Discovery Health CEO, Dr Jonathan Broomberg, addressing the Obs/Gyn Private Practice Weekend seminar

The prospect
of a bargaining chamber to settle tariff negotiation issues, as recommended in the Health Market Inquiry (HMI) report, is “risky’, Discovery Health CEO, Dr
Jonny Broomberg, told Gynaecology Management Group (GMG)/SASOG Private Practice
Weekend delegates on Saturday.

He was,
however, encouraged generally by the HMI supply-side regulator concept to
facilitate structures for providers and funders to negotiate tariffs as well as
allowing for certain negotiations to take place outside the structure: “This is something like we had before.”

But the
problem, Broomberg warned, will arise when there is no agreement and a maximum
rate set by the proposed bargaining chamber will be enforced. This, he said,
would have to be watched carefully as ‘we can’t control what’s going on in the
bargaining chamber’

This, he
said, was potentially very risky: “Someone like the minister comes in and rules,
but if it works properly, gives a proper voice to the providers and funders and
we don’t have politicians coming in calling the shots when there is deadlock,
then it should be fine but still a  real issue
to keep our eyes on.

“My view,” he
added, “based on discussions I have had with officials in government, is that
it needs a whole new bureaucracy. But being pragmatic I have to ask the question:
when will it see the light of day? I don’t think it will see the light of day
at least for the next few years – if ever.

“If there is
going to be a structure like this emerging, it will come out of collaboration in
the private sector with funders and people like yourselves, management groups,  going to the  competition  authorities and asking them to “give us permission
to do this ourselves for the benefit of all stakeholders . Only reason we can’t
do it today is because of the Competition Commission.   

Another HMI
point raised by the Discovery CEO was its “strong views” on the Health
Professions Council of SA (HPCSA) rules – rulings that doctors can’t work or
bill in teams, and more specifically, can’t be employed by hospitals.

“I know from
the various discussions I have had on this is that there are divisions on the
doctor employment issues. As far as I am concerned, it is a 200-year-old debate
and therefore very out of date. Everywhere else in the world there are entities
employing doctors. Doctors are even setting up organisations to employ themselves
– doesn’t have to be a hospital that employs them. But here they are not even
allowed to do that which to me is very old fashioned.

“To run
modern healthcare, people do have to work in teams. Employment is spreading out
and if the terms are right employment is a very safe alternative. In the US,
for example, 90% of graduates are seeking employment.

“So we
support the HMI on this and it will be interesting to see what comes of it.”

On a related
point, Broomberg noted that what was also missing in South Africa were corporate
structures to support private practitioners.

NHI – ‘high road to catastrophe!”

As expected,
Broomberg spent some time on issues pertaining to developments and the current
status of National Health Insurance (NHI), alluding specifically to the “public
spat” between the Department of Health and Treasury on “where’s the money
coming from?” and “what will happened to medical schemes under NHI”.

On the
latter, he indicated “that the small group in the presidency” advocating
amendments to what was believed to be the final proposal – resulting in the
Bill bouncing in and out of  Cabinet  – was most concerning. These changes, said
Broomberg, represented a “high road to catastrophe” – changes which included preventing
medical schemes from providing cover for conditions already covered by NHI.

An example he
gave was ante-natal care, delivery, and post-natal care, all covered by NHI: “so
you can claim from a clinic in Dobsonville” but not if carried out privately in
the northern suburbs of Johannesburg.

In is SONA
address, said Broomberg, President Cyril Ramaphosa announced that the NHI Bill
would be “coming to Cabinet soon”: “What did he mean? We just hope that when it
finally reaches parliament all that is in it is reasonable. If not, there will have
to be a public effort to prevent it from destroying the private sector.”