UHC

Development Goals (MDGs) is the

UHC if they look to replicate Western

Goals and the preceding Millennium

way that the private sector has been involved. Once it played a bit part

population

consuming

73%

of

its

income countries will never achieve health systems at home. To do that

would require something in the order of

in the global debate, but activating

US$27 trillion additional health spending

focus of policymakers of all political

Instead, governments are hoping that

commercial players has become a key

per year – a wildly unrealistic prospect.

stripes.

the private sector can provide some of

This is more the case in healthcare than

efficient models of care to their people,

other arenas, after the private sector

came to play a critical role during the

latter half of the MDG era in expanding access to health products and services.

the innovation needed to spread ultraas well as fronting investment that will contain what some see as UHC’s ‘bottomless pit’ of potential costs.

Yet this will not be private sector

80% of the market.

UHC prize will drive three fundamental

Now, as governments grapple with the

profit involvement in achieving ‘health

principal health challenge of the next decade - the commitment to achieve

sector are twofold: investment and

recent example is the Brazilian city of

Belo Horizante, which in 2016 agreed to a 20-year concession for a private

operator to build, renovate, operate and maintain 77 primary care clinics

(covering around one million people).

Other countries rolling out national health insurance will be looking to

schemes, something several Chinese

WHO:

for all’.

much

Following

broader

from

requirements

these from

governments, we will see many new

GOVERNMENTS ARE LOOKING TO SPREAD ULTRAEFFICIENT MODELS OF CARE, AS WELL AS CONTAIN UHC’S ‘BOTTOMLESS PIT’ OF POTENTIAL COSTS

becoming bigger than ever.

an increased emphasis on the private

public private partnerships (PPPs). One

shifts in the ‘what, who and how’ of for-

and challenge, for the private sector

coverage (UHC) agenda is driving

need to become viable propositions for

cities are now experimenting with.

scope and scale of the opportunity,

The reasons why the universal health

margin service areas like primary care

healthcare as we know it. The size of the

universal coverage by 2030 - I see the

I SEE THE SCOPE AND SCALE OF THE OPPORTUNITY, AND CHALLENGE, FOR THE PRIVATE SECTOR BECOMING BIGGER THAN EVER

programmes are so large, once low-

private companies to administer these

After all, in many emerging countries private providers make up as much as

medical training and much, much more.

WHAT: We will see a broadening

players join the sector – including from outside the traditional health industry.

The usual private payers and providers will be joined by telcos, retail chains,

training colleges, life science firms and others. In some markets, a major

new force will be the rise of impact investors seeking to capitalise on the

growing demands of people at the base and middle of the wealth pyramid.

The Abraaj Group is one such pioneer, having secured commitments of US$1

billion towards its Global Healthcare Fund, which has now invested in over

27 healthcare businesses from Egypt

where

to Nigeria to India to Pakistan. Their

sector for help. Traditional hospital

increase the clinical capacity, quality

be joined by partnerships for clinic

provider network.

of

the

types

of

services

private

aim is, through scale, to significantly

capacity and supply chain deals will

and efficiency into a cross-continental

governments

look

to

the

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

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HEALTHCARE 360°

THE USUAL PRIVATE PAYERS AND PROVIDERS WILL BE JOINED BY TELCOS, RETAIL CHAINS, TRAINING COLLEGES, LIFE SCIENCE FIRMS AND OTHERS.

HOW:

The

UHC

agenda

the public and private sectors needs to change. Fewer simple service contracts and more partnerships that reward

outcomes are required. The trend

towards ‘value-based contracting’ is already well underway in high-income

health systems, but UHC will surely make these models more common in emerging economies as well. At the

most basic level this could mean linking a proportion of payment to quality

measures, such as readmission rates

or service reliability. I look forward to seeing the first fully fledged population is

prompting healthcare leaders to think less about narrow vertical programmes (e.g. vaccines) and more about broad, comprehensive systems of care. This means that the nature of deals between

population health – waiting lists fell, patient

satisfaction

increased,

investment was targeted at prevention and new primary care capacity.

Looking globally, there is no doubt that Asia and Latin America are leading the charge in this new era of PPPs for UHC. Yet as African nations follow suit in ramping up their healthcare investments the continent will see its own share of innovative collaborations.

The private sector will have to rise to this

health PPP at some point in the coming

challenge – serving remote populations

some promise in the Spanish health

than the affluent, urban middle class

which brought in a private operator

solutions if we are to meet the ambitious

and paid it on the basis of improving

business leaders have made together.

years, however. These have shown

and poorer communities is far harder

system, e.g. in the town of Manises,

– but we need to look to all possible

for virtually the entire health economy

health commitments that political and

Mark Britnell is chairman and partner of the Global Health Practice at KPMG. Since 2009, he has worked in over 69 countries in 8 years, helping governments,

public and private sector organisations with operations, strategy and policy. He has a pioneering and inspiring global vision for healthcare in both the developed and

developing world and has written extensively on what works around the world (for more information, visit kpmg. com/whatworks). He has dedicated his professional

life to healthcare and has led organisations at local, regional, national and global levels. He was CEO of high-performing University Hospitals in Birmingham

and masterminded the largest new hospital built in the NHS. He also ran the NHS from Oxford to the Isle of

Wight before joining the NHS management board as

a director-general. He developed ‘High Quality Care

for All’ with Lord Darzi and published his first book, In Search of the Perfect Health System, in October 2015.

6

and

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

B H F 3 6 0 ° | JULY 2017

We are committed to paying claims and we listen.

Medshield is committed to consistently honouring member benefit entitlements, whenever members need to access these, which is when they are most vulnerable.

“To meet our commitment, we listen to our members, we listen to Health Care Practitioners, and we listen to our Brokers. Because we listen, we are able to customise our products to ensure that they are affordable and accessible.

As a medical scheme we have a high claims paying capacity because we have a Global Credit Rating of AA- positive outlook. A solvency ratio of 52% which is way above the statutory requirement of 25%. We don’t just listen, we honour member benefit entitlements.”

Dr Stanley Moloabi Medshield Medical Scheme Principal Officer

Visit www.medshield.co.za or phone 086 000 2120 to join our family.

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

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INDUSTRY PERSPECTIVES

BHF welcomes Competition Commission inquiry into

PRICING OF CANCER DRUGS

By Dr. Rajesh Patel HEAD OF THE BENEFIT AND RISK DEPARTMENT: THE BOARD OF HEALTHCARE FUNDERS (BHF)

____________________________________________________________________

The Board of Healthcare Funders of Southern Africa (BHF) has welcomed the Competition Commission’s inquiry into three pharmaceutical companies’ pricing of oncology drugs, notably biologics.

“BHF is of the view that since their

“It is noteworthy that when you compare

priced, especially when a medicine is

introduction, biologics used in cancer

the pricing of these drugs from different

treatment

overpriced and therefore unaffordable.

manufacturers, they are all within a

Furthermore, the Medicines Act allows

very narrow band, which suggests that

the set price in the private sector to be

have

been

significantly

overpriced. We also believe there should be a widening of the scope of the investigation into the pricing of biologics and specialised medicines used in the treatment of all diseases, not just cancer – these are also used for treatment of systemic lupus and rheumatoid arthritis, for example. The reality is that the incidence of diseases requiring treatment interventions with biologics is increasing, so it is essential that the issues around cost of and

even if there is no collusion, at the very least there is no active competition between the different pharmaceutical companies. While single exit pricing determines

what

pharmacies

pay

for medicine from suppliers or drug manufacturers, this pricing is set by the pharmaceutical company, which is free to determine what it charges for its medicines.

different from that paid by the state, as it is acceptable practice for the standardised private sector price of all drugs to subsidise the low price paid by the state on behalf of the majority of poor/indigent South Africans. However, we have seen the subsidised cost of certain biologics vary by more than 500% relative to private sector costs; these price differentials are simply too

access to these life-saving medicines

“BHF believes that South Africa is in

enormous to overlook and demand

be resolved,” explains Dr. Rajesh Patel,

urgent need of a scientific approach

deeper

Head: Benefit & Risk at BHF.

to

Dr. Patel.

8

determine

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

how

a

medicine

is

investigation,”

concludes

B H F 3 6 0 ° | JULY 2017

INDUSTRY PERSPECTIVES

Progressive benefit design THE WAY OF THE FUTURE FOR UNIVERSAL COVERAGE?

By Barry Childs and Masimba Mareverwa INSIGHT ACTUARIES & CONSULTANTS _________________________________________________

I

f medical schemes are to play a meaningful role in progress towards universal coverage, some shifts in benefit design will be necessary. While many lower-cost benefit options

that do not offer primary, preventative and palliative care still fulfil the insurance function, they do not align with good health policy. Currently scheme members have a plethora of choices, and trade off what benefits they think they may or may not need against affordability constraints. Income and risk cross-subsidies are undermined when there are too many options. There is also growing evidence to suggest that too much choice inhibits optimal decision-making for consumers.

At the same time provider networks are playing an increasingly important role in medical scheme benefit design. They create a more formal relationship between scheme and provider, which enables better alignment of interests and incentives. Networks need to be carefully structured to be cohesive, have the right geographical footprint and promote both cost-effective and high-quality care. Purchasing, benefit design and remuneration models should be designed to emphasise primary care and care coordination. These have a notable effect on lowering the

in return for a lower contribution. This creates a possibility of reducing the cost of cover, without reducing benefit richness.

Until recently EDOs were constructed based purely on provider networks, with schemes negotiating lower prices in return for the promise of patient volumes. At the start of 2017 GEMS launched an EDO, the Emerald Value Option, which has taken this design one step further. Members on the Emerald Value Option have the same benefits as members on the Emerald option, but are required to nominate a family practitioner for their care and only see a specialist when referred. The contributions are 10% lower. The early results of this design are encouraging – primary care engagements are up, specialist visits and hospital admissions are notably down. This effect is not due to a better risk profile as is the case on some other EDO options, as generally older and sicker patients have selected the Emerald Value Option.

We are of the view that this sort of option design, building competitive integrated and coordinated networks, is the way forward. Over time members should have access to comprehensive, more standardised benefits, and choose between a laissez-faire model – going to any provider anytime – and a network-based coordinated-care model at a substantial discount.

overall cost of care.

The deployment of more active contracting of care fits nicely into the efficiency discount option (EDO) framework. These options are ‘sub-options’ with the same benefits and limits as the main option, but offer care through a network of providers BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

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INDUSTRY PERSPECTIVES

Defining the role medical schemes can play in an NHI environment – A UNIQUE CHALLENGE healthcare

With a view to working these out,

coverage presents us with yet another

‘Workstream 4: The role of medical

opportunity to do so.

schemes

By Dr. Stanley Moloabi

implementing

PRINCIPAL OFFICER: MEDSHIELD MEDICAL AID SCHEME ________________________________

T

he

public

debate

around

different aspects of national health insurance (NHI) continues

unabated. One thing that is certain is that there are various stakeholders with different views on what the endpoint of the NHI policy changes will be.

universal

I contend that there is a need for ‘toenadering’ between policy-makers (government)

and

the

healthcare

funding industry (the medical schemes sector) to ensure a unique working solution that will be embraced by all stakeholders

and

ensure

success.

While it is important that we not try to

was

in

an

NHI

established

environment’

and

announced

in Government Gazette No 39507, published on 11 December 2015.

The ‘toenadering’ I refer to above should involve more medical schemes contributing towards Workstream 4.

Without this ‘toenadering’ the current healthcare system (often referred to as a ‘two-tiered health system’) will continue

The medical schemes sector is one

‘reinvent the wheel’, we must come up

that will without a doubt be affected

with a South African solution. Solutions

by the implementation of NHI. Hence

from elsewhere may fail if we import

its constant question – will there be a

them to our unique country.

case, as this does not augur well for the

DEFINING A NEW ROLE FOR MEDICAL SCHEMES

coverage. It is worthwhile to note that

role for medical schemes when NHI is fully implemented? Change, as we all know, is often difficult, particularly if it is perceived to threaten one’s existence.

‘TOENADERING’ – UNIQUE SOLUTIONS FOR UNIQUE SOUTH AFRICAN PROBLEMS

The White Paper published on 10 December 2015 outlines the envisaged role of medical schemes in section 8.10

to work in parallel and not in tandem.

It would be regrettable if this remains the common goal of universal healthcare the White Paper acknowledges that medical that

schemes

would

be

have

beneficial

expertise to

NHI

(paragraph 404).

and sets out some general principles

All stakeholders, especially the medical

in this regard. After publication of the

schemes sector, must continue to seek

We need a unique South African solution

White Paper, a number of follow-up

engagement with the policy-makers

for the healthcare financing challenge

statements by the Minister of Health

with a view to offering unique South

that we face. We are renowned for

indicated that more work needs to be

African solutions while the phases of

coming up with such solutions, and

done on the specifics.

NHI implementation are rolled out.

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INDUSTRY PERSPECTIVES

Nedgroup Medical Aid Scheme - OUR JOURNEY TOWARDS IMPROVED HEALTHCARE

By Julia le Roux

Non-healthcare costs are continuously

PRINCIPAL OFFICER: NEDGROUP MEDICAL AID SCHEME

currently exploring opportunities for

_______________________________

A

lthough the provision of affordable and quality healthcare is the foundation of our medical

scheme, it is becoming increasingly clear

that it is not enough simply to ‘provide’ healthcare… we also need to empower

our members to take ownership of their health and healthcare.

benchmarking

has

to be 19% lower than those of the 12 leading open medical schemes

in the market (relative to comparable options). This was made possible

by various cost-reduction measures, such as encouraging the use of

generic medicines, introducing provider expanding

preventative

wellness initiatives and making use of case management and treatment

plans. A member who uses the above measures incurs minimal out-of-pocket expenses.

A generous employer subsidy further helps to keep contributions (which are

increased at the same time as salaries) as low as possible.

CONSTANTLY INCREASING THE QUALITY OF HEALTHCARE to ensure that all key aspects are

shown our 2016 scheme contributions

networks,

the strategic procurement of services.

Our benefits are regularly reviewed

MAKING HEALTHCARE MORE AFFORDABLE Independent

scrutinised and minimised, and we are

The future will see us pro-actively identifying and interacting with high-risk beneficiaries to encourage behaviour change and improved compliance with care plans.

COMMUNICATING TO

EMPOWER OUR MEMBERS TO TAKE OWNERSHIP OF THEIR HEALTH

Custom-designed communication touch -points

covered. Thanks to being part of Health

part

evaluate our performance on at least

points

of

have

been

an

annual

as

comprehensive

Quality Assessment (HQA), we can

communication

an annual basis and identify any gaps

smartphone-friendly online tools and

or room for improvement. A key focus

is on primary health and preventative care, with wellness initiatives (such as

wellness days where members can

be screened for, e.g. diabetes or high blood pressure, or receive flu vaccines)

taking place countrywide. Members can also have these screening tests done at our network of pharmacies and obtain

lower-cost generic medicines from this

range

plan.

developed

from

These

touch-

sophisticated

a 24/7 self-help facility to traditional printed documents and face-to-face consultations.

Scheme information is communicated within the context of more holistic and ‘edutaining’ information (such as a holiday handbook or a poster that members can put up on their fridge).

network. In addition, members qualify for

Surveys ensure that we can keep our

as mammograms and prostate tests.

need and want.

a range of cancer screening tests such

finger on the pulse of what our members

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

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INDUSTRY PERSPECTIVES

National Health Insurance (NHI) – LESSONS FROM GHANA There are challenges preventing universal health from being fully achieved, but these can be overcome through private sector involvement, the strengthening of processes and introduction of effective systems.

By Nathaniel Otoo FORMER CHIEF EXECUTIVE OFFICER: GHANA NATIONAL HEALTH INSURANCE AUTHORITY (NHIA) ________________________________

P

eople with access to healthcare are more likely to seek medical assistance, meaning medical

conditions are detected and treated earlier, limiting the risk of potentially lifethreatening complications.

This is one of the improvements in the

health of the population of Ghana since

the introduction of the national health insurance (NHI) system 15 years ago.

In

Ghana,

the

NHI

system

was

established in response to the significant

reduction in access to healthcare that

resulted from the fee payment system called ‘cash and carry’ implemented from the late 1980s.

By the early 2000s, only about 20% of the population could access the healthcare they needed. The hardship

experienced by the majority of the population in accessing healthcare was therefore a significant factor that led to

12

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B H F 3 6 0 ° | JULY 2017

INDUSTRY PERSPECTIVES the establishment of the NHI system.

maladministration in the distribution of

growth that often excels in innovation,

The aim was to increase access,

funds for expanding and sustaining the

financial management, risk-taking and

especially for the poor and vulnerable.

NHI system pose a major challenge.

entrepreneurship, and customer care.

Ghana has a population of about 27.4

Measures were taken to address these,

million and the country still has some

including strengthened procurement

way to go before achieving universal

processes, control of administrative

healthcare, with only 41% of the

expenditure and operational process

population currently covered by NHI. A

improvements to ensure efficient use

critical point to be made is that the NHI

of resources. In addition, medical

is only one element of Ghana’s universal

audits were also expanded, claims

healthcare coverage (UHC) strategy.

processing

As recently as September 2016, a comprehensive review of the NHI system was completed and a report submitted

monitoring

capacity of

improved,

provider

payment

methods strengthened and adherence to treatment protocols enforced.

to the Ghanaian government with a view

To

to strengthening the fledgling scheme.

systems to obtain credible data for

A number of challenges have been experienced in Ghana’s NHI system, including poor geographical access to quality healthcare services, which is currently being worked on in tandem with the ongoing development of the

facilitate

effective

monitoring,

analysis to highlight unusual trends were instituted, ‘mystery’ shopping

In implementing NHI, South Africa could effectively leverage these private sector strengths to ensure successful implementation.

If well planned and conceived, the private sector could be a reliable partner for regulation, governance, health service provision, quality improvement, financial intermediation,

information

systems

support, commodity supply chains and, most importantly, customer care.

Governments planning to implement UHC

must

understand

multifaceted

and

that

requires

it

is

careful

exercises were undertaken and the legal

integration of all elements that ensure

regime that deals with corruption and

good

maladministration

satisfaction and risk protection. These

was

strengthened

through review of legislation.

health

outcomes,

patient

include financing, service delivery, regulation, monitoring and evaluation,

system. It is pertinent to note that the

Currently, Ghana spends 3.6% of its

policy framework for UHC achievement

GDP on health. Through enlisting both

is

to

private and public sector healthcare

accelerate the movement towards UHC.

providers, as well as catalysing private

Caution must be taken against over-

sector investment in healthcare, the NHI

politicising UHC. The ideal model is

constantly

Other

being

challenges

improved

include

NHI’s

financial sustainability of the scheme, poor regulation in the health sector,

system has improved financial flows for health service delivery.

efficient supply chains, information systems and citizen involvement.

for UHC to be a shared national effort for the development of the public good

inequitable distribution of services and

One of Ghana’s biggest lessons is that

in the form of individual, community,

poor quality of services. With over 4000

to achieve significant results within

public and global health. UHC should

health facilities accredited by the NHI

the NHI framework, the private sector

not be an afterthought, but rather a

system to provide services and about

must play a role from the outset, as

deliberate policy that is backed by the

11 million members, moral hazards and

the private sector is an engine of

requisite investment and staying power.

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

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BH F 360 ° | JULY 2 0 1 7

TRIBUTE

Tribute to

DR. HUMPHREY ZOKUFA

By Dr. Clarence Mini

Managing Director for the Board of

issue a declaratory order to clarify the

ACTING MANAGING DIRECTOR: BHF ________________________________

(BHF) for 11 years. Even though he was

healthcare

D

r. Humphrey Zokufa was born in Somerset East, in the Eastern Cape, on the 25th October 1952.

He attended Primary School in a village called kwaNojoli. He completed high

school at Healdtown Comprehensive School, a Methodist school located near Fort Beaufort.

Healthcare Funders of Southern Africa at the helm of a body that represents

the private medical industry, he was a passionate proponent of the National Health

Insurance

(NHI)

process

with the goal of achieving universal

coverage. His vision was much bigger than industry politics, he believed in

equitable, quality healthcare for all. He was passionate about promoting access

He obtained his Bachelor of Pharmacy

to healthcare for all South Africans and

in Limpopo and went on to earn a

worked tirelessly to explore the role that

doctoral Fellowship from the University

in the NHI process in order to achieve

Center

no surprise when the Minister of Health

degree from the University of the North

that is why he supported the NHI. He

Doctor of Pharmacy degree and a Post-

the private health sector needs to play

of Minnesota, St Paul Ramsey Medical

its shared aims. It therefore came as

proceeded to complete a Diploma in

appointed him to be a member of the

in

Minneapolis,

USA.

He

Health Management from the University of Cape Town. Dr. Zokufa was registered

with the South African Pharmacy Council as a Pharmacist and as a specialist in Clinical Pharmacokinetics.

A high-calibre leader whose hearty

National Health Insurance Ministerial

Advisory Committee in 2009. He also served on Work Stream 4, which was established to explore the role that

Medical Schemes will play in a NHI environment.

laugh and smile was contagious, Dr.

Dr. Zokufa was a determined leader, in

His amiable and engaging disposition

of BHF members, the interpretation

Zokufa had an effervescent personality. had procured him many friends. He was recently appointed as the Chief

Executive & Registrar of Council for

Medical Schemes after serving as the

14

2010/2011, he challenged, on behalf

of regulation 8 of Medical Schemes

Act. This played out in a highly publicised court case in which BHF

asked the Gauteng High Court to

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

interpretation.

Unfortunately

providers

various

opposed

this

initiative. Undeterred by his critics

and the Gauteng High Court judge’s rejection to provide the declaration, Dr.

Zokufa continued to engage in various meetings with the Minister of Health,

Dr. Aaron Motsoaledi, on this matter, asking him to intervene appropriately.

The amendments to Regulation 8 of the

Medical Scheme Act were ultimately issued by Department of Health in 2015. This he saw as the step towards

balancing the scales, that will make private healthcare more affordable and accessible.

Dr. Zokufa will be remembered for his willingness to talk regardless of the politics. He spoke out against

escalating private healthcare costs, he was concerned about the lack of growth in the number of people that join medical aid schemes. He was

committed to finding ways to reverse this trend, which has on a yearly basis

seen medical aid scheme contribution increases that are higher than the CPI.

He dedicated the time he served at

BHF to work with industry leaders and various stakeholders to explore means and ways to bring some relief to the South African consumer.

B H F 3 6 0 ° | JULY 2017

TRIBUTE

Dr. Humphrey Zokufa ________________________________________________________________________________________________________ Dr. Zokufa possessed a great amount of energy, which he intelligently directed towards transforming the healthcare sector. He successfully implemented the dispensing licensing process by the Department of Health, to license nonpharmaceutical health professionals to dispense medicine. In 2003, he played a crucial role in the initiation of the provision in the Pharmacy Act 88 of 1997 of allowing any person who is not a pharmacist to own a pharmacy.

With nearly four decades of experience in the health sector, Dr. Zokufa has served in numerous key positions including that of Chief Director : Health

Management Services in the Eastern Cape Provincial Health Department in Bisho and Cluster Manager: Pharmaceutical Policy and Planning in the National Department of Health.

at the restructuring of the Medicines

In January 2005, he was appointed as the Registrar for the Medicines Control Council (MCC). During this period he established the National Essential Drugs List Committee (NEDLC), and also took over the responsibility of licensing pharmacies, which was previously conducted by the South African Pharmacy Council. He was appointed by the Minister of Health to be a member of the Ministerial Task Team that looked

death has robbed the industry of his

Control Council (MCC) in 2006.

The industry has lost a strong and brave soldier, one who was not afraid to take the bullet for what he believed in. His vast knowledge and experience in the health sector.

At home Dr. Zokufa was a loving husband to his wife, Thandiwe Zokufa and a doting father of 4 , three daughters and a son as well as a grandad to his 2 grandchildren.

May his soul rest in peace‌

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

15

BH F 360 ° | JULY 2 0 1 7

ADVERTORIAL

Thebemed Embraces Affordable, Quality Universal Healthcare Sibongile Mamafha

Principal Executive Officer Thebemed Medical Scheme As South Africa contemplates the implementation of a unified health system via national health insurance (NHI), Thebemed Medical Aid Scheme is continually striving to enhance its benefits in order to offer members relevant and affordable products and services to supplement those that will be provided by the NHI. Sibongile Mamafha, principal executive officer of Thebemed Medical Scheme, says:

“Thebemed upholds a vision that more people should be able to afford quality healthcare within Africa.”

“Aligned with government’s drive to find affordable and sustainable solutions for South Africa’s healthcare challenges, our unique range of products, aimed at all income groups, provides our members with peace of mind, combining comprehensive quality medical cover with excellent value.

One of these is our phenomenal well-being programme, which focuses on empowering our members to live healthy and satisfying lives.”

A UNIVERSAL PLAN FOR UNIVERSAL HEALTHCARE Aimed at providing equitable access to affordable and comprehensive healthcare benefits, Thebemed’s flagship Universal Plan is designed to meet the changing needs of young families, offering extensive private hospital and dayto-day benefits.

This comprehensive, affordable entry-level option is designed to match the changing lives of young families starting out in life. It specifically offers cover for everyday healthcare needs, including specialists, dentistry and optometry, through Thebemed’s extensive designated service provider (DSP) network.

WHAT MAKES THEBEMED THE PREFERRED UNIVERSAL HEALTHCARE PROVIDER? Based on actual client ratings Thebemed achieved a 100% rating in terms of four key aspects, namely Visibility, Knowledge, Service, and Recommendability, which means that 100% of the respondents surveyed were of the opinion that our member servicing consultants are visible on site, have knowledge of our products and provide exceptional service. All these clients also indicated that they would recommend Thebemed Medical Aid Scheme.

Physical Address: Isle of Houghton, Old Trafford 4 Building, Ground Floor, Cnr Boundary & Carse O’Gowrie Road, Houghton, Johannesburg Postal Address: PO Box 4709, Johannesburg, 2000, South Africa

16

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

Call Centre: 0861 THEBEMED/ 0861 84 32 36 Switchboard: 011 544 8000 Fax: 011 544 8501 Email: callcentre@tybhealth.co.za Website: http://www.thebemed.co.za

B H F 3 6 0 ° | JULY 2017

ON THE COVER

Getting to know DR. ALI HAMDULAY CHIEF EXECUTIVE OFFICER – METROPOLITAN HEALTH

BHF360° spent some time with Dr. Ali Hamdulay to chat about his contributions to business, life experiences and lessons learnt along the way.

You are a medical doctor, what inspired your move from medical practice into healthcare management?

A

fter completing my master’s in family medicine, I was ready for a larger challenge and keen to make a more meaningful impact on healthcare. I joined Metropolitan Health in 2007 to design their disease management programmes and assist in managed care interventions, which gave me the chance to design interventions that would improve the lives of over three million individuals under administration. I thoroughly enjoyed the experience and found the competitive corporate culture, structure and teamwork highly conducive to healthcare innovation and advancement. We mistakenly view private healthcare companies as profit-driven only, but in reality the drive to improve healthcare quality, affordability and access for more people is a fundamental objective of many of our South African healthcare management corporates. As such, healthcare management is improving the health of millions of South Africans.

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

17

BH F 360 ° | JULY 2 0 1 7

ON THE COVER With more South Africans facing a growing risk of developing a chronic disease, non-communicable diseases (NCDs) pose a threat to South Africa’s healthcare system, workplaces and economy. What role can stakeholders

across the health value chain play in supporting and enabling individuals to adopt healthier lifestyles?

T

he different stakeholders in our industry have recognised the need for behavioural modification programmes, incentivised loyalty and rewards solutions, collaboration, engagement mechanisms and population segmentation to address the growing burden of disease.

Furthermore, we have learned a great deal over time and have realised the overall impact of health on our lives. A person who is facing expensive treatments to save their life or that of their loved ones will tap into their savings and assets to extend life. We therefore need to provide solutions beyond just health protections and consider the overall financial wellbeing and protection of the family.

People are unique and have specific preferences. Insight into choices and behaviour is key to being able to influence lifestyle decisions. There’s a need for deeper understanding and segmentation to be able to tailor behavioural modification programmes. Help the health citizen do the right thing according to their lifestyle and personalities. Sharing of information within legislative frameworks will contribute significantly to achieving these tailored solutions.

Furthermore, work collaboratively across the value chain in the health ecosystem. Funders, healthcare providers and administrators want the same thing, namely the best for patients, so we need to pull in the same direction to achieve this.

With advanced data analytics and insights looking holistically at health, lifestyle and wellness, customers’ behaviours and decision-making processes have become more apparent.

Programmes and solutions can be tailored to drive the right changes for the right person.

Leading from the front and supporting healthy lifestyles as business and healthcare leaders are also powerful tools in influencing and stimulating workplace and national healthcare lifestyle modification. In the words of the wise poet Rumi: “You are not a drop in the ocean. You are the entire ocean in a drop.”

18

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

You have been vocal on the need for the healthcare sector to adopt improved provider reimbursement models in order to remain sustainable; can you share more details on this?

T

he current fee-for-service (FFS) model has placed the private healthcare system under sustainability pressure.

No scheme wants to increase premiums and reduce benefits by choice, but they are forced to by current tariff and utilisation pressures.

Healthcare providers are forced to see as many patients as possible and drive large volumes per practice to generate revenue. The situation is further perpetuated by lack of appropriate healthcare coordination between primary care and secondary, specialist care, which means that many patients access specialist care when primary care treatment would have been adequate. The more patients admitted to hospital and the longer they stay increases incomes received by hospitals. The FFS model pushes up utilisation irrespective of quality, so that healthcare providers who see fewer patients, but have better health outcomes, generate less revenue than those who see more, irrespective of quality outcomes.

All stakeholders in the ecosystem want what’s best for patients, but we’re pulling in different directions. The FFS model encourages misaligned incentives in the health environment, irrespective of quality. The paradigm has to change to ensure sustainability.

We need to establish a more suitable method to reimburse for quality and stimulate competition for health outcomes and consumer experience. This will encourage both quality and appropriate sustainability in the health system. Alternative reimbursement models provide the building blocks to achieve competition for outcomes, improve quality and protect the funding environment.

You were recently appointed chief executive officer of Metropolitan Health; what has that move been like and what are your plans in the new position?

T

he new position has been an exciting experience for me. I am fortunate to lead a business that is supported by a very strong and motivated leadership team, with

B H F 3 6 0 ° | JULY 2017

ON THE COVER advanced and robust healthcare systems and processes. We

are assets that will help enable the transformation of public

have an innovative culture within the organisation and with

and private healthcare in our country. My organisation is also

that we are pioneering the business in the health industry. We aim to further entrench our relevance to our clients and their members and are making inroads in delivering health and

well positioned to be a strategic partner and provide NHI capabilities and solutions.

financial wellbeing to members, communities and employers.

Ultimately, we will continue to play a pivotal role in South Africa’s health reforms and contribute meaningfully to the development and implementation of national health insurance (NHI) for our clients and business.

What are you currently reading?

I

tend to read a few books at a time. At the moment, I am reading: • Exponential Organisations by Michael Malone, Salim

Given the current realities of South African healthcare and the topic that you will be presenting on at the 18th BHF annual Southern Africa conference, Possibilities with current capabilities, how medical schemes and

Ismail, and Yuri van Geest

• The Hard Thing About Hard Things by Ben Horowitz • Antifragile by Nassim Nicholas Taleb

administrators can provide insight and support, what do you consider to be the imperatives for successful transformation?

N

HI represents massive health reform and, as healthcare leaders in the country, we are able to play an instrumental role in its implementation. It is the largest reform in

our country other than the establishment of our constitution. I think we sometimes don’t realise how significant NHI is since we’re sometimes too close to the details to fully appreciate the change. We are part of history and we have a contribution

Tell us about your family?

I

am married to a wonderful wife who’s my pillar of strength.

She’s also a medical professional running a GP practice in our area. We have four children together; three daughters

(Safiyyah 16 years, Rahmah 14 years, Aisha 11 years) and a son (Zahid 10 years). I count myself blessed to have my parents living with me. We also have two cats, Cleo and Alex, in our home. Needless to say, our home is not a quiet one.

to make. Collaboration, shared decision-making and mature thought leadership are key to its successful implementation.

We also need to focus on more than just providing transitional capabilities. I believe we can speed up the implementation by applying solutions that already exist in the private health sector.

With the introduction of NHI in South Africa, young people in key leadership roles are expected to be in the forefront of its implementation; where do you see your role in the

In closing what are some of the teachings from your upbringing that you still carry with you?

M

y upbringing was a humble one rooted in strong family values and faith in God. I was taught to never be afraid to step up, always work hard regardless of

your profession and always love people unconditionally. We’ve all been gifted with potential, we have the responsibility to realise it and use it to serve mankind.

future?

I

see myself and many leaders in our health industry playing a pivotal role in the implementation of NHI. With their unique insight and innovation, many of the leaders in the industry BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

19

BH F 360 ° | JULY 2 0 1 7

HEALTHCARE INSIGHTS

The BHF Healthcare Forensic Management Unit – FIGHTING HEALTHCARE FRAUD

By Dr. Hleli Nhlapo

also participated in the international

industry-related gatherings, especially

CHAIRMAN: HFMU ________________________________

conferences hosted in London and the

during the 8th Annual Managed Care

USA in October and November 2016,

Symposium held in May 2017. While

respectively.

the HFMU has made great strides

T

he BHF Healthcare Forensic Management

Unit

(HFMU)

is a forum coordinated and

administrated

under

the

auspices

of BHF to strengthen the combined effort to fight healthcare fraud, waste and abuse in South Africa. The HFMU now represents approximately 95% of the industry, including the majority of medical schemes, their administrators and insurers. In addition, it enjoys the

collaboration

and

support

of

professional bodies in the healthcare industry.

In alignment with the strategic objective of the BHF’s board to lead a cohesive approach to manage healthcare fraud,

when it comes to increased awareness of healthcare fraud, waste and abuse, there is still much work to be done.

the HFMU hosted its annual Healthcare

The HFMU looks forward to electing

Fraud, Waste and Abuse Indaba in

a

November 2016. Through this indaba,

mandate will be to further develop

HFMU members engaged with various

mutually beneficial relationships within

statutory bodies and other stakeholders

the industry and ensure the sharing

within

of

the

healthcare

industry,

new

steering

information

committee

with

national

whose

and

determining ways in which partnerships

international participants. The HFMU

in the private and public sector could

also looks forward to launching its

be strengthened to mitigate the risk

new HFMU online data portal that will

exposure in the healthcare industry.

coordinate the sharing of information through its national and international

The HFMU is also one of the founding

In 2017 the HFMU held several working

members of an international network,

group meetings where information on

the Global Health Care Anti-Fraud

new modus operandi fraud, waste and

Network

network

abuse trends were shared, assisting

comprises members from the USA,

participants in their overall detection

As all activities undertaken by the

Canada, the UK, Europe and South

and prevention strategies, eliminating

HFMU are part of a cohesive approach

Africa. In 2016, HMFU representatives

duplication of work and enabling HFMU

to manage healthcare fraud, waste and

participated in the GHCAN strategic

members to act collectively against

abuse in South Africa, the HFMU hopes

planning session in Washington, DC,

high-risk perpetrators. The HFMU also

to be the vehicle through which positive

to develop a framework for international

got involved with healthcare fraud

change can be driven in the healthcare

anti-fraud cooperation. HFMU members

awareness campaigns during several

industry.

20

(GHCAN).

The

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

participants to enhance their detection and prevention strategies against fraud, waste and abuse.

B H F 3 6 0 ° | JULY 2017

Affordable rates – same great value!

Switch to Emerald Value and enjoy great benefits for less

Looking to save money on your medical aid? Simply switch to the Emerald Value option and enjoy the same benefits as the Emerald option at a lower rate.

Emerald Value has lower rates because: •

You and your dependants must nominate a GP in the EVO network to coordinate your care. Using one GP means that unnecessary procedures, medications and hospital admissions are avoided.

•

Specialist visits must be referred by your nominated GP.

•

You must use one of the private hospitals, day clinics and psychiatric facilities in the Emerald Value hospital network.

Lesoba 17137

By choosing Emerald Value you’ll enjoy considerable savings each month without reducing your benefits in any way.

Worried about co-payments? Don’t be!

Co-payments only apply when you visit a hospital that is out of the EVO network.

Under these conditions, you will NOT have to make the co-payment if: •

You don’t have reasonable access to a hospital within the network; or

•

You are travelling; or

•

You are hospitalised in an emergency; or

•

You require specialised care that is not available through the nominated healthcare providers.

There is an extensive list of private hospitals, clinics and psychiatric facilities in the EVO network, so finding one near you shouldn’t be a challenge.

Speak to your GEMS consultant about switching to Emerald Value – and save money today!

Visit www.gems.gov.za Email info@gems.gov.za Call 0860 00 4367 BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

21

Working towards a healthier you

BH F 360 ° | JULY 2 0 1 7

HEALTHCARE INSIGHTS

What NHI will mean to me –

A MILLENNIAL’S PERSONAL PERSPECTIVE

By Sindisiwe Kubeka MARKETING OFFICER: BHF

________________________________________________________________________________________________________

A

s a young person, with only two

afford medical scheme premiums, are

could they afford to pay out of pocket

years of service at the Board

generally healthy and spend little time

for private-sector care.

of Healthcare Funders and no

doubt a novice in the healthcare sector, I am nonetheless cognisant of the fact that despite certain areas of progress since the advent of democracy in 1994, South Africa has one of the world’s worst disparities in healthcare. However, the recent Cabinet approval of the latest version of the White Paper on national health insurance (NHI) to be gazetted as a policy document indicates that we are making strides towards attaining the desired transformation of both public and private healthcare in our

worrying about worst-case scenarios such as needing serious medical care for an unforeseen illness or accident.

The generation gap has been a cause of stagnant growth in the number of people covered by the private medical scheme industry for years; this brings to mind a disturbing incident involving a friend of mine back when I was a varsity student. She was badly injured after the minibus taxi she was travelling in was involved in a near-fatal accident close to Milpark Hospital in Johannesburg.

However, the successful implementation of NHI lies in collaboration between the public and private healthcare sectors. As a future beneficiary of and contributor to NHI, I need to see both public and private leaders working together to drive this process through

cost-effective

spending,

best management of resources, and investment in primary care services that are responsive to all. This will require the majority of private sector leaders to embrace the noble ideas of NHI and begin to urgently and seriously see the

country.

All injured passengers involved in that

I strongly believe that NHI will positively

excruciating pain - for an ambulance to

affect the lives of young people, many

rush them to Charlotte Maxeke Hospital,

of whom are still paying off tertiary

when it would have made better sense

study loans and who are less likely to

to have them admitted at the closer

have

medical

hospital. But none of the passengers

I believe that this collaboration needs

aid cover. They don’t earn enough to

belonged to a medical scheme; neither

to happen soon, in preparation for the

22

employer-subsidised

accident had to wait - bleeding and in

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

industry as a national asset that should play a key role in the establishment of a unified health system. As things stand, details pertaining to how medical schemes will continue to exist in an NHI environment remain somewhat murky;

B H F 3 6 0 ° | JULY 2017

HEALTHCARE INSIGHTS

NHI Act, which could possibly see the Medical Schemes Act being amended.

Key to the success of NHI is the government’s role in engaging with the different sectors in society. Ordinary citizens are not adequately informed about NHI. A colleague of mine was recently interviewed on a national talk radio station; the majority of those who called in were hostile to the concept of NHI, many of them part of the privileged few who can afford private medical care. They feared that they might in future receive lower-quality services than

they

currently

receive

from

private practitioners and hospitals. The government therefore needs to outline to the general public its leadership and governance strategies to safeguard the NHI system from becoming a fertile ground of corruption.

NHI has to gain the confidence of the people and have them buy in and accept their responsibility to redistribute their resources to the poor in order to realise the right to health of all as enshrined in the Constitution of

South

Africa.

The

government

therefore needs to provide details of the accountability systems contained within the NHI policy document. The future of NHI’s success is very much dependent on effective, honest and accountable leaders.

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

23

BH F 360 ° | JULY 2 0 1 7

Care for life

Care for life

THE HOSMED STORY In 1988 Hosmed was born with the purpose of making an impact on the lives of others and to give them a chance to have a good quality life. We then believed that all human beings are born equal in dignity and rights, and we still do.

“A young man struggled with an important question. When he asked his friends they said, “eish, to be rich wena, with lots of girlfriends”. He asked his father and he answered “to see your children grow up happy and healthy”. Still not satisfied, he travelled to his grandmother’s house and sat down with her. “Gogo”, he said, “What is the purpose of life?” His grandmother thought about it and then took his hand in hers, wrinkled and weathered from caring for others all her life. “Child, to me the purpose of life is to share one’s gifts… to make an impact in the lives of others… and live the life you desire.” Finally the young man was happy and he left with a clear vision in his heart and mind –he now knew how he wanted to give meaning to his life.

Lean on us Whatever you need from your Scheme and which ever option you choose, the decisions are always up to you – but it goes a long way when you can trust your Scheme and receive advice from people who care about you and who has many years’ experience.

Hosmed has been caring for members lives for 30 years… AND THE BEST IS YET TO COME! AGM 2017

NOTICE OF THE HOSMED MEDICAL SCHEME ANNUAL GENERAL MEETING TO BE HELD ON 25 JULY 2017 All members of Hosmed are invited to the Hosmed Annual General Meeting (AGM) to be held at Bon Hotel – Bloem Plaza, East Burger Street, Bloemfontein, 9301.

Registration will start at 08h30 and the AGM proceedings will commence at 10h00.

Please note: • • •

Members must identify themselves on registration, by using their Hosmed Membership Card as well as a valid Identity Document, Passport or Driver’s Licence.

Notices of Motions to be placed before the Annual General Meeting must reach the Hosmed offices at No. 8 Victoria Link, Route 21 Corporate Park, Irene, 0157 or send to PO Box 16148, Doornfontein, 2028 or email to vusi@hosmed.co.za, 14 (fourteen) days prior to the meeting.

Original proxy forms should be submitted 1 (one) week prior to the meeting. Proxy Forms can be obtained from the scheme, on request by members.

Only original proxy forms will be accepted.

By order of the Board of Trustees Dr Arthur Vusimuzi Memela Principal Officer, HOSMED Medical Scheme

24

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

B H F 3 6 0 ° | JULY 2017

Isn’t it time you stopped worrying about your medical aid?

Hosmed Medical Scheme is an open Medical Scheme providing healthcare to more than 70 000 beneficiaries nationally Designed for families that want total peace of mind for their healthcare needs

Contributions from R4 184* (based on principal member only) per month No referrals required for specialist visits Excess of

26

PLUS

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GP OR Specialist consultations per family

Hospitalisation at any hospital of your choice

Extensive

day-to-day benefits

R60 000 worth of day-to-day benefits (incl. pathology, radiology, optical, dentistry, auxiliary benefits and more...)

Designed for families that want reassurance of substantial healthcare cover

VALUE 20

Contributions from R2 964* (Based on Principal member only) per month

Unlimited

GP visits per family

Hospitalisation at any hospital of your choice

7

Comprehensive

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specialist visits per family

R50 000

Excess of worth of day-to-day benefits (incl. pathology, radiology, optical, dentistry, auxiliary benefits and more...)

Designed for families who choose to have reassurance of adequate healthcare cover

Contributions from R2 124* (Based on Principal member only)per month

R30 000

Excess of worth of day-to-day benefits (incl. pathology, radiology, optical, dentistry, auxiliary benefits and more...)

Sustainable

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ACCESS Unlimited

• PMB hospitalisation at network hospital • * GP visits and medication at Prime Cure provider

Suitable for families looking for the essential cover to keep health worries at bay

ESSENTIAL

3

specialist visits per family

•

Contributions from R1 196* (based on principal member earning below R7 000 income per month) per month

Unlimited:

PMB Conditions only

• Hospitalisation at network hospital • GP visits and medication at Prime Cure provider

Day-to-day benefits (incl. pathology, radiology, optical, dentistry and more...)

* Contributions calculated on main member only Benefit calculations based on family of 4 BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA Visit www.hosmed.co.za to access detailed benefi ts and contribution tables

25

BH F 360 ° | JULY 2 0 1 7

TITANIUM AWARDS

The 2017 Titanium Awards T

he Titanium Awards have evolved since inception in 2014.

This year saw the introduction of a number of changes to

the awards, including the Lifetime Achievement Award being

renamed the Dr. Humphrey Zokufa Lifetime Achievement

Award. This renaming honours the late former CEO of the Board of Healthcare Funders (BHF).

With access to information and audience reach becoming

increasingly important, BHF introduced the Health Journalist

Mtshiya says that acknowledging exceptional performance will contribute towards improved standards and service delivery in the healthcare sector, as would be the case in arguably any industry. They also promote long-term sustainability and drive healthy competition within the industry.

“In the past three years, we have seen a lot of submissions from South Africa and would like to see more submissions come through from the SADC region as a whole,” she said.

of the Year category, which acknowledges and applauds the

The objectives of the awards are to:

Africa.

•

Celebrate those who are contributing towards improving the quality of health services and create a platform that unites the healthcare industry in both the private and public sectors across southern Africa

•

Improve the quality of health services through recognition and exposure of industry best practices

•

Recognise best practice in action – with an emphasis on initiatives that are well rounded, sustainable, holistic and responsible.

impact of health journalists and reporters across southern

“The awards are an important event in recognising and

celebrating excellence in the healthcare sector. They aim to acknowledge the value and contributions of all healthcare industry players,” said the BHF’s Zola Mtshiya.

The vision for the awards is to inspire young people to take

ownership of the industry and aspire to do better and more for the region’s healthcare sector. This is achieved through the

Young Achiever Award, which celebrates young professionals who have made a notable impact in the healthcare industry.

This award seeks to promote effective succession within the sector to sustain the future of the medical profession.

26

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

The adjudication process for this year’s awards was still under way at the time BHF360 went to press. All the other categories and the winners will be announced on 16 July 2017.

B H F 3 6 0 ° | JULY 2017

TITANIUM AWARDS

The Judges 2017 Awards DR. GRAHAM HUKINS Director: Managed Healthcare Systems Dr. Graham Hukins’ qualifications include a BSc, MB BCh, a master’s degree in family practice and a master’s in community health.

He has lectured and consulted both locally and internationally on the design, implementation and management of cost-efficient healthcare systems. His particular interests are clinical governance, evidenced-based best practice, clinical epidemiology and the psychosocial aetiology of commonly occurring medical conditions.

ADJUNCT PROFESSOR MATHATHA TSEDU Wits Journalism Department - University of Witwatersrand Mathatha Tsedu is adjunct professor in the Department of Journalism at the University of the Witwatersrand and deputy chairperson of the Interim Board of the SABC. He holds a BA Hons in journalism and media studies from the University of the Witwatersrand and an honorary doctorate (DPhil in arts) from the University of the Western Cape.

He is past executive director of the South African National Editors’ Forum (SANEF). Prior to that he was general manager for strategic development and projects at Media24 News.

After serving as editor of City Press, he was head of the Media24 Journalism Academy, responsible for training working and learner journalists. He is a seasoned media trainer. Until September 2013 he was project director of the Print and Digital Media Transformation Task Team (PDMTTT) and before that project director of the Press Freedom Commission of South Africa, which was established in 2011 to look at the regulatory framework of print media in the country. He is a member of the advisory board of the Unisa School of Governance and member of council of the Council for the Advancement of the South African Constitution.

He has served as editor at a number of newspapers, including Sunday Times and City Press, and as deputy head of news at SABC. He has been chairperson of the African Editors Forum and SANEF. He is the recipient of a number of awards, including a Nieman Fellowship at Harvard University, the Nat Nakasa Award for Courageous Journalism, the Mondi Shanduka Lifetime Achiever Award and the SANEF Wrottesley Award, the Media24 Newspapers All Time Legend and the Naspers Phil Weber Award.

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

27

BH F 360 ° | JULY 2 0 1 7

TITANIUM AWARDS

PROFESSOR MKHULULI LUKHELE Head of School of Clinical Medicine – University of the Witwatersrand Professor Mkhululi Lukhele was born in Johannesburg (Alexandra) and grew up in Swaziland. He did part one of his BSc in Swaziland and part two in Botswana before enrolling at MEDUNSA for his medical degree. He is an orthopaedic surgeon by training and specialises in spinal surgery. Professor Lukhele joined the University of the Witwatersrand in December 2002 as head of the orthopaedics department at Charlotte Maxeke Academic Hospital. He also served as the academic head of orthopaedics at the University of the Witwatersrand for 10 years.

Professor Lukhele is involved in clinical research focusing on spinal tuberculosis, trauma and spine deformities. Since taking up his current position, his other research has focused on clinical pathways and access to quality orthopaedic care.

This research has had great significance in driving patient-centred care and safety in orthopaedics, as well as stimulating engagement in orthopaedic outreach activities. As a member of the National Osteoporosis Foundation of South Africa he is involved in research related to osteoporosis and associated fragility fractures, which are increasingly becoming a silent killer and cost driver in developing countries.

ADJUNCT PROFESSOR SHAN NAIDOO Chief Specialist and Head of Department of Public Health Medicine – Wits School of Public Health Professor Shan Naidoo is chief specialist and head of the Department of Public Health Medicine at the Wits School of Public Health. He has over 15 years of health services experience and more recently 15 years’ experience in academia. He holds a joint post with the Gauteng Department of Health, where he is involved in strategic planning, policy development, monitoring and evaluation. He is the immediate past president of the College of Public Health Medicine of the Colleges of Medicine of South Africa. He has graduated over 20 master’s students in the last 10 years and is currently supervising both master’s and PhD students.

He has extensive research interests, with over 40 publications in the last 10 years. He is also an associate editor of the Southern African Journal of Epidemiology and Infectious Diseases. He reviews for many international journals including the BMC, Plos NTD and the UK’s Journal of Public Health.

He has received many awards including the Transformation Award and the Vice Chancellor’s Academic Citizens Award of the University of the Witwatersrand. He received a fellowship by distinction from the Faculty of Public Health of the Royal Colleges of Physicians. He is a senator and also serves as a longstanding member of the Human Research Ethics Committee of the University of the Witwatersrand. He is committed to teaching and training public health specialists and growing public health research capacity in Africa.

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B H F 3 6 0 ° | JULY 2017

TITANIUM AWARDS

The Winners 2016 Awards Congratulations to the winners of the Titanium awards 2016 CATEGORY 1 Titanium Award for Service to Membership

CATEGORY 3 Titanium Award for Health Facilities

CATEGORY 6 Titanium Lifetime Achievement Award

Open Medical Schemes – BONITAS MEDICAL FUND This Award recognises and rewards open medical schemes providing the best service to their members, based on a defined set of criteria.

Public Sector – POTCHEFSTROOM HOSPITAL Public Health Facilities are adjudicated based on a set of pre-determined criteria.

PROF PRANEET VALODIA This award recognises any individual who has made a significant contribution to the healthcare industry over a number of years.

CATEGORY 4 Titanium Award for Excellence in Corporate Social Investment

CATEGORY 7 BHF Member of the Year Titanium Award

Public Health Enhancement Fund The Titanium Award for Excellence in Corporate Social Investment recognises those organisations making a difference to the upliftment of communities and improvement of South African lives and the environment.

MEDSCHEME This award recognises the BHF member organisation that consistently participates and provides support for BHF initiatives.

Closed Medical Schemes – OLD MUTUAL STAFF MEDICAL AID FUND This Award recognises and rewards closed medical schemes providing the best service to their members, based on a defined set of criteria.

CATEGORY 2 Titanium Award for Service Excellence Managed Health Care – MEDSCHEME This Award is awarded to the Managed Health Care organisation providing superior service excellence to their clients based on an agreed set of criteria.

Administrators – MEDSCHEME This Award is awarded to the Administrator organisation providing superior service excellence to their clients based on an agreed set of criteria.

CATEGORY 5 Titanium Award for Young Achiever DR. LOGANDRAN NAIDOO This award recognises the contribution that young achievers make to the healthcare industry and to the future of the medical profession.

CATEGORY 8 Titanium Award for Advisory Services Excellence ALEXANDER FORBES (PTY) LTD This award recognises healthcare consultancies providing superior service excellence to their clients, both corporate and individual.

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

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BH F 360 ° | JULY 2 0 1 7

2016 BHF CONFERENCE

Summary of the 2016 Conference

AND LOOKING AHEAD A roadmap to universal healthcare

By Zola Mtshiya MANAGER: MARKETING, BRANDING AND COMMUNICATIONS – BHF

________________________________________________________________________________________________________

T

he 17th annual BHF conference was held in Cape

managed care organisations, pharmaceutical companies and

Town from 17 to 20 July 2016 and themed A Roadmap

government departments.

to Universal Healthcare. The conference featured an

array of keynote presentations and panel debates on health policy from experts with international experience in health system reform for moving towards universal healthcare.

The conference provided a platform for attendees to share

THE FOLLOWING ARE EXCERPTS AND HIGHLIGHTS FROM SOME OF THE CONFERENCE PRESENTATIONS:

ideas, discuss and debate strategies on how the private sector can play a proactive role in the implementation of national health insurance (NHI), along with a showcase of international examples of what has worked and what has not

Conference opening Professor Mcebisi Ndletyana, University of Johannesburg

in addressing challenges related to the collection, pooling and

Professor Ndletyana opened the conference with the reminder

purchasing functions of health financing.

that we all stand to lose if we allow inequalities to exist. “The

Conference topics included: Access to essential medicine and health technology; rare diseases, oncology and biologics; value-based alternative reimbursement models for high-cost technology; IT trends and how the digital media are creating

establishment has left many people out in the cold, and these people will listen to those who give them hope. They will support those – including populist demagogues – who offer them a stake in the system.”

access to care; and the role of the private sector in an NHI

Delegates at the conference were treated to a history lesson

environment. Over 300 organisations were represented

with a purpose as Professor Ndletyana explained that all the

at the event, including administrators, medical schemes,

major democratisation movements have been underpinned by

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BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

B H F 3 6 0 ° | JULY 2017

2016 BHF CONFERENCE business interests. “Business needs a stable, democratic state

Transforming our world - the 2030 Global Agenda for

in order to prosper, and the state gets its sustenance from the

Sustainable Development

taxes of business: it is a symbiotic relationship,” he said.

Dr. Sarah Barber, WHO Representative in South Africa The goal of universal healthcare is to ensure that all people obtain the health services they need without suffering financial hardship when paying for them. In middle- and high-income

Universal health coverage: What have we learnt so far?

Dr. Adam Wagstaff, Research Manager in the Development Research Group at the World Bank Dr. Wagstaff pointed out that most people have access to some sort of health coverage. The big difference is that for the poor, out-of-pocket payments for healthcare account for a sizeable portion of household expenditure.

“Everyone everywhere is covered at least once through public health or through formal health insurance that is either subsidised or a private health insurance scheme.

But out-of-pocket expenditure payments still account for a sizeable share of healthcare and household expenditure.”

According to the World Bank, the steps towards universal healthcare coverage are not smooth, but murky and winding, and definitely not a one-size-fits all scenario, although there are some common elements in different strategies deployed around the world.

Dr.

Wagstaff

covered

aspects

such

as

demand-side

incentives, various funding models from single-risk pool, crosssubsidisation or equalisation, as well as supply side incentives and what the impact has been on quality. He concluded by stating that universal health cover is not about getting everybody into the system, but people getting the healthcare they need.

countries, well-designed healthcare reforms have been able to control escalating healthcare costs, thus contributing to stronger economic growth. In practice, this means that countries across the world have embarked on a series of reforms to reorganise the financing of health services, improve access to essential medicines and technologies, and ensure that health workers are available and motivated.

An important aspect of Dr. Barber’s presentation was that of ‘progressive realisation’. No country has set forth all the details of universal healthcare implementation, which can take decades or longer to realise. Most countries initiate their roadmap, such as South Africa’s NHI White Paper, to gain political commitment in recognition that a process is needed. Such a process requires negotiation with a wide range of stakeholders, sequenced implementation, and careful monitoring and evaluation to make adjustments along the way and correct for any unintended consequences. In terms of financing, critical policy choices have to be made. No country has achieved universal healthcare through voluntary contributions to insurance schemes. Mandatory prepayment or public financing is required to achieve it.

A critical principle is equity. Health insurance schemes can improve health service utilisation and financial protection for their members. But what is the effect of any one scheme on the broader health system and the population as a whole?

Expanding health coverage that benefits a few but takes resources away from others may compromise equity and overall universal healthcare policy objectives. Universal healthcare is now a global movement in response to unprecedented demand. While there is no blueprint, stakeholders need to work together to set forth the pathways enabling the whole population to benefit.

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

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BH F 360 ° | JULY 2 0 1 7

2016 BHF CONFERENCE In search of the perfect health system Dr. Mark Britnell, Chairman and Partner of the Global

process - and ‘disruptive innovation’, where the landscape changes dramatically but the change makes it easier for us to

Health Practice at KPMG International

get to our destination.

Dr. Britnell has spent more than 20 years working with public and

“As we transform our healthcare system, we need both,” he

private healthcare organisations, travelling to over 60 countries

said. “Innovation does not occur in a vacuum. Our context is a

on nearly 200 occasions. Combining the heart and passion of a healthcare professional and patient, with the head of a man leading a successful global enterprise, he has learned firsthand what makes a healthcare system work – and what doesn’t.

Dr. Britnell focused on compelling case studies of countries whose healthcare systems offer inspiration and insight for the rest of the world. With an insider’s acumen, Britnell explored how elements of healthcare systems as diverse as those found in India, South Africa and Singapore can contribute to meeting the global healthcare challenge, demonstrating how collaboration on a global scale can tackle these challenges.

quadruple burden of disease, a private healthcare system that covers a small fraction of the population and a public sector which is chronically underfunded and whose staffing falls just within the WHO minimum of 4.9 healthcare workers per 1000 people - we certainly need innovations to meet our needs.”

Chinyanga suggested that the first innovation opportunity that we have is to re-examine and commit to a new reimbursement model that incentivises value. “There should be a focus on the condition as a whole, not just the procedure,” he said. “We have to see accountable care where providers and patients are empowered and we incorporate outcomes that matter to patients, such as ‘When can I go back to work?’”

The second innovation opportunity comes in the re-envisioning

Innovations for better health outcomes Kuldeep Singh Rajput, Founder and CEO of Biofourmis; Dr. Farayi Chinyanga, Medscheme Kuldeep Singh Rajput, founder and CEO of Biofourmis in Singapore, demonstrated the power of wearable technology when he connected the world’s smallest ECG monitoring system to his cellphone and relayed his heart rate to the audience. His heart was beating at over 160 bpm, a rate

of patient care and the creation of an integrated system.

“This is about effective co-ordination of care, which includes the management of the entire patient rather than just the presenting condition. Entry into the healthcare system needs to be at primary level, with down-referral back to primary care when specialist care is no longer necessary. A lack of co-ordination is strongly associated with poor process and outcomes measures. Better integration will benefit everyone,” he said.

more commonly experienced during peak aerobic workouts.

For Rajput, the significance of wearable medical technology is all about making health data accessible and personal.

“Doctors need to be able to compare you to you,” he said. “The combination of mobile, wireless and digital technology has disrupted healthcare. We can now predict an adverse medical event before it happens and take the appropriate action that can save your life.”

Defining healthcare fraud in the context of NHI: Is it a victimless crime?

Alanna Lavelle: Program Manager, Healthcare Fraud – MITRE (USA) Mitre was established in 1958 as a non-profit science and

Disruptive and sustaining innovations in the context of NHI were

technology think tank and operates from seven federally

put under the spotlight by Medscheme’s Dr. Farayi Chinyanga.

funded research and development centres. Mitre works

He spoke of ‘sustaining innovation’ - an iterative, evolutionary

closely with the US government to create new payment models

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B H F 3 6 0 ° | JULY 2017

2016 BHF CONFERENCE and, through innovation, to fight fraud and work on predictive

What are the drivers of utilisation?

analytics to try to anticipate the fraud before it actually

Dr. Jonathan Broomberg: CEO – Discovery Health;

occurs. Alanna Lavelle’s current role is to bring together the

Dr. Guni Goolab: Principal Officer – GEMS

private insurance companies and the public payers in order to aggregate claims data and, in doing so, identify instances of fraud that they would not have known about if they hadn’t pooled their data.

In one example she demonstrated how the pooling of data revealed how some psychologists were billing for over 150 hours in a single day, and how a doctor was found to be diagnosing patients who did not have cancer as having cancer, aggressively treating them with chemotherapy in a bid to receive kickbacks from treating clinics.

She emphasised the importance of innovation as well as partnerships in stopping this kind of fraud, waste and abuse, pointing to the global healthcare anti-fraud network of which BHF is a member. This global anti-fraud network represents 21 countries tackling global issues such as the trafficking of counterfeit pharmaceuticals, including antivirals, antimalarials and HIV drugs.

She went on to define the many facets of healthcare fraud,

In separate presentations, Dr. Jonathan Broomberg, chief executive of Discovery Health, which administers Discovery Health Medical Scheme (DHMS), and Dr. Guni Goolab, principal officer of the Government Employees’ Medical Scheme (GEMS), focused on the increase in use of medical services and the increase in chronic diseases.

Both DHMS and GEMS pointed to an increase in hospital and hospital-related claims, specifically in regions that have seen the opening of new private hospitals. Broomberg said 25 new hospitals with 2653 beds had opened over the past eight years. In 12 out of 18 regional case studies conducted by Discovery Health, it was shown that new hospitals resulted in a significant increase in hospital admissions among its scheme members, despite the fact that the prevalence of disease had not increased. In Durban, an analysis showed that the admission rate was 14% higher than the national average in 2010. In 2011, after a new hospital opened in Hillcrest, it was 19.8% higher, and in 2014, after a new hospital opened in Umhlanga, it was 29.7% higher.

including waste and abuse, services not rendered, upcoding,

Goolab presented evidence of how admissions in Polokwane

performing of medically unnecessary services, unbundling,

and Pietermaritzburg had increased from less than 3% a year

misrepresentation of services, falsification of services and

to more than 12% after hospitals opened in those areas. Over

kickbacks. The bottom line of her presentation focused on one

the past five years, there had been an almost 20% increase

key aspect - healthcare fraud is not a victimless crime, and

in hospital bed capacity, while medical scheme beneficiaries

typically involves significant patient abuse.

had increased by only 6%, yet private hospitals continue to

In closing and in response to a question from the floor, Lavelle said that a healthcare fraud unit should be centrally located and connected because there has to be collaboration between the benefits programme and the investigators. She showed how in the USA it works at a central location under the health and human services agency and gives those federal agencies a lot more power to investigate and prosecute, along with access to all data and records.

report high occupancies.

The tough economic climate and the record level of unemployment have led to an increase in fraud and abuse.

Since 2010, GEMS had investigated 5000 cases of fraud.

According to Goolab, another trend is the abuse of hospital cash-back plans. Medical scheme members are admitted to hospital, but no pathology tests are conducted during their stay in hospital, which is highly unusual according to GEMS. It is suspected that members are admitted under false pretences, often after being approached by a fraud syndicate.

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

33

BH F 360 ° | JULY 2 0 1 7

2016 BHF CONFERENCE The scheme pays the hospital bill and the member collects the cash pay-out from the insurance policy, which is shared with the syndicate.

fraudulent claims between 2013 and 2015. In 2013, the scheme recovered R288 million, and by 2015 this had increased 21% to R394 million. International studies estimate that fraud accounts for 3-15% of healthcare funders’ costs. was

Action plans to actualise universal healthcare Dr. Rajesh Patel: Head of Benefit and Risk – BHF;

Broomberg said that Discovery recovered R1.04 billion in

There

Panel discussion: Where to from here?

also

evidence

of

anti-selection,

Dr. Tony Behrman: CEO – IPA Foundation; Dr. Brian Ruff: CEO – PPO Serve; Vishal Brijlal: NHI Coordinator – National Department of Health In a panel session facilitated by Dr. Tebogo Phaleng, it was

which

is

accelerating the cost of claims. DHMS statistics show that over the eight years to the end of 2015, the average age of its members increased by 6.9% from 31.51 to 33.68 years, indicating that young people are waiting until they are older and sicker before joining a medical scheme. Over the same time Discovery experienced a 59% increase in the prevalence of chronic illnesses. In 2008, 13.9% of beneficiaries had chronic illnesses; by 2015, this had increased to 22.1%.

Broomberg said that, on average, a member with a chronic illness claims four times more than a member who does not have one. Another indication of anti-selection is the increase in the number of members claiming for rare diseases, such as multiple sclerosis and rheumatoid arthritis, indicating that members were advised to join a scheme because their claims were likely to be high.

Goolab added that anti-selection was prevalent in restricted schemes as well and that GEMS had found that principal members enrolled family members as beneficiaries only when they needed to claim. GEMS’ statistics show that within the

clear from the four days of the conference that every health system is different and based on a unique set of values and national imperatives. South Africa’s effectiveness in addressing the challenges of access, quality and affordability depends largely on the balanced interplay between three factors: policy direction and oversight, financing and the provision of care.

Health systems globally are characterised by mixed public and private financing and provision of care. Raising revenues to meet our healthcare needs is not simple and is limited by economic growth, the size of the tax base and opportunity cost. There’s no common path to universal healthcare, and we know that the role of the private sector cannot be delinked from the pursuit of national human rights and economic socioeconomic imperatives. We need to mobilise socially and there are compromises to be made. The panel session was a lively debate providing provider, funder and government perspectives on how we need to take NHI from policy to implementation through the optimal combination of resources, financing, technology, organisation and management that culminate in the delivery of appropriate health services to the population.

first three months of members joining the scheme, hospital admissions are 53.4% higher than in subsequent periods.

These statistics provide an indication of the uphill battle that medical schemes are waging in trying to keep contribution increases in line with increases in salaries and wages.

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BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

HEALTH CANNOT BE A FUNCTION OF INCOME. IT MUST BE A FUNDAMENTAL HUMAN RIGHT. – NELSON MANDELA

B H F 3 6 0 ° | JULY 2017

About EOH Listed in 1998, EOH is Africa’s largest technology service provider, offering superior consulting, technology and outsourcing services through 134 locations in South Africa and over 50 countries internationally. Following a stringent operating model, EOH provides high value, end-to-end solutions to clients in all industry verticals.

EOH Health At EOH Health, our focus is to strengthen and enhance health service delivery by drawing on the consulting, technology, and outsourcing competencies within the EOH group, which include claims processing management; health sector consulting; health facility operation management and engineering; workplace health solutions; information systems development and business modelling.

To find out how EOH can assist you, please contact Derry Heron on derry.heron@eoh.co.za for more information.

Technology makes it possible...

People make it happen

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

35

BH F 360 ° | JULY 2 0 1 7

ANNUAL BHF CONFERENCE

Conference

PROGRAMME Saturday, 15 July 2017 10h00 - late

Exhibition build-up - Exhibitors only Exhibition Hall 1

15h00 - 18h00

Delegate Registration

CTICC

Sunday, 16 July 2017 | THE JOURNEY BEGINS 10h00 - 16h30

BHF Golf Challenge 2017 | Shotgun start

Pearl Valley Golf Course

11h00 - 18h00 Delegate Registration CTICC 18h00 - 20h30

OPENING CEREMONY Auditorium 2 Facilitator: Dr. Clarence Mini; Acting Managing Director; BHF

WELCOME REMARKS Hon. Cllr. Alderman Ian Neilson; Executive Deputy Mayor; City of Cape Town

Keynote Address

Leadership decision - making: balancing principles and consequences Dr. Max Price; Vice Chancellor; University of Cape Town

CASE STUDY (1) - Private Sector Creating Access Dr. Iain Barton; Group Business Development Executive - Healthcare; Imperial Logistics

Guest Speaker Dr. Precious Matsoso; Director General; South African National Department of Health 20h30 - 22h30 RE-CONNECT Networking Cocktail Strelitzia Restaurant Entertainment by: Soul Tone Band South Africa Kindly sponsored by EOH

Monday, 17 July 2017 | JOURNEY EXPERIENCES 07h30 - 08h00 Tea & coffee on arrival Exhibition Hall 1

Plenary Session Ballroom East & West 08h00 - 08h10

Facilitator: Mr. Abdullah Verachia; Director for the Centre for Leadership and Dialogue; University of Pretoria’s Gordon Institute of Business Science

08h10 - 08h30

Why the private sector needs to evolve to achieve Universal Healthcare Dr. Rufaro Chatora; Country Representative; World Health Organisation (WHO)

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BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

B H F 3 6 0 ° | JULY 2017

“COURAGE IS NOT THE ABSENCE OF FEAR” – NELSON MANDELA

ANNUAL BHF CONFERENCE

Monday, 17 July 2017 | JOURNEY EXPERIENCES CONTINUED SESSION 1

WEALTH OF EXPERIENCE - LESSONS, CHALLENGES AND FUTURE ACTIONS

08h30 - 09h00 The fate of Obamacare: Lessons and implications for Universal Coverage in other countries

Dr. Elizabeth Fowler; Vice President for Global Health Policy at Johnson & Johnson; former

USA Special Assistant to President Obama on Healthcare and Economic Policy at the National Economic Council (USA) 09h00 - 09h20

What it really means to manage US$ 4,3 billion in an NHI Fund Dr. Tihomir Strizrep; Former Managing Director; National Health Insurance Fund (Croatia)

09h20 - 10h00 Key lessons learnt and challenges faced - The African experience

Mr. Nathaniel Otoo; Former Chief Executive Officer; National Health Insurance Authority (Ghana) Mr. Geoffrey Mwangi; Chief Executive Officer; National Hospital Insurance Fund (Kenya) 10h00 - 10h15

CASE STUDY (2) - Creating Access Dr. Nthabiseng Legoete; Chief Executive Officer; QualiHealth

Q & A Session - 15 Minutes

10h30 - 11h00

Networking Tea Break & Exhibition

SESSION 2 11h00 - 11h30

Exhibition Hall 1

OPPORTUNITIES FOR INVOLVEMENT New and emerging solutions for affordable healthcare Dr. Niti Pall; Medical Director; KPMG Global Healthcare Practice (UK)

11h30 - 11h50 Possibilities with current capabilities - how medical schemes and administrators can provide insight and support

Dr. Ali Hamdulay; Chief Executive Officer; Metropolitan Health 11h50 - 12h25

Progressive Benefit Design - Re-engineering for NHI alignment Mr. Barry Childs; Joint Chief Executive Officer; Insight Actuaries and Consultants

12h25 - 12h45

Disrupting healthcare through cross-industrial learning and multi-platform solutions: “It takes a village” Ms. Kudzai Chigiji; Actuary; FirstRand Bank

Q & A Session – 15 Minutes

13h00 - 14h00 SESSION 3 14h00 - 14h20

Networking Lunch & Exhibition

Exhibition Hall 1

PRINCIPAL OFFICERS AND TRUSTEES NAVIGATING THROUGH THE COMPLEXITIES

What really keeps Principal Officers awake at night?

Dr. Stanley Moloabi; Principal Officer; Medshield Medical Aid Scheme

14h20 - 14h40

The impact of asset allocation on scheme solvency: An investment manager’s perspective Mr. Mike Sithole; Portfolio Manager; Old Mutual Wealth

14h40 - 15h00

Insights from a closed scheme - a case study for NHI Ms. Nontobeko Ntsinde; Chairperson; Government Employees Medical Scheme (GEMS)

15h00 - 15h20

Reimbursement models – lessons from the UK and the case for change Ms. Victoria Barr; Senior Director; Economic and Financial Consulting; FTI Consulting

Q & A Session – 20 Minutes 19h00 - 24h00 3rd Annual Titanium Awards: Recognising Excellence in Healthcare MC: Azania Mosaka

Entertainment: Mafikizolo

Evening kindly sponsored by: Batsumi Insight Actuaries & Consultants BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

37

BH F 360 ° | JULY 2 0 1 7

ANNUAL BHF CONFERENCE “EVERY NEW IDEA AND INITIATIVE MEETS WITH RESISTANCE. WE HAVE TO FIND THE COURAGE TO TAKE RISKS, EVEN TO FAIL, IF THE GOAL IS WORTHWHILE” - KOFI ANNAN

Tuesday, 18 July 2017 | WALKING THE WALK SESSION 1 08h30 - 09h00

THE BIG QUESTIONS Tea & coffee on arrival

Exhibition Hall 1

Plenary Session Ballroom East & West

Facilitator: Dr. Vusi Memela; Executive Principal Officer; Hosmed 09h00 - 09h30

Are we competing on healthcare fraud, waste and abuse? A case for sectors to collaborate Adv. Andy Mothibi; Chief Executive and Head of the Unit; Special Investigating Unit Dr. Gregory Pratt; Medical Advisor on Healthcare Forensics; Medscheme

09h30 - 09h50

Effects of dominance on price - is this altering the market dynamics?

Dr. Anthony Norton; Founder; Nortons Inc Attorneys at Law

09h50 - 10h15 Case Study (3) - Creating Access

Ms. Mariska Vente-van Staden; Business Development Manager; Philips Health Systems Southern Africa

10h30 - 11h00

Q & A Session - 15 Minutes Networking Tea Break & Exhibition

Exhibition Hall 1

Tuesday, 18 July 2017 | WALKING THE WALK SESSION 2

TRANSFORMING THE HEALTHCARE SYSTEM TO ACHIEVE BETTER VALUE AND EFFICIENCY IN THE SERVICE DELIVERY CHAIN Facilitator: Ms. Neo Khauoe; Principal Officer; Sizwe Medical Fund

11h00 - 11h30 A health economic analysis of nutrition support: A cost-effective and clinically beneficial

intervention - in the context of PMBs

Dr. Karen Freijer; Market Access/ Health Economics Manager;

Nutricia Advanced Medical Nutrition (Netherlands) 11h30 - 11h50 Driving enhanced value and efficiency in the healthcare delivery chain

Ms. Geraldine Bartlett; Managing Director; Care Management Unit; Universal Healthcare 11h50 - 12h50 Value-based Purchasing - a case for integrated healthcare for better clinical outcomes Panelists:

Dr. Munyadziwa Kwinda; Acting Chief Operating Officer; Health Professions Council of South Africa

Dr. Odwa Mazwai; Group Functional Specialist; GEMS Fund Management

Dr. Brian Ruff; Chief Executive Officer; PPO Serve Integrated Clinical Consortia

Dr. Grant Rex; Chief Executive Officer; Improved Clinical Pathway Services

Q & A Session - 10 Minutes

13h00 - 15h00

Networking Lunch & Exhibition

13h00 - 15h00

BHF AGM FOR MEMBERS ONLY (During Lunch)

13h00 - 15h00 BHF Leadership Incubator - working Lunch

Exhibition Hall 1 Meeting Room 2.41 Venue Meeting Room 1.4

A session dedicated to developing next generation CEOs and Executives - A panel discussion:

Future leaders deconstructing challenges and opportunities in Healthcare

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BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

B H F 3 6 0 ° | JULY 2017

ANNUAL BHF CONFERENCE 15h00 - 17h30 PARALLEL SESSIONS Fraud, Waste and Abuse Workshop Venue: Meeting Room 2.44 Facilitator: Dr. Hleli Nhlapo; HFMU Chairman

Regional Workshop Venue: Ballroom East and West Facilitator: Dr. Thato Moumakwa; Principal Officer; PULA Medical Aid Fund (Botswana)

15h00 – 15h30 Renal Dialysis - Case Study Mr. Paul Midlane; General Manager;

Healthcare Forensics; Medscheme 15h30 - 16h00 Rephetse Pharmacy - Case Study –

Ms. Connie Bakkes; HFMU member; Risk

manager at Polmed (TBC)

15h00 for 15h20 Exploring possible regional collaboration to

Q & A Session - 30 Minutes

contain healthcare costs Mr. Joseph Mthetwa; Senior Programme Officer

for Health and Pharmaceuticals; Directorate for

Social Human Development and Special

Programmes; SADC Secretariat Headquarters (Botswana) 15h20 for 15h40 Use of biometric technology for membership management regionally Mr. Nicolas Garcia; Regional Director of Sales;

Sub-Saharan Africa; OEM Modules Morpho South Africa 15h40 for 16h00 Pro-active wellness management tool –

Namibian Case Study Ms. Ciske Smith - MiLife Q & A Session - 30 Minutes

18h00 for 18h30 Women in healthcare dinner

Westin In partnership with KPMG, BHF is proud to launch a forum celebrating women in leadership,

in the healthcare sector.

21h00 till late Universal Healthcare Party (check your inbox for details) All BHF Delegates are invited

Wednesday, 19 July 2017 | THE ROAD AHEAD WRAP UP 08h30 - 09h00

Tea & coffee on arrival

Exhibition Hall 1

Plenary Session Ballroom East & West Facilitator: Dr. Rajesh Patel; Head of Benefit and Risk; BHF

09h00 - 10h00

Council for Medical Schemes - Session Dr. Sipho Kabane; Acting Registrar; CMS

Implementation of the Demarcation Mr. Paresh Prema; General Manager - Benefits Management; CMS

Beneficiary Registry Mr. Jaap Kugel; Chief Information Officer; CMS Q & A Session - 20 Minutes 10h20 - 10h40

Access to medicines and vaccines - an SDG imperative Mr. Gavin Steel; Chief Director; Sector-wide Procurement; National Department of Health

10h40 - 11h15 National Department of Health - Session Mr. Vishal Brijlal; Technical Advisor; NDOH

• Implementation of NHI

• Actionable strategies - for the private sector • Regulatory framework

• Establishment of the NHI Fund

Q & A Session - 30 Minutes

CPD POINTS: Day 1 = 2 Clinical Day 2 = 5 Clinical, 2 Ethics Day 3 = 5 Clinical, 2 Ethics Day 4 = 2 Clinical

12h00 CONFERENCE CLOSURE BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

39

BH F 360 ° | JULY 2 0 1 7

ANNUAL BHF CONFERENCE

Conference SPEAKERS ABDULLAH VERACHIA Director for the Centre for Leadership and Dialogue: University of Pretoria’s Gordon Institute of Business Science Abdullah Verachia is director for the Centre for Leadership and Dialogue - University of Pretoria’s Gordon Institute of Business Science. He is an admitted attorney of the High Court of South Africa and holds qualifications from some of South Africa’s leading academic institutions. He has served as executive: international at Rand Merchant Bank (a division of FirstRand Bank Ltd) as well as on the management board of FirstRand India. Rand Merchant Bank was recently recognised as the 2014 Investment Bank of the Year in Africa

by The Banker – Investment Banking Awards. He is also the chief executive officer of MVA Strategy Consulting – a leading strategy consulting firm. He currently serves as executive chairperson of The Collective Genius and is a director of Education Africa. The Collective Genius is a leading youth strategy consulting firm and has designed a number of flagship youth strategies and projects for leading corporates and government departments. Having worked with over one million young people in the last 10 years, The Collective Genius has a unique vantage point with which to engage and understand the youth market. Having presented in over 60 cities globally, Abdullah Verachia has been recognised as a leading dealmaker, strategist and thought leader on company competitiveness and strategy and on frontier and emerging markets. He has presented around the world to leading listed firms, international organisations and governments. He has been asked to present at some of the world’s leading institutions including the School of Public and International Affairs at Columbia University in New York, the Said Business School at Oxford University, the OECD in Paris and Casa Asia in Madrid. He has provided business strategy solutions on behalf of listed and multinational clients in Asia, Africa, Europe and Latin America and has initiated and advised on some of the largest Asian investments into Africa. He also advised numerous South African companies on their internationalisation strategies with various emerging market economies and has an incredible understanding of the internationalisation of listed firms. He has headed up research, strategy and consulting assignments in an array of sectors including banking, mining, finance, asset management, construction, insurance, legal, audit, FMCG, retail and automotive. In addition, he has headed up consulting assignments on behalf of a number of South African industrial development zones and investment promotion agencies. He has also done work on behalf of leading donor organisations, specifically on the intra-emerging market flows between Asia and Africa.

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ANNUAL BHF CONFERENCE

DR. ALI HAMDULAY Chief Executive Officer: Metropolitan Health Dr. Ali Hamdulay, MBChB (UCT), MFamMed (Stellenbosch)(Cum Laude), was recently appointed Chief Executive Officer of Metropolitan Health and represents Metropolitan Health as a director: Board of Healthcare Funders (BHF). Having served the healthcare industry for over 18 years in many senior positions, he has developed vast expertise in healthcare business, administration and managed care. As a strategic thinker and leader, he’s successfully researched, planned and led implemented new models of healthcare to improve the health business’ capabilities. In addition, he’s successfully provided leadership and management of large teams to improve business performance. He has a comprehensive understanding of healthcare ecosystems, identifying critical role-players, markets dynamics, interdependencies and functioning. He’s forged strong relationships across the supply side (health practitioners and facilities), funder community, regulatory bodies and government leaders, and has developed a prominent reputation as an industry thought-leader. He has excellent communication skills and has had considerable media exposure. After qualifying as a medical doctor at the University of Cape Town in 1998, he worked in the public health sector at Sebokeng Hospital, Gauteng, and Tygerberg Hospital, Western Cape. Two years later, he moved into the private sector, leading the establishment of several successful primary healthcare practices in the Western Cape. He joined Metropolitan Health Risk Management as clinical advisor in the Clinical Best Practice Unit in 2007. Between 2008 and 2014, he held several executive positions in disease risk management, provider management and the Health Policy & Provider Management Unit before being appointed executive head of clinical risk solutions in 2015. The main objective of the position was to provide strategic direction, leadership and management of the managed care unit responsible for delivering health risk capabilities to enhance value to shareholders, clients and health citizens. During his tenure in these positions, he has achieved measurable successes including enhanced product development, innovative managed care solutions, business growth, enhanced clinical governance processes, enhanced risk management analytics and value realisation, and competitive tariff negotiations for clients. Over the past years, the business has entrusted him with several strategic projects and initiatives. These included formulating Metropolitan Health’s position on NHI and heading up the steering committee responsible for dealing with the requirements of the Competition Commission’s inquiry into healthcare.

Ali Hamdulay is passionate about social development and community upliftment and has served in several leadership positions of educational, social and welfare organisations. He has strong leadership qualities and is intensely enthusiastic about making a difference in the health industry.

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ANNUAL BHF CONFERENCE ANTHONY NORTON Founder and Director: Nortons Inc Anthony Norton holds a BA LLB (cum laude) from the University of the Witwatersrand and an MLit (Oxon).

Prior to co-founding Nortons Inc., he was head of the competition law department at Webber Wentzel. His principal areas of practice are South African and African competition law and competition litigation, as well as white-collar crime, general litigation and regulatory advice. He was the first South African competition law practitioner to appear before the South African Competition Appeal Court. He has experience in merger notifications, merger interventions and applications for advisory opinions in relation to mergers and acquisitions.

He has also provided advice to clients in respect of prohibited practices, corporate leniency applications, horizontal and vertical restrictive practices, abuses of dominant position, applications for exemption and interim relief as well as in relation to the new criminal provisions under the South African Competition Act. His expertise in competition law is highly regarded and he has advised clients on a number of seminal competition law matters. Recent merger notifications include representing Western Digital in respect of its global acquisition of SanDisk Corporation and the JSE-listed Mpact Limited in respect of its acquisition of Remade Holdings.

He advised Sasol Polymers, a division of Sasol Chemical Industries Limited, in the most important excessive pricing case before the South African Competition Tribunal and the Competition Appeal Court. This was in relation to two complaints regarding the excessive domestic pricing of propylene and polypropylene, which the Competition Commission had referred to the Competition Tribunal.

The Competition Appeal Court found in favour of Sasol Polymers and the Constitutional Court declined to hear the Commission’s application for leave to appeal. Anthony Norton currently represents Netcare Limited in relation to the Competition Commission’s market inquiry into private healthcare, as well as Pick n Pay Retailers (Pty) Ltd in relation to its retail grocery market inquiry. Recent competition/antitrust cases include: Netcare’s acquisition of the Community Healthcare Group, Medicross and Primecure as well as Netcare’s opposition to the attempt by Medi-Clinic to acquire a minority stake in Afrox Healthcare. Anthony Norton has been recognised as a leader in the field of competition and antitrust, and has received a number of local and international accolades in this regard.

DR. ARTHUR VUSIMUZI (VUSI) MEMELA Executive Principal Officer: Hosmed Medical Scheme Dr. Vusi Memela has years of extensive experience working within the healthcare industry as well as the public sector. His academic qualifications include an MBChB (MEDUNSA), an LLB (University of the Witwatersrand), an LLM (UNISA), a diploma in management studies and an MBA (coursework completed).

He is well versed with the Medical Schemes Act, its regulations and codes. His work experience includes being registrar of the Health Professions Council of South Africa (HPCSA), and general manager, clinical executive and more recently principal officer of Hosmed Medical Scheme, where he has managed the improvement and implementation of governing policies and procedures in line with best practice. His key strengths and skills include strategy initiation, development and implementation, effective management of human resources, management of outsourced strategic functions with partner service providers, including industry bodies, regulatory authorities and government departments. Other key areas of responsibility include effective financial management, clinical risk management, marketing and communications, and public relations.

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ANNUAL BHF CONFERENCE BARRY CHILDS Joint CEO: Insight Actuaries & Consultants Barry Childs is joint CEO of Insight Actuaries & Consultants. He is a Fellow of the Institute and Faculty of Actuaries with a postgraduate diploma in health economics. He is passionate about healthcare and provides advice to a wide range of healthcare role-players, including NGOs, government agencies, healthcare providers and pharmaceutical companies, medical schemes and their administrators and managed care organisations, as well as wellness and loyalty programmes.

DR. BRIAN RUFF Chief Executive Officer: PPO Serve Integrated Clinical Consortia Dr. Brian Ruff holds an MB BCh (Wits 1983); FCP (SA 2002); Rheumatology, D HM E FP (UCT 2002) and CPMD (Wits 2006). He is a physician, rheumatologist and health economist. He is currently CEO of PPO Serve (Professional Provider Organisation Services), a position he has held since March 2015.

PPO Serve is a healthcare management company that helps clinicians organise themselves into integrated teams, called Integrated Clinical Consortia™. It is supported by the Foundation of Professional Development and Stone3 Venture Technologies. Integrated Clinical Consortia are multidisciplinary teams owned by the working clinicians. They deliver healthcare of high value to patients – good quality on a sustainable basis. PPO Serve provides a complete support infrastructure including a tailor-made toolkit to form and manage the consortium along with data analytics and a clinical workflow health IT solution – the Intelligent Care System for patient management. Integrated Clinical Consortia take many forms, including for general population management; for HIV and other chronic disease management; for maternity care and for surgical episodes. Demonstration projects are under way. PPO Serve’s purpose stems from a recognition that South Africa’s healthcare system is in crisis; people can no longer afford their high medical scheme premiums. These are the result of a lack of teamwork, which leads to fragmented care with gaps in needed treatment. Because of this, problems don’t get fully resolved. Integrated Clinical Consortia team clinicians provide high-value patient-centred care to populations, thus reducing overall healthcare costs with high levels of patient and clinician satisfaction. Until March 2015, Brian was head of strategy at Discovery Health. He managed various divisions including risk intelligence which did innovative clinical data and case mix analytics; and the integrated care unit, which drove supply side reform. His work included the development of a macro-economic model of the South African private healthcare sector. He headed up a technical task team for provincial healthcare services during the transition from apartheid to democracy. The focus was on service reconfiguration to provide effective and equitable care for South Africans. Before that he was a clinician in public sector hospitals and at Alexandra Clinic. He has also worked for the NHS in London.

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ANNUAL BHF CONFERENCE DR. CLARENCE MINI Acting Managing Director: Board of Healthcare Funders of Southern Africa (BHF) Clarence is currently the Acting Managing Director of the Board of Healthcare Funders of Southern African.

He also serves as Chairperson of the Clinical Governance and Ex-Gratia Committee and Board member of the Government Employees Medical Scheme. Prior to his current commitments, he also previously successfully fulfilled the following roles: Principal Medical Officer for Port Elizabeth Municipality. National Director for Family Health International. National Coordinator and Deputy National Director of Management Sciences for Health. Served as co-chairperson of National AIDS Convention of South Africa (NACOSA) - NACOSA wrote the first National HIV/AIDS Plan for South Africa in 1994. Served on the Committee of Inquiry into National Health Insurance (NHI). Served on the Board of Directors for the Hospice Palliative Care Association. Executive Director of the MESAB Palliative Care Initiative. Served on the core team that wrote the latest HIV/AIDS National Strategic Plan. The past President of the Gauteng Medical Association. Chairperson of the Gauteng Health Facility Accreditation Committee. Board member of the Institute for Human Evolution at Wits University. Trustee of St Andrews school for Girls. Served as a member of the Johannesburg Mayoral AIDS Council. Chairman of the Board of Directors for Africa Health Placements. Chairperson of the Board of Healthcare Funders of Southern Africa. Corporate Affairs Executive for Thebe ya Bophelo Healthcare Administrators.

DR. ELIZABETH J. FOWLER (USA) Vice-President: Global Health Policy, Johnson & Johnson Dr. Elizabeth Fowler, Ph D, J D, is currently vice-president for global health policy at Johnson & Johnson, where she focuses on delivery system and payment reform in the USA and healthcare systems reform in emerging markets. Prior to joining Johnson & Johnson, she was special assistant to President Obama on healthcare and economic policy at the National Economic Council. During the health reform debate in 20092010, she was chief health counsel to Senate Finance Committee chair, Senator Max Baucus (D-MT), where she played a critical role in developing the Senate version of the Affordable Care Act. She also played a key role in drafting the 2003 Medicare Prescription Drug, Improvement and Modernization Act (MMA). She has nearly 25 years of experience in health policy and health services research. She earned a bachelor’s degree from the University of Pennsylvania, a Ph D from Johns Hopkins School of Public Health, where her research focused on risk adjustment, and a law degree (J D) from the University of Minnesota.

She is admitted to the Maryland bar, the District of Columbia bar and the US Supreme Court. Dr. Fowler is a Fellow of the inaugural class of the Health Innovators Fellowship and a member of the Aspen Global Leadership Network.

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ANNUAL BHF CONFERENCE GEOFFREY MWANGI (KENYA) CEO/Board Secretary: National Hospital Insurance Fund Geoffrey Mwangi is the CEO/board secretary of National Hospital Insurance Fund, a Kenyan state corporation with the mandate to provide affordable social health insurance to Kenyan residents. Prior to being appointed CEO in November 2016, he was acting CEO and director: finance and investments. In the latter role, he was faced with two delicate assignments: designing a strategic healthcare purchasing mechanism and rolling out an outpatient package under the national scheme previously available under the civil servants’ scheme. His skills matrix includes knowledge of healthcare financing, provider payment mechanisms, financial accounting, financial planning, cash flow management, asset management, corporate financial affairs, process flow design, behavioural finance and public finance. He is a certified public accountant and a member of the Institute of Certified Public Accountants of Kenya (ICPAK) with 15 years’ post-qualification experience. He has extensive knowledge of financial planning and has valuable experience in healthcare financing strategies applied globally. He was awarded a Master of Commerce by the School of Commerce and Management, Strathmore University, where he specialised in behavioural finance theory. His publications include Behavioural factors influencing investment decisions in the Kenyan property market, which appeared in the Afro-Asian Journal of Finance & Accounting in 2014. He also holds a Bachelor of Science in business administration accounting from the United States International University, where he specialised in accounting systems and processes.

GERALDINE BARTLETT Managing Director: Universal Care Geraldine Bartlett holds an M Pharm (Cum Laude). She is the managing director of Universal Care (Pty) Ltd, an accredited managed care organisation that is a wholly owned subsidiary of Universal Healthcare (Pty) Ltd. She is responsible for the overall management of the managed care function, which includes hospital benefit management, pharmacy benefit management, disease management, oncology management, dental benefit management and provider network management. A pharmacist by qualification, she has a master’s degree in pharmacy and over 30 years’ experience in managed care at senior management and executive level within the medical schemes industry. She has been responsible for pioneering a number of managed care initiatives in South Africa, such as medicine formularies, chronic medicine management programmes, medicine reference pricing and disease management programmes. She has presented on managed care both internationally and locally.

DR. GRANT REX Chief Executive Officer: Improved Clinical Pathway Services Dr. Grant Rex qualified with an MB BCh from the University of the Witwatersrand in 1987 and went on to obtain a B Soc Sci (Hons) from UND and an SMP from Henley (UK). He went into clinical management at Alexandra University Clinic, where he was general manager of the Institute of Urban Primary Healthcare; this was followed by a stint as superintendent at Baragwanath Hospital before joining Life Healthcare as a hospital manger, regional manager and eventually managing director of its overseas operations in the UK. He then joined Care UK as head of its secondary care hospital division, where he was exposed to the measurement of clinical outcomes or clinical quality assurance and the development of standardised care pathways based on this. In 2013 he returned to South Africa where he started the first ‘ value-based’ clinical network called Improved Clinical Pathway Services (ICPS), offering quality controlled joint replacement to the private medical aid industry as well as government.

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ANNUAL BHF CONFERENCE DR. GREGORY PRATT Medical Advisor on Healthcare Forensics: Medscheme Gregory Pratt qualified as a general practitioner in 1995 at Pretoria University and after 10 years in private practice completed an MBA and then joined Medscheme, providing advisory services to a number of its corporate and open schemes. He has been involved with forensic investigations for the schemes in the Medscheme stable since 2007 and has pursued this interest over the last decade. He has been closely involved with GEMS since 2008 across many of its divisions and has served on its fraud forum since its inception. He joined Universal Healthcare in 2012 and helped develop the strategic managed care unit, which provided actuarial and clinical analyses to GEMS, until returning to Medscheme in October 2016. Forensic investigation has always intrigued him and spurred him on to qualify as a certified fraud examiner through a US institution. He is passionate about eradicating fraud in the healthcare industry and is continually looking for collaborative ways to achieve this.

HARDY NCUBE Strategist and Coach Hardy Ncube holds an MBL, BCom, FCII and a diploma in professional consciousness coaching.

He is currently working on his PhD through the University of the Witwatersrand. He has over 19 years of working experience in strategic roles in various financial institutions. These roles include business development, research and innovation, product development and product management, strategic planning and outsource partner oversight management. He has also worked as an internal coach and external coach (i.e. business, leadership and personal coaching).

DR. HLELI NHLAPO Chairman: HFMU Dr. Hleli Nhlapo qualified with a BChD from MEDUNSA in July 1991. He obtained a postgraduate diploma in forensic dentistry and MSc Dent Sc (Forensic Dentistry) from Stellenbosch University in 1999 and 2001, respectively. He is registered with the HPCSA as a general dental practitioner and is a member of the South African Dental Association (SADA). He served as a director of Oralnet from 1998 until January 2005 and as an executive member of the South African Medical and Dental Practitioners Association (SAMDP) from 1996 to 2001. He is currently managing director of the medical schemes division at Dental Information (Pty) Ltd, a position he has held since January 2005. He is an executive of EOH’s health business unit and, since October 2014, has also served as chairman of the HFMU within BHF. He is a director and board member of BHF since July 2016. He practised as a dental surgeon for 14 years before joining DENIS in January 2005. He has attended various postgraduate courses within the dental specialties. He served as dental advisor for Medscheme (1998-2004), Managed Health Systems (2002-2004) and a local area manager for Bankmed under MHS. He was part of the SAMDP’s yearly tariff increase negotiation team with the then RAMS, and was also involved in the negotiations with the Dental Technicians Council that made it possible for dental technicians to claim directly from medical aid schemes. He is an annual invitee of the University of the Western Cape’s Dental Faculty to speak to their final-year students on the subject of private healthcare funding in South Africa.

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ANNUAL BHF CONFERENCE DR. IAIN BARTON Group Business Development Executive: Healthcare Imperial Logistics Dr. Iain Barton is a leading expert in developing and implementing best practice supply chain functions in global health. A committed South African, he is a medical doctor with 10 years clinical practice and 20 years in supply chain management. Dr. Barton specialises in pharmaceutical supply chain solution design and market-shaping start-ups. He is group strategy executive: healthcare for Imperial Logistics, coordinating operations across all of Imperial’s healthcare businesses. Imperial is Africa’s largest logistics company and its healthcare operations deliver more than 350 million patient packs of medicine each year. Dr. Barton was responsible for developing the concept of regional distribution centres to support the scale-up of PEPFAR, which provides life-saving drugs and commodities for more than six million HIV patients in 17 countries across Africa. Other innovations developed under his leadership include Unjani Clinics, Warehouse-in-a-Box, Clinic-in-a-Box and Lulama Pharmacies. He currently serves on the advisory boards of Merck for Mothers, South Africa’s Public Health Enhancement Fund and People That Deliver.

JAAP KUGEL Chief Information Officer: Council for Medical Schemes (CMS) Jaap Kugel holds a master’s degree in technology and is currently chief information officer (CIO) at the Council for Medical Schemes (CMS). He is passionate about investigating and implementing innovative information technology enablers to meet business requirements. Prior to joining the CMS, he was employed by the national Department of Health from 1992 to 2000. During this time, he was responsible for handling the budgets, IT and procurement as well as allocation and management of donor funds and donor projects for the various directorates and clusters he worked under. While at the department he was involved in conceptualising ICT-driven solutions to improve administrative efficiencies. His keen interest in ICT and attendance of various ICT courses culminated in his being appointed IT manager of the CMS. He joined the CMS in June 2000 and was primarily tasked with setting up the council’s IT infrastructure and developing custom software applications. He was responsible for conceptualising and pinning the business requirements for several custom applications and for project managing the development of these applications.

These applications included the CMS accreditation, complaints and financial return systems, to name a few. He is a member of the executive management committee, risk management committee and IT steering committee of the CMS. He was recently appointed chair of the IT advisory group (ITAG) of the medical schemes industry, responsible for coordinating all IT-related developments and standards. He is currently tasked with establishing the beneficiary registry of all funded patients in South Africa.

JOSEPH MTHETWA Senior Programme Officer Secretariat: Southern African Development Community (SADC) Joseph Mthetwa Is currently the senior programme officer for health and pharmaceuticals of the Southern African Development Community (SADC) Secretariat, based in Gaborone, Botswana, a position he has held since January 2006. He has a Master of Science in Medicine (Epidemiology and Biostatistics) from the University of the Witwatersrand, South Africa, along with a number of international qualifications. His previous work experience includes being a Scientific Officer in Health Systems research and development at the Tropical Diseases Research Centre, Ndola, Zambia, and a lecturer in pharmacology at Chainama College of Health Sciences, Lusaka, Zambia. He is a member of the Commonwealth Health Advisory Committee (CACH) among other professional memberships.

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ANNUAL BHF CONFERENCE DR. KAREN FREIJER (NETHERLANDS) Market Access/Health Economics Manager: Nutricia Advanced Medical Nutrition, The Netherlands Dr. Karen Freijer is market access/health economics manager at Nutricia Advanced Medical Nutrition (NAMN) in the Netherlands. After finishing secondary school at the Nieuw Lyceum in Hilversum (VWO in 1985), she first obtained her Board Secretary licence before starting her college education in nutrition and dietetics at the University of Applied Sciences (HvA, Amsterdam). In 1992 she received her bachelor in health science degree, with specialisation in methodology. After graduation she worked in a number of roles: she was variously a sales representative for Pfizer BV, temporarily in charge of a private dietician practice, and a nutritionist in nutritional food supplement companies. She also undertook several functions within NAMN. Since 2007 she has specialised in health economics and market access which, in late 2011, led to her in starting her PhD studies in nutrition economics at the University of Maastricht, the Netherlands, alongside her working career at NAMN. She received her Ph D in 2014. Together with three others, she founded a special interest group on nutrition economics, which was officially acknowledged by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) in 2014 as the first group to focus on nutrition. Dr. Freijer is the chairperson of ISPOR. Next to her health economics/market access management function at NAMN, on a global as well as at a BeNeLuX level, and chairing and further developing the ISPOR SIG nutrition economics, she is still affiliated to Maastricht University as a researcher in nutrition economics. She has written multiple international peer-reviewed publications, is an advisor to European nutrition organisations and is a board member of international peer reviewed journals.

KUDZAI CHIGIJI Consulting Actuary: FirstRand Bank Kudzai Chigiji is a consulting actuary from Zimbabwe, currently working for WesBank Group in South Africa as its Head of Strategic Analytics and Research. Her experience spans life insurance, management consulting, healthcare consulting, social security development, banking and loyalty programmes. She is currently pursuing a master’s degree in development finance to bring the fundamentals of finance and economics closer to the needs of developing African countries. Using her experience across several sectors has allowed her to tap into the cross-industrial benefits of closer collaborations. She seeks to develop solutions that meet the holistic needs of communities to foster sustainable development. She has spoken at several conferences in the past few years, including the last two Actuarial Society of South Africa conventions, the International Congress of Actuaries, the Singapore Actuarial Health and Retirement Conference in 2016, the 2016 IAA Joint Colloquium held in St John’s, Newfoundland, and two symposiums for the Government Employees’ Medical Scheme. She currently volunteers across several committees within the Actuarial Society of South Africa, Actuarial Society of Zimbabwe, International Association of Consulting Actuaries and the Institute and Faculty of Actuaries. She is the Africa representative on the International Association of Consulting Actuaries’ committee. She seeks to find new areas where the actuarial profession can introduce its expertise.

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ANNUAL BHF CONFERENCE DR. KWINDA MUNYADZIWA Acting Chief Operating Officer: Health Professions Council of South Africa Dr. Kwinda Munyadziwa was born and raised in Dzumbama, Mutale Local Municipality, in Vhembe District (Limpopo), where he received his primary and secondary education. He went on to obtain, among other qualifications, a Bachelor of Science from the University of Venda, a Bachelor of Medicine and Surgery from the University of Natal, a Certificate in Advanced Health Management from FPD/Yale University and a MMed (Family Medicine from the University of Limpopo. He received his MSc Med (Bioethics and Health Law) from the University of the Witwatersrand in 2016. Further to holding a number of positions in the Department of Health, he is currently acting chief operations officer of the Health Professions Council of South Africa (HSPCA), a position he has held since June last year. He holds a number of professional leadership positions with industry bodies such as the South African Medical Association and the Aeromedical Committee of the Civil Aviation Authority. His many achievements/awards include his being named South Africa’s Rural Doctor of the Year 2008 by the Rural Doctors Association of South Africa and the Best Clinical Manager for Vhembe District for the 2007/8 financial year.

ADVOCATE LEKGOA (ANDY) MOTHIBI Head of the Special Investigating Unit (SIU) Advocate Andy Mothibi started his career as public prosecutor in the Magistrate’s and Regional Courts.

He also served on the bench as a magistrate in the Johannesburg and Soweto Magistrate’s Courts. He was appointed head: employee relations at the then Department of Finance in 1995. He was part of the project that led to the establishment of the South African Revenue Service (SARS). At SARS he also served as head of corporate legal services and head of governance. In 2005 he was appointed head of compliance at South African Airways (SAA). After completing the implementation of SAA’s enterprise and compliance risk management framework, he was appointed senior manager: enterprise risk management at Nedbank in 2007. Within six months he became general manager: group operational risk management. After successfully completing the implementation of the Basel II Operational Risk Management Framework (Basel II ORMF), in 2012 he was appointed head of operational risk for Standard Bank of South Africa. After successful implementation of Basel II ORMF there he became head: Standard Bank group operational risk management. Basel II ORMF implementation entailed assessing operational risks, which included the development of anti-fraud and anti-money laundering scenarios. In October 2013 he was appointed as an executive director at Medscheme Holdings, a subsidiary of AfroCentric Health. His role at Medscheme was equivalent to that of a chief risk officer, which provided for wider career growth. The role included leading group legal services, governance, risk and compliance. He was also responsible for the Medscheme Road Accident Fund business unit. At AfroCentric Group he championed the successful implementation of the AfroCentric enterprise risk management framework. One of the key initiatives was the reorganisation of the group forensic investigations business unit, which improved forensic investigations capability and recoveries. On 1 May 2016, he was appointed head of the Special Investigating Unit (SIU) by the president of South Africa.

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ANNUAL BHF CONFERENCE MARISKA VENTE-VAN STADEN Business Development Manager: Philips Health Systems Southern Africa Mariska Vente-van Staden is currently a business development manager for long-term strategic partnerships at Philips Health Systems Southern Africa. This role has a solid focus on primary healthcare and mother and childcare. Coming from a clinical engineering background she believes in having a strong technical and clinical approach to building better and sustainable solutions. With a greenbelt in six sigma process and quality improvements within the health system, this is the low-hanging fruit required to build lasting partnerships with government and non-government institutions. She has won big with the WHO in Namibia for supplying medical equipment, services and training to the Program for Accelerating the Reduction of Maternal & Child Mortality (PARMaCM) which was founded by first lady, Ms Pohamba. Furthermore she was the leader of a project undertaken with the University of Stellenbosch and Tygerberg Hospital to co-develop emergency maternal care solutions for the hospital. With her strong focus on maternal, neonatal and child care, she concluded a quality improvement programme and research study which took place in three rural hospitals in Mozambique. She and her team tested a methodology for introducing a package of interventions to improve patient safety and detect clinical complications early. Philips is scaling this up to a national programme..

DR. MAX PRICE Vice-Chancellor: University of Cape Town Dr. Max Price took up the post of vice-chancellor of the University of Cape Town in July 2008. From 1996 to 2006, he was dean of the Faculty of Health Sciences at the University of the Witwatersrand. After obtaining his medical degree from the University of the Witwatersrand, Dr. Price was awarded a Rhodes scholarship. He studied philosophy, politics and economics at Oxford. Following clinical work in academic and rural hospitals in South Africa, he took a master’s degree at the London School of Hygiene and Tropical Medicine, continuing there as a research Fellow in health economics. He joined the Centre for Health Policy at the University of the Witwatersrand in 1988 as a senior researcher and became its director in 1992. Dr. Price’s research has covered the political economy of health in South Africa, health economics, rural health services, health systems research and health science education. He is an Honorary Fellow of the Colleges of Medicine of South Africa in recognition of his leadership role in public health medicine and medical education. Dr. Price is currently chair of the African Research Universities Alliance, and was previously chair and now vice-chair of the Worldwide Universities Network.

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ANNUAL BHF CONFERENCE MIKE SITHOLE Portfolio Manager: Old Mutual Wealth Mike Sithole is a portfolio manager at Old Mutual Wealth Private Client Securities and is based in Johannesburg. He joined the company in 2015. He holds a B Com from the University of South Africa (UNISA), is a CFA charterholder and has over a decade’s experience in the financial services industry. He began his career at Investec Asset Management as a relationship manager in 2004. He then moved on to become a senior stockbroker at Investec for just under four years. In 2009, he joined Stanlib as their head of fund research and analysis. Prior to taking up his current position, he was a senior portfolio manager at Ashburton Investments, where he worked with high-net-worth clients.

DR. MONICA SPRINGFIELD Medical Director and COO: Helen Joseph Hospital Dr. Springfield has a Master’s degree in Health Informatics obtained at UCL in the UK. She is also a Wits graduate with degrees in both Physiotherapy and Medicine and is one of the first black women to graduate as a physiotherapist and specialize in Anaesthesia at the University of Witwatersrand. Dr. Springfield recently relocated back from the UK where she spent 8 years working in the NHS as a Consultant Anaesthesiologist. Her interest is clinical governance and Standardised Care Pathways and she was part of the first teams in the UK developing a standardised Fast Track Arthroplasty program for joint replacements.

20 000 patients were operated on over a 5 year period using this program which has now become the mainstay of joint replacement surgery in the world. As Clinical Director for ICPS in South Africa, she was instrumental in implementing the first standardised care pathway for hip and knee joint arthroplasty surgery in over 50 orthopaedic practices in South Africa. She is currently the Medical Director and COO at Helen Joseph Hospital which is a 600 bed public hospital in Gauteng.

NATHANIEL OTOO (GHANA) Former CEO: National Health Insurance Authority Nathaniel Otoo holds a bachelor’s degree in law from the University of Ghana and a master’s degree in international relations from the International University of Japan. He worked for over 10 years with Ghana’s National Health Insurance Authority. He eventually rose to become its CEO, a position he held until he resigned in February 2017. His previous work experience spans the social security, manufacturing and trade promotion sectors. Nathaniel is a founding member of the Joint Learning Network for UHC, and became the network’s first convener in 2013, a position he held for two years. He is currently an independent consultant and runs his own firm, Wazuri Consulting.

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ANNUAL BHF CONFERENCE NEO KHAUOE Principal Officer: Sizwe Medical Fund Neo Khauoe’s qualifications include a Dip Nursing (General, Psychiatry, and Midwifery), Dip HR, BTech HRM, MAP, MBA and BTh. She began her career as a nurse at Baragwanath Hospital, where she excelled

before moving into the medical schemes industry 22 years ago. She started as a customer services

consultant at Medscheme and moved up the ranks, occupying several management positions in CRM, HR,

IR, and training and provider relationship management, among others. She later went on to work as a client

relationship manager at Alexander Forbes and Sizwe Medical Services, where she was instrumental in improving customer relations and query resolution at both organisations. She managed diverse teams and supported brokers who were involved with different

schemes. When she moved to Metropolitan Health in 2006, she was tasked with the challenging role of managing the POLMED business unit as its scheme executive. Her focus was on people management, client relations, customer services and improvement of financial and operational challenges. Her ability to communicate, operate and interact at different levels was key to her success

in building productive and coherent teams. POLMED business unit experienced improvements and member satisfaction, which prompted the scheme to request her appointment as general manager in 2009 because of her ability to co-ordinate and establish

high-performing teams. It was during this time that she actively involved different stakeholders at SAPS and POLMED, including health risk managers, service providers and members, in scheme-related matters. Member education and communication were enhanced with high participation at different levels. Member voice and fair practice have always been among her priorities. In

2014 she spearheaded the takeover of the strategic management of Sizwe Medical Fund out of curatorship. Thanks to her proven track record of good governance, ensuring effective and efficient functioning organisations, member participation and stakeholder management, the scheme is now stable with a good financial outlook. It has imposed the lowest contribution increases in the market

since 2015 and has a high solvency ratio coupled with rich benefits. Her various qualifications have honed her ability to build high-

performing organisations. She has trained, developed, coached and mentored many in and outside the medical schemes industry

and continues to do so. She has been featured in many publications and has commented on issues of interest while providing input at different forums that deal with changes in the industry.

NICOLAS GARCIA (FRANCE) Regional Director of Sales for Sub-Saharan Africa: OT-Morpho Nicolas Garcia started his career in France as an information technology specialist when floppy disks were still in use, many moons ago. In 2002, he moved to South Africa to work for the French Embassy – Trade Commission as the IT manager for southern Africa operations for two years. He was subsequently introduced to access control and biometrics in 2004 when he was appointed by OT-Morpho - then called SAGEM South Africa. SAGEM was a France-based company and world leader in biometrics and access control and this was the first time they were penetrating the African market. Over the past 13 years, he has occupied key positions such as technical manager, sales and operations manager, sales and marketing director and business unit manager; he is currently the regional director of sales for sub-Saharan Africa at OT-Morpho, a position he has held for the past three years.

He draws his legitimacy as an expert in his field from his involvement in information technology, and biometrics in particular, over the past decade. He currently oversees all biometric terminal sales activity in sub-Saharan Africa, including but not limited to South Africa, Botswana, Kenya, Tanzania, Namibia, Zambia and Zimbabwe.

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ANNUAL BHF CONFERENCE

The health of our community is in your hands.

Healthcare Solutions. That’s how we help.

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Terms and conditions apply. FNB Business, a division of FirstRand Bank Ltd t/as FNB Insurance Brokers.

AnBOARD authorised Services and Credit Provider (NCRCP20) Registration OFFinancial HEALTHCARE FUNDERS OF SOUTHERN AFRICA No: 1929/001225/06 FSP Licence No: 20081

B H F 3 6 0 ° | JULY 2017

ANNUAL BHF CONFERENCE

At FNB Business, we recognise the importance of healthcare in our society. That’s why our Healthcare Solutions are geared to give you and your practice a well-rounded, all-inclusive banking offering that helps you focus on running your practice. We offer you competitive card payment acceptance solutions, tailored Personal, Business and Malpractice Insurance and Asset-based Finance for your practice’s unique growth needs.

So, switch to the only bank to collaborate with BHF to remove the administrative burden of notifying medical aids of your new banking details.

It’s more than just business to you. It’s more than just banking to us.

That’s why we help.

For more information, email healthcare@fnb.co.za

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ANNUAL BHF CONFERENCE DR. NITI PALL (UK) Medical Director: KPMG Global Healthcare Practice Dr. Niti Pall, medical director, KPMG Global Healthcare Practice, is a visionary senior clinician, who has combined clinical practice with an entrepreneurial edge to design and deliver new models of health care in the UK and international markets using an inclusive and creative style to ensure buy-in from teams. She is highly skilled at building sustainable networks for improving patient care across boundaries, particularly with secondary care, the voluntary sector, governments and businesses. Dr. Pall worked as a doctor in a thriving inner-city practice, which integrated other practices and is now the largest general practice in the UK: the Modality partnership. She has had many senior roles in commissioning in the UK NHS. She was a board member of Diabetes UK and is chair elect of the International Diabetes Federation Europe, with strong links in healthcare both at the EU and the Council of Europe. As chairperson and MD, she led the formation of Health India Private Limited, a primary healthcare business set up to redesign primary healthcare in India. She was recognised by the Wellcome Trust and asked to contribute to a high-level White Paper on links between India and the UK. Building on her Indian experience, she worked for a year with HCL, a technology company, as their CMO to develop and scale a primary health care model in India. The first eight clinics are launched and operational. In her last job she worked for the Indian health insurance company, Max Bupa, in the international development markets where she was responsible for the medical and innovation function in the funding and provision businesses across emerging markets. She helped create an innovative model of low-cost care with Telenor Health in Bangladesh, which included looking closely at the role of microinsurance. She helped establish clinics in China and Saudi Arabia and supervised clinics in Poland and Hong Kong. She helped create a system of health benefit management in India, Hong Kong and Thailand. In India she worked closely with the government and Max Bupa on RSBY, a low cost-health insurance scheme. She has been recognised by the Royal College of GPs, having received a special commendation for outstanding contributions to the discipline of primary care.

NONTOBEKO M MSINDE Chairperson: GEMS Nontobeko M Msinde is an admitted attorney and notary public. Her qualifications include a Baccalareus Procurationis from the University of Fort Hare. She practised in the Eastern Cape for six years as a conveyancer before the current political dispensation. She has 10 years’ experience as an attorney in private practice, focusing on property law, notarial work and High Court commercial litigation. In 1994, having completed her MBA at Wits Business School, she started her career in investment banking and finance, working for among others FirstCorp Merchant Bank, Standard and Corporate Merchant Bank, the Southern Africa Enterprise Development Fund and the Industrial Development Corporation. Her career as corporate governance specialist began in 2001 when she was appointed to the board of the South African National Roads Agency (SANRAL) and continues to date, more than 15 years later. Her experience has been mainly in different roles in finance and consulting and includes the following areas: private equity, SMEs and economic infrastructure. Her current board positions include being a trustee of the Government Employees’ Medical Scheme (GEMS) and a member of the University of KwaZulu-Natal Council. Past positions include being a director of the South African Institute of Professional Accountants (SAIPA), the South African Dental Association (SADA), the Tshwane Economic Development Agency (TEDA), and the section 21 company, Omukunda Development Network.

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ANNUAL BHF CONFERENCE DR. NTHABISENG LEGOETE Founder and CEO: Quali Health Dr. Nthabiseng Legoete holds an MB ChB and an MBA. She is a medical practitioner who is passionate about improving access to primary healthcare. She has a vision that, if realised, will make quality primary healthcare affordable for all global citizens in emerging markets. She founded Quali Health in May 2016.

This organisation provides affordable high-quality healthcare services to the disenfranchised communities of South Africa. This network of clinics currently services 500 patients a day. She has spent the last 10 years navigating the private health sector, firstly as a medical advisor and product manager in the pharmaceutical division of Roche and also as a partner in a medical practice that manages three emergency units in South Africa. Her main role was that of clinical director. She also has experience in the sub-acute environment and sees opportunities in it to curb exorbitant and often unnecessary private healthcare costs. She completed her MBA through the Gordon Institute of Business Science. Her research project entitled ‘Factors that influence the nonurgent use of emergency departments in the South African private healthcare sector’ seeks to aid in the development of divergent strategies for these patients.

DR. ODWA MAZWAI Group Functional Specialist: GEMS Fund Management Dr. Odwa Mazwai is currently group functional specialist: GEMS Fund Management, GEMS Managed Care, Medscheme Holdings. He has extensive clinical experience and integrates this with public health, health economics and health policy knowledge. He qualified with an MB ChB from Walter Sisulu (formerly UNITRA) Medical School. He served as a medical officer in the public sector in Gauteng, where he earned not only his Diploma in Anaesthesiology, but also gained a keen understanding of the need for healthcare reform in this country. His passion for equitable and sustainable healthcare found him working in the national Department of Health as a technical advisor in the office of the director-general. Here, he provided input on health policy planning to assist various directorates align their strategy to conform to proposed NHI initiatives. He joined Medscheme as a senior specialist in provider networks with a specific focus on the Government Employees’ Medical Scheme (GEMS). As an interface between GEMS and Medscheme, his roles include the facilitation of the creation of a GEMS hospital network, the continued contracting of family practitioners and specialists into GEMS networks, and maintaining and deepening relationships between GEMS and other service providers. As part of the healthcare provider relations multidisciplinary team, his other responsibilities include creating strong ties with most departments in the company, particularly GEMS clinical risk management, clinical fund management, HIU, actuarial, legal, health policy unit, managed care department and assessing.

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ANNUAL BHF CONFERENCE PARESH PREMA General Manager of the Benefits Management Unit: Council for Medical Schemes (CMS) Paresh Prema is currently general manager of the benefits management unit at the CMS responsible for the registration of schemes’ rules, contributions and benefits. He is a fellow of the Actuarial Society of South Africa and a member of the society’s healthcare committee. Prior to joining the CMS, he was part of the actuarial division of one of the large administrators. He has experience in the field of employee benefits and consulting.

PAUL MIDLANE General Manager: Healthcare Forensics – Medscheme Holdings Paul Midlane holds an LLB degree and is currently the general manager: healthcare forensics for Medscheme Holdings, the first position of this kind in the country. He was admitted as a practising attorney in September 2005, specialising in commercial and civil litigation. He joined the AfroCentric Group in April 2010 where he started as a legal advisor, before being promoted to senior legal manager in 2012 and finally to general manager of LGRC in 2014. He identified healthcare forensics as a key area that could make a substantial impact on the funding industry and became focused on raising awareness of the financial risks posed by fraud, waste and abuse in healthcare claims. He has since established the largest healthcare forensic unit in South Africa and has been permanently dedicated to forensics since September 2016. He has appeared on a variety of TV shows, written many articles on healthcare fraud, waste and abuse and presented on the subject at local and international conferences.

DR. RAJESH PATEL Head of the Benefit and Risk Department: Board of Healthcare Funders (BHF) Dr. Rajesh Patel is currently head of the benefit and risk department at the Board of Healthcare Funders (BHF). Prior to that, he worked as a family physician from 1987 to 1995. After leaving private practice he joined the medical aid industry. His roles in the industry have included medical advisor, scheme manager and clinical risk manager. Prior to joining the BHF in 2005, he spent two and a half years in the pharmaceutical industry. His special interests are quality assurance, value-based medicine and the application of public health principles in health risk management in the private sector. He is a member of the health data ministerial advisory committee. Prior to this, he was a non-executive director of the Council for Health Service Accreditation of Southern Africa (COHSASA) and Health Quality Assessment (HQA), as well as a former chairman of the clinical review committee of HQA.

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ANNUAL BHF CONFERENCE DR. RUFARO RICHARD CHATORA (TANZANIA) WHO Representative Prior to his arrival in South Africa in August 2016, Dr. Rufaro Chatora served as WHO representative in Tanzania. This entailed representing the RD and DG in the country, as well as being the head of the office. He managed the WHO biennial programme of work from planning, to implementation, to monitoring and evaluation. Between 2000 and 2010 he served as director in different divisions of the Tanzania/Kenya regional office. In his capacity as director for health systems, he produced guidelines for the development of health policy, tools for assessing the operationality of district health systems and a report on the migration of human resources. As director for non-communicable diseases, he was responsible for a STEPS survey undertaken in 18 countries, which led to the debate around and recognition of non-communicable diseases (NCDs) as a public health problem in Africa. Through advocacy, he contributed to 32 countries’ ratifying of the FCTC. In his capacity as director for AIDS, TB and malaria (ATM), Dr. Chatora contributed towards the reorganisation of the regional office to include the creation of inter-country support teams, of which ATM staff form the largest component. This improved the speed of response to country calls for support. Dr. Chatora started his career in 1981 in his home country of Tanzania. When he left in 1996, he was principal secretary in the Ministry of Health. His responsibilities entailed management of all health resources and coordination of all preventive and curative health programmes and partners, which included development of health legislation. He also represented the government on national and international bodies. He has a medical background with postgraduate qualifications in public health and health economics.

DR. SIPHO KABANE Acting Registrar: Council for Medical Schemes (CMS) Dr. Sipho Kabane holds a PhD in health systems from the University of Pretoria and an MPhil in economic policy from the University of Stellenbosch. He has extensive experience in the regulation of the medical schemes industry. He is currently senior strategist with the Council for Medical Schemes (CMS), a position he has held since July 2016. He is responsible for the overall management of strategic projects and clinical units, the development and review of the prescribed minimum benefits, definition and code of conduct, and the management of the liaison between CMS and the national Department of Health on key policy issues such as the national health insurance and health market inquiry. He is a key player in the development of CMS strategy and advisor to the council on important policy development. He has an outstanding record in managing province-wide health service provision with a focus on quality, reform and continuous improvement. He is skilled in managing diverse and multidisciplinary teams as well as the financial and operational aspects of health departments. He is experienced in building and communicating strategy and vision, and has a strong understanding of economics and its effect on health services. He is also an active and productive member of numerous committees contributing to the health and well-being of communities and individuals.

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ANNUAL BHF CONFERENCE DR. STANLEY MOLOABI Principal Officer: Medshield Medical Aid Scheme Dr. Stanley Moloabi is a qualified medical practitioner. He obtained his primary medical degree, MBChB, at what was then the Medical University of Southern Africa (MEDUNSA). His other qualifications are a diploma in business management from Damelin Management School, a certificate in HIV management, and an advanced certificate in private health sector funding from continuing education from Pretoria University. He studied towards a master’s in family medicine, passing his coursework final exams at the University of the Witwatersrand. He is also a member of the Institute of Directors of South Africa (IODSA). He started his medical career as a general practitioner, successfully running a clinical private practice for 13 years. He joined the corporate sector in August 2005 and is currently the principal officer of Medshield Medical Scheme. Medshield Medical Scheme is the ninth biggest medical scheme registered in South Africa.

DR. THATO MOUMAKWA (BOTSWANA) Principal Officer: Pula Medical Aid Fund Thato Moumakwa graduated from the School of Medicine, University of Manchester (UK), in 1998. Having attained full registration as a medical practitioner in the UK, he returned to serve as a doctor in Botswana for 14 years. In that time, Dr. Moumakwa developed a special interest HIV medicine, an emerging pandemic at that point, and was instrumental in the award-winning Debswana HIV/AIDS Programme roll-out, as well as the government of Botswana’s national HIV/AIDS programme roll-out. He received HIV/AIDS training from the University of Witwatersrand. His clinical career culminated in his serving as the chief medical officer of Debswana for about five years. He received business and leadership training from the Graduate School of Business, University of Cape Town, and the London Business School. He has served in leadership roles in strategy and business improvement. Over the years he has served on numerous boards, including those of Bokamoso Private Hospital, the Botswana Red Cross Society, the Botswana Health Professions Council, the Botswana Government Audit Committee and the Board of Healthcare Funders of Southern Africa (BHF).

He is currently the principal officer of a prominent medical aid scheme in Botswana.

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ANNUAL BHF CONFERENCE DR. TIHOMIR STRIZREP (CROATIA) Former Managing Director: National Health Insurance Fund Croatia Dr. Tihomir Strizrep is a medical doctor. He studied at the School of Medicine, University of Zagreb, and worked for nine years in the healthcare administration of the Republic of Croatia, holding a variety of positions, including that of director of the National Health Insurance Fund of the Republic of Croatia (2009-2012). He is currently adjunct professor at Effectus Business School and director of the consulting company, Audenta Savjetovanje. Being a key specialist and decision-maker during the reform and harmonisation of Croatia’s healthcare system according to EU standards, Dr. Strizrep was responsible for the implementation of reforms in all major structures of the system, including financing reform and implementation of the DRG system; health services pricing policy; the national strategy for the development of human resources in healthcare, organisation and restructuring of primary health care and hospitals; development and implementation of a comprehensive IT system, including full implementation of e-prescription; implementation of transparency and anti-corruption decision-making procedures; external reference pricing of medicines (international price comparisons); internal reference pricing of medicines (ATC levels 3 and on); tender-based procurement of medicines and vaccines; claw-back, rebate and cross-product agreements for expensive drugs; and mandatory ethical promotion agreements for pharmaceutical companies. Dr. Strizrep has co-written numerous papers on the subject of healthcare reform, published in national and international journals, including EuroHealth. He acts as a healthcare reform consultant for the World Bank, World Health Organization, USAID and others in numerous European, central Asian and African countries, including Azerbaijan, Belarus, Bosnia/Herzegovina, Kazakhstan, Kosovo, Kyrgyzstan, Latvia, Macedonia, Moldova, Montenegro, Serbia, South Africa and Ukraine.

TRYPHINE ZULU Advanced Clinical Risk Specialist: Medscheme Holdings Tryphine Zulu holds a bachelor of pharmacy degree and an MSc (Med) in pharmacotherapy. In addition, she holds a master’s in public health, specialising in health economics. She is currently an advanced clinical risk specialist at Medscheme Holdings. This role draws heavily on her educational background in health economics, health policy, health systems, universal health coverage, economic evaluation and her prior experience as a healthcare practitioner and public health researcher. She previously worked as a consultant for the Health and Social Development Directorate of the National Treasury in the Public Finance Division before moving to the national Department of Health, where she worked as coordinator of two of the NHI workstreams. She has also worked as a pharmacist in both the private and public sectors in South Africa, as a researcher at the Health Sciences Research Council and an analyst at the Clinton Health Access Initiative. She is a passionate scholar of public health and health economics and is currently pursuing a PhD in health economics at the University of Cape Town. Her research focuses on inequality, inequity and effective coverage of health services in relation to non-communicable diseases.

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ANNUAL BHF CONFERENCE VICTORIA BARR Senior Director: Economic and Financial Consulting Victoria Barr is a Senior Director in the Economic Consulting segment at FTI Consulting. Victoria joined FTI in London in 2012 and transferred to Cape Town in 2016, where she is developing FTI’s Economic and Financial Consulting practice in South Africa. Victoria is an experienced economist, who combines structured thinking and rigorous analysis with strong communication skills. She has worked as an economic consultant since 2008 and her experience covers public policy, economic regulation (in the energy, healthcare, telecommunications and water sectors), economic development and competition issues. Since 2011, Victoria has specialised in the healthcare sector. Her work has focused on three main areas: regulatory framework design; incentive analysis, including pricing and contracting strategy; and economic and financial modelling, including cost-benefit analysis. In 2016, Victoria worked with the World Health Organisation (WHO) to develop their strategy for a global initiative to improve quality of care for mothers and new borns, focused on seven African countries, as well as India and Bangladesh. During a two-year secondment at Monitor, the healthcare sector regulator in England, Victoria acted as Deputy Director of Pricing, building Monitor’s new pricing function and implementing large-scale reform of the payment system for the National Health Service (NHS). Previous to this, she advised the UK Department of Health (2011-12), building cost-benefit analysis models of different treatments for use by local healthcare funders. She has also worked with healthcare providers and funders in England on a range of pricing and contracting issues, including the development of innovative payment mechanisms to support the delivery of ‘value’-based healthcare. Victoria has undertaken economic modelling projects in a wide range of industry sectors. She led a large team to build a financial model of the whole health system in the city of Liverpool to assess the impact of different demand scenarios and service configuration options on the financial position of hospitals and healthcare funders in the city. Other examples of her modelling work include statistical analysis of price movements over time in the Dutch fixed line telephone market, analysis of the UK market for prescription medical supplies ahead of a proposed merger, and cost-benefit analysis of proposed government regulation in the UK retail sector. Before joining FTI, Victoria had previously worked as a consultant for the World Bank in Malawi and as a political and macroeconomic analyst, focused on the Middle East and Africa.

VISHAL BRIJLAL NHI Coordinator: National Department of Health Vishal Brijlal trained as a health economist and has over 20 years of experience in various aspects of health and financing policy in many countries, including South Africa and India. After completing his postgraduate studies at the University of Durban-Westville (now the University of KZN), he joined the Health Economics and Financing Unit at the Centre for Health Policy (University of the Witwatersrand). In 1998, he left to join the Health Economics and Finance Directorate at the national Department of Health (NDOH) as a deputy director. In 1999, he was appointed to the post of director: health financing and economics. After leaving the NDOH in late 2003, he joined the Board of Healthcare Funders (BHF) as executive for research and advocacy. In 2006 he was appointed country director for the CHAI programme in India. He was instrumental in the introduction and implementation of a paediatric ART programme in partnership with the National AIDS Control Organisation (NACO). In 2008, he established the CHAI programme in South Africa and currently serves as country director. In 2012, he was seconded to the office of the directorgeneral: health at the NDOH as technical advisor on health financing and national health insurance (NHI). In December 2015, he was appointed to lead Workstream 4: The Future of Medical Schemes, one of the six NHI workstreams. In May 2016, the Minister of Health appointed him NHI coordinator.

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ANNUAL BHF CONFERENCE XOLILE BHENGU Communications and Public Affairs Manager: Innovative Pharmaceutical Association of South Africa (IPASA) Xolile Bhengu is communications and public affairs manager for the Innovative Pharmaceutical Association of South Africa (IPASA), a position she has held since January 2015. She holds a national diploma in journalism from the Durban University of Technology (former ML Sultan Technikon) and more recently acquired a certificate on programme for management development from the Gordon Institute of Business Science. She worked as a journalist for several years, including at the BDFM Group (Financial Mail), the Times Media Group (The Herald & Weekend Post (Port Elizabeth), The Times/Sunday Times (Johannesburg)) and Independent Newspapers (the Sunday Tribune, Daily News and Isolezwe (KwaZulu-Natal)). She has won several journalism awards including Newcomer of the Year in Citadel’s annual Words on Money Financial Journalism Awards (2008) and Discovery Health Journalism Awards’ Best Health Economics Journalism (2012). Prior to joining IPASA she was a corporate communications officer for the National Empowerment Fund. Her other experience includes working for First National Bank and the Department of Human Settlements.

ZANDILE MOLOI Strategy Support Manager: Government Employees’ Medical Scheme (GEMS) Upon obtaining a BCom degree at the University of Pretoria, Zandile Moloi completed her honours at Vega School of Brand Leadership and used her marketing and international business management experience to carve a career. She worked at a German multinational and went on to garner experience across prominent sectors including premium retail brand, Woolworths, and financial services company, Discovery Holdings. She is currently in the office of the principal officer as a strategy support manager at South Africa’s largest closed medical scheme, the Government Employees’ Medical Scheme (GEMS), where she is partly responsible for embedding the new five-year scheme strategy. She bolsters her extensive corporate and public sector experience with postgraduate qualifications conferred by her alma mater, UP’s Gordon Institute of Business Science (GIBS). She subscribes to a modern pedagogy of hermeneutics, applying systems thinking in developing and integrating solutions to build holistic, equitable and sustainable capital within the healthcare system. She believes that smart, energetic and creative young women like her are the alchemists needed to spearhead disruptive systemic change for the greater good. She enjoys synthesising new relationships between previously unrelated aspects of work and adopts a collaborative approach to facilitate Greenfield thinking. Her interests lie in philosophy, holistic health and wellness, strategy, innovation, sustainable leadership and women development, as she seeks to inspire young girls from disadvantaged backgrounds.

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GROUP

One

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CONFERENCE SPONSORS

18th Annual Conference

SPONSORS & EXHIBITORS South Africa’s undisputed leader in providing modern ICT

3ONE Consulting Actuaries is a niche actuarial consulting firm,

brings broad experience and deep technical expertise to clients

consulting. This includes consulting in a variety of markets,

management and life and general insurance. 2CANA’s clients

stands for meaningful consulting, with its focus on true client

Administrators, TopMed Medical Scheme, First Mutual Health,

and professional experience. As an independent consult-

Old Mutual, MiWay Insurance, Cellmed Health and Altfin Health.

without bias, incentive or reward, and therefore represents an

business solutions to the insurance sector – 2Cana Solutions –

run by three actuaries with significant experience in healthcare

in healthcare funding, administration, managed care, disease

including South Africa, Botswana, Namibia and Angola. 3ONE

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2CANA’s HiP system is regarded as the premier solution in southern Africa for efficient and reliable administration of medical schemes, incorporating policy and claims administration,

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enables you to dynamically and rapidly adapt to the changing market conditions and compliance requirements with innovative products and superior service levels.

2CANA Solutions currently supports more than 20 insurers in 15 countries across four continents with over 740 000 policy holders

and a total premium yield of more than US$880 million (over R10bn).

www.2cana.co.za Tel: 031 583 3200

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CONFERENCE SPONSORS

Abbott believes that access to information about health should be universal, painless and worry-free. The

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Batsumi Claims Management Solutions has been providing third party and supply claims administrative services to medical schemes and the public health sector since 1995.

The company’s purpose: ‘To assist our clients in creating equitable, sustainable, quality healthcare for all, in the quest for excellence in healthcare service.’ This is achieved through the integration and balancing of the diverse needs of all stakeholders.

Services

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GROUP AfroCentric Investment Corporation Limited (AfroCentric) is a blackowned, investment holding company substantially invested in healthcare.

AfroCentric was established in 2008 and is listed in the healthcare sector on the JSE.

risk

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Batsumi focuses on maximising the recovery of costs incurred by clients, in an effort to reduce financial shortfalls. This is achieved through the use of dynamic claim processing technology, which facilitates effective and swift submission of claims against the Road Accident Fund and the Compensation for Occupational Injuries and Diseases.

Through its operating subsidiaries, AfroCentric provides health administration and health risk management solutions to the healthcare funding industry. In addition, it provides a range of complementary services to its traditional medical scheme clients as well as a portfolio of healthcarerelated enterprises. These services include IT solutions, transactional switching and specialised disease management.

As

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66

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BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

A unique news-based mobile application available to more than 20 000 of the country’s healthcare professionals on a daily basis has been launched by newly established specialist IT publishing entity, BlankPage Publishing.

The app is distributed among sixteen specialist medical disciplines, including general practice, and features additional posts covering pharmacy, nursing, optometry and psychology.

Content comprises freshly sourced, written and edited clinical, medicopolitical and practice management news items prepared on an ongoing basis by a team of news media-trained journalists with almost 60 years of medical reporting and editing experience between them.

Provision has also been made for regular features such as in-practice management, legal and funding matters.

By arrangement with their professional bodies and the assistance of a leading medical practice management consultancy, medical specialists are registered to freely access their own specific area within the app with the appropriate clinical and in-practice news at will, while general medical news such as NHI, market enquiry developments and exclusive conference coverage is common to all.

The app can be accessed by visiting either the Apple iStore or Google play store and downloading the app free of charge. There is a brief registration requirement to ensure that only medical professionals have access.

Email: info@blankpage.co.za.

Tel: 087 095 3225

B H F 3 6 0 ° | JULY 2017

CONFERENCE SPONSORS

The Centre for Diabetes and En-

docrinology (Pty) Ltd (CDE) is a private, registered managed care

organisation, which pioneered comprehensive, person-centred and evi-

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gramme (DMP). The DMP is a capitation fee-based reimbursement model that allows patients to receive the necessary healthcare consultations without the usual limitations on the

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specialist) and over 340 contracted primary care general practitioners.

The CDE network includes global

opinion leaders, who have developed

national guidelines and are international keynote speakers. The CDE

is internationally recognised for its continuous

research,

leadership,

teaching, and its ability to bring

innovative drugs and technologies into the consultation room.

The benefits of the CDE DMP have

been published internationally. Mem-

bership of the CDE DMP is available to people with diabetes who are ben-

eficiaries of 19 contracted medical aid schemes.

Clicks is the country’s largest retail pharmacy chain with a national footprint comprising over 380 in-store dispensaries and over 170 in-store ‘feel good clinics’.

Clicks is devoted to making professional primary healthcare services more accessible to all; our compliant and transparent pharmacy network, which charges no hidden costs and additional administration fees, and offers opportunities to collaborate on marketing initiatives, is one of the key reasons why we are the preferred service provider to most medical schemes.

Speak to our dedicated key accounts team to find out how we can be your strategic primary healthcare partner. www.clicks.co.za Tel: 021 460 1359

Council

for Medical Schemes

The Council for Medical Schemes (CMS) promotes vibrant and affordable healthcare cover for all. It ensures protection for medical scheme members and informs them of their rights. Furthermore, the CMS keeps an eye on medical schemes’ financial performance and ensures their compliance with the Medical Schemes Act of 1998. www.medicalschemes.com information@medicalschemes.com Customer Care: 0861 123 267

live again Documentation Based Care (DBC) is the global leader in back and neck rehabilitation. DBC radically reduces the cost of care for medical schemes, corporates and insurers by providing highly successful evidence-based functional rehabilitation that keeps patients mobile, active and productive further to costly back and neck surgery. www.dbcklinikka.fi Tel: 011 671 2538

www.cdediabetes.co.za Tel: 082 802 1091

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

67

BH F 360 ° | JULY 2 0 1 7

CONFERENCE SPONSORS

DENIS, Africa’s leading dental funder, has been providing innovative dental solutions for the past 21 years. The company is passionate about dental matters and strives to exceed the expectations of all its clients. As part of EOH Healthcare, it has the scale and support of the JSE’s leading technology provider. www.denis.co.za Tel: 021 528 5300

For over 16 years, DLA Group has provided comprehensive maternity and toddler healthcare programmes and solutions to medical schemes in South Africa and across its borders.

DLA provides detailed pregnancy/ baby care information through: • regular telephonic and email communications • SMS and mobile applications • packed scheme branded diaper bags filled with goodies • a 24-hour advice line • pregnancy/birth books • identifying pregnancy risk pre-birth for case management intervention • chronic disease articles relating to mother’s disease and pregnancy • information on the stages of pregnancy, common ailments, birthing options, pain relief options, nutrition and breastfeeding • networking mothers into birth support associations • coping with the newborn and baby’s first year packs • numerous discounts off essential items • services related to immunisation, childhood illnesses and development stages.

The programmes can be customised to cater for any scheme’s brand and uniqueness.

Email: deryse@dlagroup.co.za Tel: 082 588 7934/ 011 704 4646

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BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

Listed in 1998, EOH is Africa’s largest technology service provider, offering superior consulting, technology and outsourcing services through 134 locations in South Africa and over 50 countries internationally. Following a stringent operating model, EOH provides high-value, end-to-end solutions to clients in all industry verticals. EOH Health’s focus is to strengthen and enhance health service delivery by drawing on the consulting, technology and outsourcing competencies within the group, which include claims processing management, health sector consulting, health facility operations management and engineering, workplace health solutions, information systems development and business modelling. www.eoh.co.za

Tel: 010 241 7000

B H F 3 6 0 ° | JULY 2017

CONFERENCE SPONSORS

We aspire to relentlessly improve customer service and operational excellence to ensure Firstcare Courier Pharmacy’s position as one of the leading providers of HIV medication in South Africa. Our client-centric call centre’s prime objective is to promote compliance and an uninterrupted treatment plan. We address patients’ unmet needs and provide them with access and assistance in healthcare wherever and whenever they may need it. We believe we can unlock additional value for patients without compromising their integrity and confidentiality.

The Government Employees’ Medical Scheme (GEMS) was specifically established to meet the healthcare needs of government employees. As a scheme, GEMS offers five excellent healthcare benefit options: Sapphire, Beryl, Ruby, Emerald Value, Emerald and Onyx. GEMS’ goal is to help public service employees and their families get the best possible healthcare at the most affordable rate.

www.firstcarecourier.co.za Tel: 011 952 4000

Its vision is to become an excellent, sustainable and effective medical scheme that drives transformation in the healthcare industry, aligned with the principles of universal healthcare coverage.

Its mission is to provide all members with equitable access to affordable and comprehensive healthcare, thus promoting member wellbeing.

Helios specialises in innovative technology solutions to support the delivery of efficient, sustainable healthcare to its customers. As the healthcare industry evolves, there is an increasing need for robust systems equipped to deal with large transactional volumes. This is where Helios’ team and the products and services it offers add real value.

Its unique positioning and expertise within the IT and healthcare sectors allows Helios to offer superior technology solutions that transform businesses within the healthcare industry and offer inter-operability across diverse applications. www.heliosits.com Tel: 011 671 2538

www.gems.gov.za Email: enquiries@gems.gov.za GEMS Call Centre: 0860 00 4367

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

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BH F 360 ° | JULY 2 0 1 7

CONFERENCE SPONSORS

The HPCSA is a statutory body and is committed to protecting the public and guiding the professions.

The HPCSA’s vision is to enhance the quality of health by developing strategic policy frameworks for effective coordination and guidance of 12 professional boards.

The mission of the HPCSA is quality healthcare standards for all. The Council is mandated to regulate the health professions in the country in aspects pertaining to registration, education and training, professional conduct and ethical behaviour, ensuring continuing professional development and fostering compliance with healthcare standards. www.hpcsa.co.za Email: info@hpcsa.co.za and servicedelivery@hpcsa.co.za Tel: 012 338 9301 Fax: 012 328 5120

70

Independent Community Pharmacy Association (ICPA) is an organisation that provides independent community pharmacies with collective strength and a coherent voice that is heard by government, medical schemes, pharmaceutical suppliers and, importantly, the consumer. ICPA represents a large pool of professionals in the healthcare sector with over 1000 pharmacies, about 2500 pharmacists and 20 000 supportive healthcare personnel spread across metropolitan, urban and rural South Africa.

The objective of ICPA is to assist and support its members in securing a sustainable and successful future as independent, owner-managed pharmacies. In addition to this, ICPA strives to foster an understanding of the role that independent pharmacies play in delivering important healthcare services to the communities that they serve. www.icpa.co.za Tel: 021 671 4473

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

Insight Actuaries & Consultants have a deep understanding of the issues their clients face. We have developed the tools and capabilities needed to address the complexities of the healthcare system and insurance markets. Our advice is succinct, understandable and relevant.

Insight’s services include: actuarial consulting, healthcare provider benchmarking (family practitioners, specialists, hospitals and pharmacists), patient risk classification, DRG-based hospital analysis, business intelligence, optimised investment strategies and alternative reimbursement model development. www.insight.co.za Tel: 011 541 0900

B H F 3 6 0 ° | JULY 2017

CONFERENCE SPONSORS

Iso Leso Optics Ltd is a South African optometric network that is broadly owned by the majority of practising optometrists. Iso Leso enjoys an enviable demographic representation that allows peace of mind to medical funders.

Our practitioner enhancement programme (PEP) and our telemedicine development with the Africa Vision Institute (AVI) are groundbreaking initiatives in introducing advanced clinical interventions at a primary care level.

The Iso Leso VisionPartner Programme is designed to deliver world-class quality to patients via strategic alliances with global leaders in prescription lens manufacture.

We are proud of our fraud mitigation programme which uses analytical matrices developed by Insight Actuaries to identify and root out deviant behaviour. In addition, our software-driven claims processing and laboratory verification process adds depth to a robust programme.

Combining local understanding with truly global insight, KPMG’s deep, practical understanding of the unique nature of South Africa’s health sector helps its clients to develop solutions that are tailored to their specific challenges and that will be sustainable in the long term. The international experience of its team and global network of healthcare experts ensure that the solutions it provides are at the leading edge of healthcare.

Life Healthcare Group, one of the

www.home.kpmg.com Tel: 011 647 7111

Business-to-business services include

largest private healthcare providers in southern Africa, offers specialist, focused,

multidisciplinary

hospital

and related healthcare services at

64 medical facilities. The group also provides

complementary

services

including acute rehabilitation, mental healthcare and renal dialysis.

Focused on quality and clinical excellence, Life Healthcare places its patients at the centre of care.

employee wellness and occupational

health, as well as contracted healthcare management services to government facilities.

Internationally, the group is represented by Scanmed SA in Poland, Alliance

Medical Group in the United Kingdom and Max Healthcare in India. www.lifehealthcare.co.za Tel: 011 219 9000

We are excited about the opportunity to deliver clinically sound and innovative eye care to all patients.

Please visit our stand at the BHF conference where we invite you to ‘Share our View’! www.isoleso.co.za Tel: 011 340 9000

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

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BH F 360 ° | JULY 2 0 1 7

CONFERENCE SPONSORS

The Medical Advisors Group (MAG) is an association of medical advisors and other professionals in the healthcare funding industry. Its objectives are promoting cost-effective and equitable healthcare and contributing towards sustainable and socially responsible health systems.

The benefits of membership include liaising with similar colleagues, CPD-accredited meetings and conferences, and promoting industry initiatives and professional paths. www.medicaladvisors.co.za Tel: 021 461 0297

With its proud 75-year track record as leaders in healthcare innovation in South Africa and acknowledged global expertise, MediKredit has carved a niche for itself in the field of healthcare claims management, including pharmacy benefit management, doctor claims processing, hospital claims processing (both public and private), provider network management and real-time connectivity through our ability to switch claims for healthcare providers to a number of medical schemes, managed care organisations and administrators.

At present the locally developed, flexible internationally patented IT systems of MediKredit touch more than seven million lives. The fully integrated end-to-end MediKredit service is used by more than 3 500 pharmacies, 194 private hospitals, 4 700 doctor practices, 80 medical schemes as well as 95 public sector hospitals in five provinces.

Known as a healthcare benefit management force to be reckoned with MediKredit not only pioneered on-line real time claims processing within the South African healthcare industry but is also the custodian of the NAPPI® Price File and an industry expert in medicine and clinical database management. www.medikredit.co.za Tel: 011 208 1275

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BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

Medipost is South Africa’s largest courier pharmacy with a 26-year successful track record in the dispensing and delivery of medication. Medipost specialises in seamless take-on processes and the delivery of chronic, HIV, oncology and other speciality medication to any destination in South Africa. It is proud to serve both the medical scheme/private industry as well as NHI chronic patients.

Medipost’s technological advancements have set it apart from the rest of the industry and services are provided in all 11 official languages.

Pharmacy personnel are trained in scheme/client reimbursement rules and can assist patients in understanding and following the authorisation process in order to obtain their medication from their correct benefit.

As part of Medipost’s patient-centric service offering, it provides personal telephonic clinical consultations through friendly and qualified pharmacists and pharmacists’ assistants.

Delivery is free of charge to the destination of choice. www.medipost.co.za Email: rentia@medipost.co.za Tel: 012 426 4007 Cell: 082 373 3981

B H F 3 6 0 ° | JULY 2017

CONFERENCE SPONSORS

Medshield Medical Scheme has been in operation since 1968, making it one of the most experienced, most knowledgeable and most reliable medical schemes in South Africa. The scheme’s extensive experience in the healthcare funding sector guides its understanding of members’ needs.

Today, the scheme is one of the largest and most trusted in the country.

Excellent medical cover and benefits, combined with the best quality systems and service, have resulted in the scheme’s exceptional size and financial sustainability.

The scheme has for the last decade consistently maintained an AA- global credit rating. This accolade confirms the scheme’s ability to pay members’ claims promptly and in a sustainable manner. As a scheme with an AAglobal credit rating, a solvency ratio that is significantly higher than the required 25% and a reputation for prompt claim settlements, Medshield delivers exceptional value to its members. www.medshield.co.za Tel: 086 000 2120

Merck is a pioneering company that advances technologies for life.

Across healthcare, life science and performance materials, it brings specialist and high-quality products to the world.

Brilliant ideas are born at Merck. They can be life-changing, influencing how major illness is tackled, or integral to the objects people rely on. From cancer therapies and laboratory tools, to the screen on a Smartphone or the colour of one’s car – Merck ideas are everywhere.

Merck’s door is always open to collaboration. Long-term partnerships enable the company to build business success with its customers and partners around the world. In 2015, Merck generated total revenues of € 12.8 billion.

Founded in Darmstadt, Germany, in 1668, Merck is the world’s oldest pharmaceutical and chemical company.

Over 350 years, it has grown to 50 000 people across 66 countries worldwide. The founding family remains the majority owner of the company.

The company is known globally as Merck, except in the USA and Canada where it operates as EMD Serono, MilliporeSigma and EMD Performance Materials. www.merck.co.za Tel: 011 372 5085

Healthier lifestyles are heralded as ‘the new cure’. However, sustaining healthy behaviour change is tough!

Your members may know the basics of what to do to stay healthy, but often lack the skills and willpower to apply that knowledge.

The probability of success increases significantly when managed care programmes, administration services,

benefit design, provider networks, workplace wellness initiatives and rewards programmes align behind a common goal.

MMI has acquired a carefully selected range of ‘best-of-breed’ companies and capabilities. Its clients can benefit from their unique expertise and capability via an integrated value proposition and seamless, customer -centric delivery.

Benefits include the enhanced network capabilities of CareCross Health, as well as the ability to diversify benefit structures using the largest gap product supplier in the market, Guardrisk. Hello Doctor strengthens MMI’s ability to engage and support healthy behaviour change through digital channels.

MMI Health can improve the ‘financial wellness’ of individuals, businesses and their communities. It has many years of experience in improving the wellness of medical scheme members while delivering successful and sustainable risk management for schemes. www.mmiholdings.co.za Tel: 012 671 8911

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

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B H F 3 6 0 ° | JULY 2017

BH F 360 ° | JULY 2 0 1 7

ADVERTORIAL

GENDER-BASED VIOLENCE IN SOUTH AFRICA TODAY South Africa is 23 years past its constitutional

This suggests that violence against women is a primary

democracy. In as much as this has resulted in the

concern, affecting the economic development of the

country’s development of good laws and the South

country as it acts as a significant barrier to education.

African constitution being considered one of best

According to 2012 KPMG research, gender-based

globally, protection of women and girls remains a

violence costs the economy an estimated R42 billion

challenge, as they continually live in fear of their lives.

per year. This therefore calls for the government to

Crime and violence are pervasive in South Africa. The levels of violence as reflected in the official murder statistics are among the highest in the world.1 Women and girls often bear the burden of this widespread violence as they constitute over half of the country’s population.

prioritise implementation of the National Strategic Plan on Gender-based Violence that is properly costed, budgeted and monitored with focused plans and clear indicators to be implemented via a multisectoral approach within a given period of time.

References available on request.

Research surveys have estimated that

one in six women falls victim to violence at the

hands of their partners nationally,2 and every six

hours a woman is killed by an intimate partner in

South Africa. An estimated more than one million rapes occur in South Africa.

For further details please contact People Opposing Women Abuse (POWA) at: Tel: 011-642-4345 Fax: 011-484-3195 Email: info@powa.co.za Website: www.powa.co.za Like us on Facebook: POWA Follow us on Twitter: POWA_ZA

74

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

B H F 3 6 0 ° | JULY 2017

CONFERENCE SPONSORS

Medscheme is an innovative specialist medical scheme administrator and managed care provider focusing on the corporate medical scheme market.

It was an industry first for South Africa. Since its inception 42 years ago, Medscheme has become the largest health risk management and third-largest health administration provider in southern Africa. www.medscheme.co.za Tel: 011 671 2000

Established in 2004, Pharmacy Direct reliably dispenses and couriers medicine to patients where others simply can’t, ensuring that patients remain on chronic programmes and reducing overall treatment costs. www.pharmacydirect.co.za Tel: 011 671 2538

PPN is the largest optometry network with 4.3 million lives under administration.

We constantly re-engineer our systems, knowing that it takes investment and innovation to stay ahead of the game. Our unique philosophy and methodology of managing optical claims provides both value-added and effective solutions for our clients. Our anti-fraud systems reduce claims values by up to 20%.

The year 2017 will see PPN launching another new and unique anti-fraud measure to assist both schemes and their members.

At Old Mutual Wealth, we believe in integrated wealth planning – a structured holistic advice process – to manage true wealth. Our approach shifts the focus from planning for the money to planning for the individual and their goals and aspirations. Whether your clients’ priority is growth, income or capital preservation, we fully understand this and are here to support them in achieving their dreams. www.omwealth.co.za Tel: 0836 761 508

FACT: Excellent service record for

22 years FACT: The most sophisticated and

effective fraud controls FACT: The most effective basic

benefit design FACT: New innovative improvements FACT: Cost-effective optical and

cataract management FACT: If you haven’t asked us to

quote, you may be missing

out – allow us to demonstrate

the effectiveness of using our

initiatives by emailing us on management@ppn.co.za www.ppn.co.za Tel: 041 506 5900

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

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BH F 360 ° | JULY 2 0 1 7

CONFERENCE SPONSORS

Prior has re-invented health delivery for a time such as this, and has finally launched its unique mobile health voucher product. Prior is engaging the future – with innovative mobile technology – to meet the needs of the employed uninsured market and low-income earners.

Low cost of entry and simplicity are the hallmarks of this amazing comprehensive, authentic solution for access to health, crafted for a target market that knows how to use cell phones!

RapidDeploy simplifies the complexity of emergency services dispatch, making a real and positive impact on its clients’ business. Through the use of advanced telematics, it creates full electronic ecosystems that provide complete control of system data from beginning to end. As world leaders in dispatch technology, RapidDeploy has the experience and expertise to deploy this technology effectively. www.rapiddeploy.com

A web-based portal provides ease of registration for brokers, employers, health practitioners – and allows all participants to gain access to the mobile health vouchers, which can be redeemed via Prior’s network of practitioners around the country.

The system also provides a reports dashboard for informative voucher activity for all parties in real-time live - 24/7. It embraces the complete process of employer voucher purchases, issues to staff, broker fees, redemption by doctors – and payments to all parties, fully automated via Prior’s world-class voucher IT systems.

Healthcare for everyone made simple! www.priormobile.co.za Tel: 011 702 1249

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BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

From conception to creation, RISKAFRICA is produced entirely in Africa, offering insightful articles, interviews with industry leaders, news, events and analysis from across the continent. It can be found in the boardrooms of the largest financial services companies right down to the reception areas of the smallest independent brokerage. We bring the African financial services industry to you.

RISKAFRICA is not only available in print; it offers a multi-platform solution for your brand and is available as a digital magazine, online, via social media as well as events.

Partnering with RISKAFRICA means you will associate your company with an award-winning publication. www.riskafrica.com Tel: 021 555 3577

B H F 3 6 0 ° | JULY 2017

CONFERENCE SPONSORS

The South African Medical Association (SAMA) as we know it today was formally constituted on 21 May 1998 as a unification of a variety of doctors’ groups that had represented a diversity of interests. Today, SAMA is a non-statutory, professional association for public and private sector medical practitioners. It functions as a non-profit company registered in terms of the Companies Act as well as a public sector entity registered in terms of the Labour Relations Act. SAMA is a voluntary membership association, existing to serve the best interests and needs of its members in any and all healthcare-related matters. www.samedical.org Tel: 012 481 2000

Transpharm is one of South Africa’s largest pharmaceutical wholesalers and distributors.

Transpharm is dedicated to providing its clients with top-quality products and world-class service. The company stocks an extensive range of ethicals, front shop, surgical and veterinary products.

Transpharm’s philosophy is simple wider range, better prices and quicker deliveries. www.transpharm.co.za Tel: 012 377 9065

Excellence, quality healthcare, easy access and affordability are the qualities that set South Africa’s fastest growing healthcare brand apart from its competitors. Universal Healthcare is a world-class managed care organisation and medical scheme administrator offering a diverse range of healthcare products and services.

Renowned for its winning culture and pioneering role in the healthcare management industry, Universal Healthcare and the medical schemes under its administration continue to outperform competitors with impressive benefits offering unmatched value.

The effective management of these medical schemes and the considerable attention paid to ensuring the

well-being of the members of the schemes under its administration remain central to Universal Healthcare’s ability to provide appreciable value for its clients.

The journey to healthier, happier and more productive staff begins with Wellness Odyssey. Employee wellness affects the health of a business or organisation in many ways. Wellness Odyssey’s aim is to help an organisation achieve wellness through client-centric personal health risk assessment services, delivered at its corporate wellness days – raising awareness and enhancing preventative care to the advantage of the medical scheme, employer groups and participating members. The choices made today determine well-being tomorrow. Wellness Odyssey is with its clients every step of the way. www.wellnessodyssey.co.za Tel: 010 007 22 36

The client-centric, results-driven Universal Healthcare operating model underpins every aspect of the business. It integrates knowledgeable, competent and experienced people; robust and streamlined processes; and a scalable, proven system to deliver best-of-breed healthcare services and products.

Universal Healthcare has perfected the balance between quality, access, excellence of care and cost efficiency. www.universal.co.za Tel: 011 208 1275 BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

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BH F 360 ° | JULY 2 0 1 7

Mediscor Medicines Review: What is trending?

Mediscor is a large independent

pharmaceutical benefit

management company in southern Africa and has been providing managed care solutions for 29 years.

Our annual Mediscor Medicines Review (MMR) is highly regarded as a point of reference by many organisations. It provides an overview of key trends in medicine expenditure, including a dedicated analysis focused on the member’s experience at point of dispensing.

The MMR collates, compares and analyses data gained from claims submitted by southern African pharmacies, doctors and scheme members during the period of review.

It also illustrates Mediscor’s analytical capabilities and demonstrates the significant impact we have on the

markets in which we operate.

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B H F 3 6 0 ° | JULY 2017

Some of the key findings we uncovered:

•

Overall medicine expenditure, measured as the cost per beneficiary per annum, increased by 6.4% for 2016 compared to 2015. This increase was mainly driven by

Medicine expenditure

up by 6.4% in 2016

a 5.1% increase in item cost.

•

The Single Exit Price (SEP) of a basket of medicine increased by 4.87%.

•

Generic utilisation increased to 58.9% in 2016, while the generic uptake increased from 76.5% in 2015 to 78.6% in 2016.

•

New chemical entities constituted 1.7% of total medicine expenditure

For a copy of the report, visit www.mediscor.co.za

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

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REGIONAL UPDATE BOTSWANA

Botswana Healthcare

INDUSTRY UPDATE

By Dr. Thato Moumakwa

of Health and Wellness, to

PRINCIPAL OFFICER: PULA MEDICAL AID FUND

improve and expand access to healthcare. Existing

T

medical aid schemes are

______________________

hrough the membership of BPOMAS, BOMaid and PULA, BHF covers over 90% of lives under cover in Botswana. Additionally, AFA (an administrator) is a member of BHF. Overall, Botswana has seen the emergence of a new medical aid scheme in the last quarter, bringing the number of schemes to a total of 10.

part of the working group

Significant updates in Botswana include the soonto-be promulgation of regulations for the funders, which is anticipated before the end of 2017, under the NBFIRA Act.

which will improve access

Universal health care, in the form of a national health insurance fund, is being considered through a USAID health finance and governance sponsored project, in partnership with the Ministry

80

that will define and shape the way forward.

Lastly, Botswana is not insulated from common regional challenges such as exponentially increasing healthcare costs, and fraud, waste and abuse. Three new private hospitals are at various stages of development/construction across the country, for members; however this development

should

be

viewed with caution given a limited domestic market.

The

sustainability

solvency

of

and

Botswana’s

schemes will be under pressure in the current economic environment, and need to be monitored and managed carefully to ensure longterm survival.

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

B H F 3 6 0 ° | JULY 2017

REGIONAL UPDATE LESOTHO

Private sector in Lesotho

EMBRACES UNIVERSAL HEALTHCARE government of Lesotho has

succeeded in its implemen-

tation of primary healthcare by partnering with the pri-

vate sector and a number of NGOs. The main aim is to deliver better health ser-

vices to all Basotho in both remote and urban areas.

These better health services strengthen the pillars of the

country’s health system. Primary healthcare in Lesotho is structured in a manner whereby

up to an average of 75% per

GENERAL MANAGER/PRINCIPAL OFFICER: MAMOTH HEALTH PLAN

__________________________________________________

niversal healthcare is usually defined as a system that

tho, universal healthcare is

provides healthcare and fi-

existed for years, combined

nancial protection to all citizens of a country. In Leso-

government

subsidises health services

By Ms. Thato Moshoeshoe

U

the

evident in a robust primary healthcare system that has with a programme of trained village health workers. The

patient.

pacts the country’s output.

Primary healthcare in Lesotho is a self-centred service that focuses fully on each individual, thus addressing this challenge. Further to this, the public-private partnership intervention in place to help address secondary health challenges has enhanced the quality of health of all Lesotho’s citizens.

The combination of primary and secondary healthcare services, provided in partnership with the private sector, includes cross-border

It is expected that the suc-

referrals. Services are com-

vention will integrate com-

munity of business people

chronic illnesses such as TB/

This has improved people’s

rate has increased to 74%

ensured affordable health-

cess of the above inter-

monly accessed by a com-

prehensive

for

and medical aid members.

HIV, where the co-infection

health and well-being and

and therefore negatively im-

care services for all.

treatment

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

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BH F 360 ° | JULY 2 0 1 7

REGIONAL UPDATE MALAWI

Embracing universal healthcare coverage: THE CASE FOR MALAWI

By Bright Kamanga CHIEF EXECUTIVE OFFICER: MEDHEALTH

_________________________________________________

M

alawi’s population at the time of independence in

1964 was four million. Over the last five decades it has

increased to 17.5 million. In essence it has grown almost 4.5-fold and it is estimated

that it will exceed 29 million

by 2030 and 45 million by 2050.

move that calls for concerted efforts.

Eighty-five percent of Mala-

wi’s population lives in rural areas where the majority of the poor remain locked

in low-productivity subsistence farming with high lev-

els of vulnerability, including

poor nutrition and rising numbers of people living

The country inherited a universal

healthcare

system

from its colonial masters,

the British, who ruled it for 73 years (1891-1964). This means that for 126 years

healthcare services in government

hospitals

have

been free, putting the coun-

try under severe budgetary

with HIV/AIDS.

With the support of the International Monetary Fund

(IMF) and the World Bank, Malawi has seen some eco-

nomic and structural reform

progress and sustained its

economic growth rate over the years, while overcoming

ers. Bureaucracy is one

cal Council, with the support

factor that has hampered

of the Consumer Associa-

progress on the tabling of

tion of Malawi, Competitions

the Medical Aid Bill in Parlia-

and Fair Trading Commis-

ment. Consequently there is

sion and the Registrar of

no law that obliges the Reg-

Financial Services, to lobby

istrar of Financial Services

lawmakers to make them

to institute the required reg-

understand its importance.

the impact of corruption and

ulatory framework for medi-

HIV/AIDS.

cal schemes in the country.

human resource capacity,

In order to allow the private

The Medical Aid Bill was

or later the Medical Aid Bill

drafted in 2014 but still

will see light of the day and

and

sector to embrace universal healthcare there is a need

awaits tabling in the Nation-

allow the private sector to

for an aggressive holistic

approach by all stakehold-

al Assembly. Meanwhile, the

embrace universal health-

way forward is for the Medi-

care in Malawi.

pressures in respect of infrastructure

development,

and procurement of drugs medical

equipment.

The government intends to

introduce hospital fees, a

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BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

MedHealth offers services that will ensure that sooner

B H F 3 6 0 ° | JULY 2017

REGIONAL UPDATE MOZAMBIQUE

Healthcare in

MOZAMBIQUE Challenges includes substandard service providers and

facilities,

fluctuations

of commodity prices, fraud, members being unfamiliar with the do’s and don’ts of

H

present

numer-

ous challenges to medical schemes operating there, requiring them to be creative in finding functional solutions.

Mozambican service provid-

dants without postal services

lack the necessary health-

media such as email.

fraud. Medical schemes are

and/or access to electronic

care legislation to address

Mozambican

econo-

donors to the government

budget, because of mas-

sive debts incurred by the previous

government,

as

well as recent political un-

country,

in South Africa.

pulsory coding system and

of contributions by foreign

ealthcare services in Mozambique, as in any other African

access healthcare services

tion with members/depen-

effects of the suspension

______________________

writing

ers are not subject to a com-

my is still suffering from the

CEO: MEDIPLUS

excluded during the under-

allowing their members to

medical aids, communica-

The

By Ricardo Palermo

miums in Metical while still

rest and drought in the south

often subject to fraudulent claims because it is difficult to confirm legitimacy of providers and claims received from different providers and members. Guidelines set by the National Health Reference Price List (NHRPL) do not exist and tariffs are not regulated.

of the country. These and

The majority of invoices is-

a huge devaluation of the

ers in Mozambique do not

currency) against the dollar

procedure and diagnostic

schemes operating in Mo-

process.

Medical

schemes and insurers need to be inventive in interpreting claims and allocating benefits. Many claims issued by service providers are handwritten in Portuguese and are difficult to read.

Despite all these challenges, there is always hope and progress. Mediplus is the first medical aid operating in Mozambique to have been registered and licenced at both the Departments of Health and Finance, introducing new structures to the industry and leading the way towards implementing necessary processes, coding and protocols, step by

other factors contributed to

sued by healthcare provid-

Metical (Mozambique’s local

specify the diagnosis, item,

and rand, placing strain on

codes, making it almost impossible to manage existing

of existing structures and

zambique that receive pre-

conditions and conditions

addressing the lack thereof.

step. There is no quick fix; all role-players in the industry work hard towards the improvement/development

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

83

BH F 360 ° | JULY 2 0 1 7

REGIONAL UPDATE NAMIBIA

Namibia Healthcare

INDUSTRY UPDATE that they remain financially

professionals and service

decision on a possible pen-

sound, sustainable and offer

providers, who were badly

alty levied against the med-

affordable and accessible

affected because of the im-

ical schemes.

healthcare cover.

pact on their cash flow.

PSEMAS provides cover for

Private medical aid schemes

almost 60% of the insured

are similarly facing the chal-

market in Namibia; the bal-

lenge of addressing abuse/

ance is covered by private

waste and fraud, and are cur-

medical aid funds/schemes.

rently considering all options

PSEMAS is managed by the

and initiatives. The outcome

Ministry of Finance and ad-

of the complaint of collusion

ministered through a private

from a group of health pro-

By Carl (Callie) Schafer CEO (NAMIBIA): CORPORATE PROSPERITY GROUP

medical aid administration

fessionals to the Competition

company. Recently the Min-

Commissioner, because of

istry of Finance suspended

the publishing of the Namib-

all payments for services to

ian benchmark tariff sched-

T

PSEMAS and introduced a

ule, is still pending. In No-

he Namibian healthcare industry is facing major challenges

peer review of all claims be-

vember 2016, the High Court

fore payment is made. This

ruled that medical aid funds

aggressive intervention was

undertake business for profit

and it is expected that 2017

primarily due to a suspect-

and are therefore restricted

could be a watershed year

ed high number of cases

from publishing the Namib-

for many or all stakeholders.

of abuse/waste and fraud.

ian benchmark tariff sched-

Both the private medical aid

All agreements with private

ule as a guide to both funds

funds and the government’s

health professionals have

and

professionals.

vate healthcare stakehold-

Public

Employ-

been terminated and are

The outcome of the appeal

ers. Collaboration with the

ees Medical Aid Scheme

currently under review. The

will soon be known, and will

government to become part

(PSEMAS)

fi-

delayed payment of claims

be followed by the Namibian

of the reform process is

nancial pressure to ensure

stirred an outcry from health

Competition Commissioner’s

imminent.

______________________

84

Service are

under

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

health

The

Namibian

authorities

engaged in an initiative to extend cover and give equitable access to quality health services to a broader percentage of the Namibian population. An industry work group is considering the development of a universal health plan for Namibia. This will form part of the possible implementation of a national medical benefit fund for the uncovered, but employed, Namibian workforce in terms of the Namibian Labour Act. The healthcare reform facing Namibia calls for leadership

and

engagement

constructive among

pri-

B H F 3 6 0 ° | JULY 2017

REGIONAL UPDATE SWAZILAND

The Kingdom of SWAZILAND small-to-medium businesses (corporates), government parastatals,

municipalities

and direct paying members (DPMs) have registered their employees with Swazimed.

The membership cards are accepted by providers in Swaziland and South Africa.

Specialised cases are referred to South Africa.

By Peter Simelane PRINCIPAL OFFICER: SWAZIMED

_______________________

S

waziland has only one medical scheme registered with BHF,

the Swaziland Medical Aid Fund (Swazimed). This is an open scheme that operates as a non-profit making entity. It was established in 1980 by the Swaziland government and is the oldest and largest scheme in Swaziland. Most large and

country. The committee set

forum where experts in the

all requests, decides on the

disciplines within and out-

up for referrals scrutinises

need for all referrals and reports on their progress.

The Ministry of Health has strengthened the medical

ambulance services for patients who need specialised

care services in South Africa.

The Phalala office books the

patient into the hospital pro-

(For more information visit

viding the specialist care.

www.swazimed.com)

All required patient docu-

PHALALA MEDICAL REFERRAL FUND

document, medical visa and

Swaziland’s through

the

ments, such as the travel guarantee letter for payment

government, Ministry

of

Health, is aiding the refer-

ral of citizens not registered with Swazimed through the Phalala Fund. The objective of the fund is to assist de-

serving Swazi citizens, who would otherwise not have

are prepared by this office.

An ambulance with a driv-

er and nurse is provided.

(Source: www.gov.sz)

access to specialist medical

The

either within the Kingdom

National Health Research

care, to secure such care, of Swaziland or, in special

circumstances, outside the

of

Health

will be holding the fourth Conference

towards

side the borders of Swaziland come together to share scientific knowledge on cut-

ting-edge research and programmes/projects

whose

findings have been and

continue to be instrumental

in shaping health policy, programming and practice.

The conference is there-

fore a must-attend event for leaders, policy-makers,

change agents, health and development practitioners,

scientists, researchers and

participants from all walks of life who have an interest in health. To this end the

Ministry of Health is calling

SWAZILAND NATIONAL HEALTH RESEARCH CONFERENCE 2017 Ministry

field of health and related

the

end of the year. This is a

on individual researchers,

scholars, organisations and institutions that carried out

research between 2012 and

2017 to submit high-quality oral or poster presentation

abstracts relevant to any of the conference subthemes.

For more information visit www.shrswaziland.com

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

85

BH F 360 ° | JULY 2 0 1 7

REGIONAL UPDATE ZIMBABWE

AHFoZ makes a difference

IN ZIMBABWE’S HEALTHCARE SECTOR The emphasis this year is

huge shortfalls as a result

how such a scheme could

on training. Next year it will

of the differences between

be established and fund-

be on installing systems

fees charged for health ser-

ed. The government has

to facilitate capturing and

vices and the amounts paid

application of the coding.

by funders. For this reason,

It is hoped that by 2019 all health

service

providers

and funders will be using ICD10 coding. The Ministry of Health and Child Care is leading the process.

AHFoZ has identified consultants to work on recali-

By Shylet Sanyanga CEO: ASSOCIATION OF HEALTHCARE FUNDERS OF ZIMBABWE

______________________

T

he

Association

of

Healthcare Funders

brating the tariff structure for the health sector. For many years before hyperinflation, funders and providers used a negotiated and commonly agreed tariff. This is no

some patients opt to seek medical treatment outside the country, the most popular destination being India, where fees surprisingly work out cheaper even after factoring in travel and other

that the proposed NHIS will co-exist with the private schemes.

The

government

is

also

working on amendments to strengthen the regulation of medical aid societies. AHFoZ continues spearhead-

The government is working

care fraud, which is on the

on establishing a National

ing the fight against healthincrease and is pushing up

Health Insurance Scheme

healthcare costs. In an effort

(NHIS) that would benefit

to raise awareness, AHFoZ

all Zimbabweans in need of health services, particu-

of Zimbabwe (AHFoZ)

longer the case, as the hyperinflationary era resulted

care funders and service

in the distortion of fee struc-

providers on ICD10 coding,

tures between healthcare

with a view to its universal

disciplines. In many instanc-

Discussions

use in the country by 2019.

es patients are faced with

place within government on

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

schemes through AHFoZ

related expenses.

has started training health-

86

assured the private medical

larly those who do not belong to private medical aid schemes. are

taking

held a fraud indaba which was attended by various stakeholders, including representatives of law enforcement agencies.

B H F 3 6 0 ° | JULY 2017

BHF AT A GLANCE

BHF MEMBERS MEDICAL SCHEMES

Medimed Medical Scheme

Alliance Midmed Medical Scheme

Medipos Medical Scheme

Barloworld Medical Scheme

Medshield Medical Scheme

BIMAF EC

Metropolitan Medical Scheme

BIMAF WC

Nedgroup Medical Aid Scheme

ADMINISTRATORS

Bonitas Medical scheme

Old Mutual Staff Medical Aid Fund

Medscheme Holding (Pty) Ltd

BP Medical Aid Society

Opmed (SSA - State Security Agency)

Metropolitan Health Group

Building & Construction Industry Medical Aid Fund

PG Group Medical Scheme

Sanlam Healthcare Management

Rand Water Medical Scheme

Sechaba Medical Solutions

Rhodes University Medical Scheme

Thebe Ya Bophelo Healthcare Administrators

Cape Medical Plan Chartered Accountants (SA) Medical Aid Fund (CAMAF) Community Medical Aid Scheme (COMMED)

SABC Medical Aid Scheme SAMWUMED

Sizwe Medical Fund

De Beers Benefit Society

POLMED - South African Police Service Medical Scheme

Fishing Industry Medical Scheme (FISH-MED) Government Employees Medical Scheme (GEMS) Grintek Electronics Medical Aid Scheme Horizon Medical Scheme

EOH Health

Universal Healthcare Administrators (Pty) Ltd

SEDMED

Compcare Wellness Medical Scheme

Engen Medical Benefit Fund

MANAGED CARE ORGANISATION(S)

Sisonke Health Medical Scheme Suremed Health TFG Medical Aid Scheme Thebemed Tiger Brands Medical Scheme

Hosmed Medical Aid Scheme

University of The Witwatersrand Johannesburg Staff Medical Aid Scheme

Imperial Group Medical Scheme

Witbank Coalfields Medical Aid Scheme

Libcare Medical Scheme

Wooltru Healthcare Fund

Makoti Medical Aid

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

87

BH F 360 ° | JULY 2 0 1 7

BHF AT A GLANCE

SADC MEMBERS BOTSWANA

SWAZILAND

Associated Fund Administrators Botswana (Pty) Ltd

Swaziland Medical Aid Fund

Botswana Public Officer’s Medical Aid Scheme

ZIMBABWE

PULA Medical Aid

Association of Healthcare Funders of Zimbabwe

Southview (Pty) Ltd

Altfin Medical Aid Scheme Cimas Medical Aid

LESOTHO

Engineering Medical Fund

MAMOTH HEALTH PLAN

First Mutal Health

MOZAMBIQUE MediPlus Lda

NAMIBIA Namdeb Medical Scheme Napotel Medical Aid Fund Prosperity Africa Holdings (Pty) Ltd Renaissance Health Road Contractors Company Medical Scheme Medical Aid Fund

88

Generation Health Medical Fund Harare Municipal Medical Aid Society Kwekwe City Council Medical Aid Society Municipality of Masvingo Medical Aid Society AGRIMED

MALAWI MedHealth

BOARD OF HEALTHCARE FUNDERS OF SOUTHERN AFRICA

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BHF Trustee Development Programme Are you a medical scheme trustee?

Do you work in the healthcare environment?

Are you looking to upskill yourself?

BHF PREMIER EVENTS

The October registrations are now opened Four day programme staggered over two blocks: First block:

19th – 20th October 2017

Second block: 02nd – 03rd November 2017 The Board of Healthcare Funders of Southern Africa (BHF), in partnership with Wits Business School, have developed the BHF Trustee Development Programme just for you.

The programme will advance your understanding on: • defining the business of a medical scheme • the role and responsibilities of trustees • fraud, waste and abuse • health governance and more

19th Annual BHF Conference 2018

Register Today

Since its inception in 1999, the BHF Conference attracts an impressive line-up of local and international speakers and draws around 900 representatives from the healthcare industry, including local, regional and international healthcare executives, healthcare professionals, policy makers, regulators and Government.

900

Delegates Registered

17

Countries Represented

The Annual Titanium Awards

The Annual Titanium Awards 2018 recognise excellence in the public and private healthcare sector in Southern Africa, recognising leading performers among medical schemes, administrators, managed healthcare, private and public facilities and the healthcare industry at large. Entires open May 2018.

www.bhfglobal.com 011 537 0240 011 5370270

300

Organisations

BHF Leadership Incubator

In 2017 BHF launched the leadership Incubator to mentor and develop the next generation of Healthcare executived and CEOs by exposing middle managers to Business leaders, influencers and entrepreneurs from various industries.

Vist us at www.bhfglobal.com for more information